Information:
Error:
ID
16997
Description
ODM derived from: http://www.qmcr.ualberta.ca/en/ToolsandTemplates/CaseReportFormCRFTemplates.aspx. Template Name: Randomization and Enrollment. 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)
- 8/19/16 8/19/16 -
Uploaded on
August 19, 2016
DOI
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License
Creative Commons BY-NC 3.0
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Randomization and Enrollment: CRF QMCR University of Alberta
Randomization and Enrollment: CRF QMCR University of Alberta
- StudyEvent: ODM
Similar models
Randomization and Enrollment: 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
Baseline (1)
CL Item
Randomization (2)
Item
Is the participant eligible for the study based on Inclusion and Exclusion Criteria?
text
Code List
Is the participant eligible for the study based on Inclusion and Exclusion Criteria?
CL Item
Yes (1)
CL Item
No (leave the rest of the form blank) (2)
1. Date enrolled (meet all eligibility criteria)
Item
1. Date enrolled (meet all eligibility criteria)
date
2. Date randomized if different from enrolled
Item
2. Date randomized if different from enrolled
date
Item
3. If eligible and not randomized, indicate reason (optional)
text
Code List
3. If eligible and not randomized, indicate reason (optional)
CL Item
Failed to return (1)
CL Item
Declined participation (2)
CL Item
Other (specify) (3)
If Other, please specify
Item
If Other, please specify
text