Informatie:
Fout:
ID
17003
Beschrijving
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
Trefwoorden
Versies (1)
- 20-08-16 20-08-16 -
Geüploaded op
20 augustus 2016
DOI
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Licentie
Creative Commons BY-NC 3.0
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Study Completion: CRF QMCR University of Alberta
Study Completion: CRF QMCR University of Alberta
- StudyEvent: ODM
Similar models
Study Completion: CRF QMCR University of Alberta
- StudyEvent: ODM
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
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
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