Englisch

Study Completion: CRF QMCR University of Alberta

1 Formulare  
Study Completion
Beschreibung

Study Completion

Study Name
Beschreibung

Study Name

Datentyp

text

Site Number
Beschreibung

Site Number

Datentyp

integer

Pt_ID
Beschreibung

Pt_ID

Datentyp

integer

Visit Date
Beschreibung

Visit Date

Datentyp

date

1. Date of final study visit
Beschreibung

1. Date of final study visit

Datentyp

date

2. Date of last known study intervention
Beschreibung

2. Date of last known study intervention

Datentyp

date

3. Primary reason for terminating participation in the study
Beschreibung

3. Primary reason for terminating participation in the study

Datentyp

text

If Other, please specify
Beschreibung

If Other, please specify

Datentyp

text

Comments
Beschreibung

Comments

Datentyp

text

PI Signature
Beschreibung

PI Signature

Datentyp

text

Date
Beschreibung

Date

Datentyp

date

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Ähnliche Modelle

Study Completion: CRF QMCR University of Alberta

1 Formulare
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
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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