ID

17005

Beschrijving

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

Trefwoorden

  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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Visit Checklist: CRF QMCR University of Alberta

Visit Checklist: CRF QMCR University of Alberta

General Information
Beschrijving

General Information

Study Name
Beschrijving

Study Name

Datatype

text

Site Number
Beschrijving

Site Number

Datatype

integer

Pt_ID
Beschrijving

Pt_ID

Datatype

integer

Visit Date
Beschrijving

Visit Date

Datatype

date

Visit Checklist
Beschrijving

Visit Checklist

1. Did the participant attend this visit?
Beschrijving

1. Did the participant attend this visit?

Datatype

text

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

Visit: Baseline

Datatype

boolean

Assessments completed at this visit: Medical History
Beschrijving

Assessments completed at this visit

Datatype

boolean

Assessments completed at this visit: Vital Signs
Beschrijving

Assessments completed at this visit

Datatype

boolean

Assessments completed at this visit: Physical Exam
Beschrijving

Assessments completed at this visit

Datatype

boolean

Assessments completed at this visit: Prior and Concomitant Medication
Beschrijving

Assessments completed at this visit

Datatype

boolean

Assessments completed at this visit: Inclusion/Exclusion Criteria
Beschrijving

Assessments completed at this visit

Datatype

boolean

Assessments completed at this visit: Randomization and Enrollment
Beschrijving

Assessments completed at this visit

Datatype

boolean

3. Is the participant continuing in the study?
Beschrijving

3. Is the participant continuing in the study?

Datatype

text

Comments
Beschrijving

Comments

Datatype

text

Similar models

Visit Checklist: CRF QMCR University of Alberta

Name
Type
Description | Question | Decode (Coded Value)
Datatype
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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