ID

17005

Description

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.

Lien

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

Mots-clés

  1. 20/08/2016 20/08/2016 -
Téléchargé le

20 août 2016

DOI

Pour une demande vous connecter.

Licence

Creative Commons BY-NC 3.0

Modèle Commentaires :

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Visit Checklist: CRF QMCR University of Alberta

Visit Checklist: CRF QMCR University of Alberta

General Information
Description

General Information

Study Name
Description

Study Name

Type de données

text

Site Number
Description

Site Number

Type de données

integer

Pt_ID
Description

Pt_ID

Type de données

integer

Visit Date
Description

Visit Date

Type de données

date

Visit Checklist
Description

Visit Checklist

1. Did the participant attend this visit?
Description

1. Did the participant attend this visit?

Type de données

text

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

Visit: Baseline

Type de données

boolean

Assessments completed at this visit: Medical History
Description

Assessments completed at this visit

Type de données

boolean

Assessments completed at this visit: Vital Signs
Description

Assessments completed at this visit

Type de données

boolean

Assessments completed at this visit: Physical Exam
Description

Assessments completed at this visit

Type de données

boolean

Assessments completed at this visit: Prior and Concomitant Medication
Description

Assessments completed at this visit

Type de données

boolean

Assessments completed at this visit: Inclusion/Exclusion Criteria
Description

Assessments completed at this visit

Type de données

boolean

Assessments completed at this visit: Randomization and Enrollment
Description

Assessments completed at this visit

Type de données

boolean

3. Is the participant continuing in the study?
Description

3. Is the participant continuing in the study?

Type de données

text

Comments
Description

Comments

Type de données

text

Similar models

Visit Checklist: CRF QMCR University of Alberta

Name
Type
Description | Question | Decode (Coded Value)
Type de données
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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