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Randomization and Enrollment: CRF QMCR University of Alberta

1 Formulieren  
General Information
Beschrijving

General Information

Study Name
Beschrijving

Study Name

Datatype

text

Site Number
Beschrijving

Site Number

Datatype

integer

Pt_ID
Beschrijving

Pt_ID

Datatype

integer

Visit Date
Beschrijving

Visit Date

Datatype

date

Visit Type
Beschrijving

Visit Type

Datatype

text

Randomization and Enrollment Form
Beschrijving

Randomization and Enrollment Form

Is the participant eligible for the study based on Inclusion and Exclusion Criteria?
Beschrijving

Is the participant eligible for the study based on Inclusion and Exclusion Criteria?

Datatype

text

1. Date enrolled (meet all eligibility criteria)
Beschrijving

1. Date enrolled (meet all eligibility criteria)

Datatype

date

2. Date randomized if different from enrolled
Beschrijving

2. Date randomized if different from enrolled

Datatype

date

3. If eligible and not randomized, indicate reason (optional)
Beschrijving

either Question 2 or 3

Datatype

text

If Other, please specify
Beschrijving

If Other, please specify

Datatype

text

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Randomization and Enrollment: CRF QMCR University of Alberta

1 Formulieren
Name
Type
Description | Question | Decode (Coded Value)
Datatype
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
Baseline (1)
CL Item
Randomization (2)
Item Group
Randomization and Enrollment Form
Item
Is the participant eligible for the study based on Inclusion and Exclusion Criteria?
text
Is the participant eligible for the study based on Inclusion and Exclusion Criteria?
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
3. If eligible and not randomized, indicate reason (optional)
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
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