ID

17003

Description

ODM derived from: http://www.qmcr.ualberta.ca/en/ToolsandTemplates/CaseReportFormCRFTemplates.aspx. Template Name: Study Completion. 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)
  1. 8/20/16 8/20/16 -
Uploaded on

August 20, 2016

DOI

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License

Creative Commons BY-NC 3.0
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Study Completion: CRF QMCR University of Alberta

English

Study Completion: CRF QMCR University of Alberta

1 forms  
Study Completion
Description

Study Completion

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

1. Date of final study visit
Description

1. Date of final study visit

Data type

date

2. Date of last known study intervention
Description

2. Date of last known study intervention

Data type

date

3. Primary reason for terminating participation in the study
Description

3. Primary reason for terminating participation in the study

Data type

text

If Other, please specify
Description

If Other, please specify

Data type

text

Comments
Description

Comments

Data type

text

PI Signature
Description

PI Signature

Data type

text

Date
Description

Date

Data type

date

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Similar models

Study Completion: CRF QMCR University of Alberta

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Study Completion
Study Name
Item
Study Name
text
Site Number
Item
Site Number
integer
Pt_ID
Item
Pt_ID
integer
Visit Date
Item
Visit Date
date
1. Date of final study visit
Item
1. Date of final study visit
date
2. Date of last known study intervention
Item
2. Date of last known study intervention
date
Item
3. Primary reason for terminating participation in the study
text
3. Primary reason for terminating participation in the study
Code List
3. Primary reason for terminating participation in the study
CL Item
Completed study (1)
CL Item
Participant was determined after enrollment to be ineligible (Provide comments) (2)
CL Item
Participant withdrew consent  (3)
CL Item
In the Investigator´s opinion it was not in the participant´s best interest to continue. (Provide Comments) (4)
CL Item
Adverse Event (If checked, complete AE form) (5)
CL Item
Death (6)
CL Item
Lost to follow-up (7)
CL Item
Other (specify):___ (8)
CL Item
Unknown (9)
If Other, please specify
Item
If Other, please specify
text
Comments
Item
Comments
text
PI Signature
Item
PI Signature
text
Date
Item
Date
date
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