Anglais

Demographics: CRF QMCR University of Alberta

1 Formulaires  
General Information
Description

General Information

Study Name
Description

Study Name

Type de données

text

Site Number
Description

Site Number

Type de données

integer

Pt_ID
Description

Pt_ID

Type de données

integer

Visit Date
Description

Visit Date

Type de données

date

Visit Type
Description

Visit Type

Type de données

text

Demographics
Description

Demographics

1. Gender
Description

1. Gender

Type de données

text

2. Date of Birth
Description

2. Date of Birth

Type de données

date

3. Race (See Description)
Description

Choose only one with which you most closely identify

Type de données

text

4. Ethnicity (See Description)
Description

Choose only one with which you most closely identify

Type de données

text

Date Informed Consent Signed
Description

Date Informed Consent Signed

Type de données

date

Investigator Signature
Description

Investigator Signature

Type de données

text

Date
Description

Date

Type de données

date

Retour au début de la page

Similar models

Demographics: CRF QMCR University of Alberta

1 Formulaires
Name
Type
Description | Question | Decode (Coded Value)
Type de données
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
Retour au début de la page