ID

16978

Description

ODM derived from: http://www.qmcr.ualberta.ca/en/ToolsandTemplates/CaseReportFormCRFTemplates.aspx. Template Name: Inclusion/Exclusion Criteria. University of Alberta, Quality Management in Clinical Research. Copyright: 2002-2016 University of Alberta.

Link

http://www.qmcr.ualberta.ca/en/ToolsandTemplates/CaseReportFormCRFTemplates.aspx

Keywords

  1. 8/17/16 8/17/16 -
Uploaded on

August 17, 2016

DOI

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License

Creative Commons BY-NC 3.0

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Inclusion/Exclusion Criteria: CRF QMCR University of Alberta

Inclusion/Exclusion Criteria: CRF QMCR University of Alberta

General Information
Description

General Information

Study Name
Description

Study Name

Data type

text

Site Number
Description

Site Number

Data type

integer

Pt_ID
Description

Pt_ID

Data type

integer

Visit Date
Description

Visit Date

Data type

date

Visit Type
Description

Visit Type

Data type

text

Inclusion Criteria
Description

Inclusion Criteria

Inclusion Description
Description

Inclusion Description

Data type

text

Applicability of inclusion criteria (See Description)
Description

Note: All Inclusion Criteria must be answered YES, to be included in study.

Data type

boolean

Exclusion Criteria
Description

Exclusion Criteria

Exclusion Description
Description

Exclusion Description

Data type

text

Applicability of exclusion criteria (See Description)
Description

Note: All Exclusion Criteria must be answered NO, to be included in study.

Data type

boolean

Result
Description

Result

Did the participant meet the eligibility requirements for this study?
Description

Did the participant meet the eligibility requirements for this study?

Data type

boolean

Similar models

Inclusion/Exclusion Criteria: CRF QMCR University of Alberta

Name
Type
Description | Question | Decode (Coded Value)
Data type
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
Code List
Visit Type
CL Item
Screening (1)
CL Item
Baseline (2)
Item Group
Inclusion Criteria
Inclusion Description
Item
Inclusion Description
text
Applicability of inclusion criteria
Item
Applicability of inclusion criteria (See Description)
boolean
Item Group
Exclusion Criteria
Exclusion Description
Item
Exclusion Description
text
Applicability of exclusion criteria (See Description)
Item
Applicability of exclusion criteria (See Description)
boolean
Item Group
Result
Did the participant meet the eligibility requirements for this study?
Item
Did the participant meet the eligibility requirements for this study?
boolean

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