Englisch

Demographics: CRF QMCR University of Alberta

1 Formulare  
General Information
Beschreibung

General Information

Study Name
Beschreibung

Study Name

Datentyp

text

Site Number
Beschreibung

Site Number

Datentyp

integer

Pt_ID
Beschreibung

Pt_ID

Datentyp

integer

Visit Date
Beschreibung

Visit Date

Datentyp

date

Visit Type
Beschreibung

Visit Type

Datentyp

text

Demographics
Beschreibung

Demographics

1. Gender
Beschreibung

1. Gender

Datentyp

text

2. Date of Birth
Beschreibung

2. Date of Birth

Datentyp

date

3. Race (See Description)
Beschreibung

Choose only one with which you most closely identify

Datentyp

text

4. Ethnicity (See Description)
Beschreibung

Choose only one with which you most closely identify

Datentyp

text

Date Informed Consent Signed
Beschreibung

Date Informed Consent Signed

Datentyp

date

Investigator Signature
Beschreibung

Investigator Signature

Datentyp

text

Date
Beschreibung

Date

Datentyp

date

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Ähnliche Modelle

Demographics: CRF QMCR University of Alberta

1 Formulare
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
General Information
Study Name
Item
Study Name
text
Site Number
Item
Site Number
integer
Pt_ID
Item
Pt_ID
integer
Visit Date
Item
Visit Date
date
Item
Visit Type
text
Visit Type
Code List
Visit Type
CL Item
Screening (1)
CL Item
Baseline (2)
Item Group
Demographics
Item
1. Gender
text
1. Gender
Code List
1. Gender
CL Item
Female (1)
CL Item
Male (2)
2. Date of Birth
Item
2. Date of Birth
date
Item
3. Race (See Description)
text
3. Race (See Description)
Code List
3. Race (See Description)
CL Item
American Indian or Alaska Native (1)
CL Item
Asian (2)
CL Item
Black or African-American (3)
CL Item
Native Hawaiian or Pacific Islander (4)
CL Item
White (5)
CL Item
More than one race (6)
CL Item
Unknown or not reported (7)
Item
4. Ethnicity (See Description)
text
4. Ethnicity (See Description)
Code List
4. Ethnicity (See Description)
CL Item
Hispanic or Latino (1)
CL Item
Not Hispanic or Latino (2)
CL Item
Unknown or not reported (3)
Date Informed Consent Signed
Item
Date Informed Consent Signed
date
Investigator Signature
Item
Investigator Signature
text
Date
Item
Date
date
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