ID

17005

Descrizione

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.

collegamento

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

Keywords

  1. 20/08/16 20/08/16 -
Caricato su

20 agosto 2016

DOI

Per favore, per richiedere un accesso.

Licenza

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
Descrizione

General Information

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

Visit Checklist
Descrizione

Visit Checklist

1. Did the participant attend this visit?
Descrizione

1. Did the participant attend this visit?

Tipo di dati

text

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

Visit: Baseline

Tipo di dati

boolean

Assessments completed at this visit: Medical History
Descrizione

Assessments completed at this visit

Tipo di dati

boolean

Assessments completed at this visit: Vital Signs
Descrizione

Assessments completed at this visit

Tipo di dati

boolean

Assessments completed at this visit: Physical Exam
Descrizione

Assessments completed at this visit

Tipo di dati

boolean

Assessments completed at this visit: Prior and Concomitant Medication
Descrizione

Assessments completed at this visit

Tipo di dati

boolean

Assessments completed at this visit: Inclusion/Exclusion Criteria
Descrizione

Assessments completed at this visit

Tipo di dati

boolean

Assessments completed at this visit: Randomization and Enrollment
Descrizione

Assessments completed at this visit

Tipo di dati

boolean

3. Is the participant continuing in the study?
Descrizione

3. Is the participant continuing in the study?

Tipo di dati

text

Comments
Descrizione

Comments

Tipo di dati

text

Similar models

Visit Checklist: CRF QMCR University of Alberta

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