Anglais

Randomization and Enrollment: 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

Randomization and Enrollment Form
Description

Randomization and Enrollment Form

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

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

Type de données

text

1. Date enrolled (meet all eligibility criteria)
Description

1. Date enrolled (meet all eligibility criteria)

Type de données

date

2. Date randomized if different from enrolled
Description

2. Date randomized if different from enrolled

Type de données

date

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

either Question 2 or 3

Type de données

text

If Other, please specify
Description

If Other, please specify

Type de données

text

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Randomization and Enrollment: 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
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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