Inglese

Study Completion: CRF QMCR University of Alberta

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Study Completion
Descrizione

Study Completion

Study Name
Descrizione

Study Name

Tipo di dati

text

Site Number
Descrizione

Site Number

Tipo di dati

integer

Pt_ID
Descrizione

Pt_ID

Tipo di dati

integer

Visit Date
Descrizione

Visit Date

Tipo di dati

date

1. Date of final study visit
Descrizione

1. Date of final study visit

Tipo di dati

date

2. Date of last known study intervention
Descrizione

2. Date of last known study intervention

Tipo di dati

date

3. Primary reason for terminating participation in the study
Descrizione

3. Primary reason for terminating participation in the study

Tipo di dati

text

If Other, please specify
Descrizione

If Other, please specify

Tipo di dati

text

Comments
Descrizione

Comments

Tipo di dati

text

PI Signature
Descrizione

PI Signature

Tipo di dati

text

Date
Descrizione

Date

Tipo di dati

date

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Study Completion: CRF QMCR University of Alberta

1 moduli
Name
genere
Description | Question | Decode (Coded Value)
Tipo di dati
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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