Information:
Error:
ID
16981
Description
ODM derived from: http://www.qmcr.ualberta.ca/en/ToolsandTemplates/CaseReportFormCRFTemplates.aspx. Template Name: Medical History II. 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
Versions (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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Medical History II: CRF QMCR University of Alberta
Medical History II: CRF QMCR University of Alberta
- StudyEvent: ODM
Similar models
Medical History II: CRF QMCR University of Alberta
- StudyEvent: ODM
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Study Name
Item
Study Name
text
Site Number
Item
Site Number
integer
Pt_ID
Item
Pt_ID
integer
Visit Date
Item
Visit Date
date
CL Item
Screening (1)
CL Item
Baseline (2)
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
If Yes, Explain
Item
If Yes, Explain
text
CL Item
Current (1)
CL Item
Resolved (2)
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
If Yes, Explain
Item
If Yes, Explain
text
CL Item
Current (1)
CL Item
Resolved (2)
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
If Yes, Explain
Item
If Yes, Explain
text
CL Item
Current (1)
CL Item
Resolved (2)
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
If Yes, Explain
Item
If Yes, Explain
text
CL Item
Current (1)
CL Item
Resolved (2)
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
If Yes, Explain
Item
If Yes, Explain
text
CL Item
Current (1)
CL Item
Resolved (2)
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
If Yes, Explain
Item
If Yes, Explain
text
CL Item
Current (1)
CL Item
Resolved (2)
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
If Yes, Explain
Item
If Yes, Explain
text
CL Item
Current (1)
CL Item
Resolved (2)
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
If Yes, Explain
Item
If Yes, Explain
text
CL Item
Current (1)
CL Item
Resolved (2)
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
If Yes, Explain
Item
If Yes, Explain
text
CL Item
Current (1)
CL Item
Resolved (2)
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
If Yes, Explain
Item
If Yes, Explain
text
CL Item
Current (1)
CL Item
Resolved (2)
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
If Yes, Explain
Item
If Yes, Explain
text
CL Item
Current (1)
CL Item
Resolved (2)
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
If Yes, Explain
Item
If Yes, Explain
text
CL Item
Current (1)
CL Item
Resolved (2)
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Specification
Item
If Other, please specify
text
If Yes, Explain
Item
If Yes, Explain
text
CL Item
Current (1)
CL Item
Resolved (2)
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