ID

17005

Beschreibung

ODM derived from: http://www.qmcr.ualberta.ca/en/ToolsandTemplates/CaseReportFormCRFTemplates.aspx. Template Name: Visit Checklist. University of Alberta, Quality Management in Clinical Research. Copyright: 2002-2016 University of Alberta.

Link

http://www.qmcr.ualberta.ca/en/ToolsandTemplates/CaseReportFormCRFTemplates.aspx

Stichworte

  1. 20.08.16 20.08.16 -
Hochgeladen am

20. August 2016

DOI

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Lizenz

Creative Commons BY-NC 3.0

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Visit Checklist: CRF QMCR University of Alberta

Visit Checklist: CRF QMCR University of Alberta

General Information
Beschreibung

General Information

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

Visit Checklist
Beschreibung

Visit Checklist

1. Did the participant attend this visit?
Beschreibung

1. Did the participant attend this visit?

Datentyp

text

2. Please check all the assessments completed at this visit: Demographics
Beschreibung

Visit: Baseline

Datentyp

boolean

Assessments completed at this visit: Medical History
Beschreibung

Assessments completed at this visit

Datentyp

boolean

Assessments completed at this visit: Vital Signs
Beschreibung

Assessments completed at this visit

Datentyp

boolean

Assessments completed at this visit: Physical Exam
Beschreibung

Assessments completed at this visit

Datentyp

boolean

Assessments completed at this visit: Prior and Concomitant Medication
Beschreibung

Assessments completed at this visit

Datentyp

boolean

Assessments completed at this visit: Inclusion/Exclusion Criteria
Beschreibung

Assessments completed at this visit

Datentyp

boolean

Assessments completed at this visit: Randomization and Enrollment
Beschreibung

Assessments completed at this visit

Datentyp

boolean

3. Is the participant continuing in the study?
Beschreibung

3. Is the participant continuing in the study?

Datentyp

text

Comments
Beschreibung

Comments

Datentyp

text

Ähnliche Modelle

Visit Checklist: CRF QMCR University of Alberta

Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
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 Group
Visit Checklist
Item
1. Did the participant attend this visit?
text
Code List
1. Did the participant attend this visit?
CL Item
Yes (If yes, continue) (1)
CL Item
No (2)
2. Please check all the assessments completed at this visit
Item
2. Please check all the assessments completed at this visit: Demographics
boolean
Assessments completed at this visit
Item
Assessments completed at this visit: Medical History
boolean
Assessments completed at this visit
Item
Assessments completed at this visit: Vital Signs
boolean
Assessments completed at this visit
Item
Assessments completed at this visit: Physical Exam
boolean
Assessments completed at this visit
Item
Assessments completed at this visit: Prior and Concomitant Medication
boolean
Assessments completed at this visit
Item
Assessments completed at this visit: Inclusion/Exclusion Criteria
boolean
Assessments completed at this visit
Item
Assessments completed at this visit: Randomization and Enrollment
boolean
Item
3. Is the participant continuing in the study?
text
Code List
3. Is the participant continuing in the study?
CL Item
Yes (schedule next visit) (1)
CL Item
No (remember to complete a study completion form) (2)
Comments
Item
Comments
text

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