ID

17005

Beskrivning

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.

Länk

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

Nyckelord

  1. 2016-08-20 2016-08-20 -
Uppladdad den

20 augusti 2016

DOI

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Licens

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
Beskrivning

General Information

Study Name
Beskrivning

Study Name

Datatyp

text

Site Number
Beskrivning

Site Number

Datatyp

integer

Pt_ID
Beskrivning

Pt_ID

Datatyp

integer

Visit Date
Beskrivning

Visit Date

Datatyp

date

Visit Checklist
Beskrivning

Visit Checklist

1. Did the participant attend this visit?
Beskrivning

1. Did the participant attend this visit?

Datatyp

text

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

Visit: Baseline

Datatyp

boolean

Assessments completed at this visit: Medical History
Beskrivning

Assessments completed at this visit

Datatyp

boolean

Assessments completed at this visit: Vital Signs
Beskrivning

Assessments completed at this visit

Datatyp

boolean

Assessments completed at this visit: Physical Exam
Beskrivning

Assessments completed at this visit

Datatyp

boolean

Assessments completed at this visit: Prior and Concomitant Medication
Beskrivning

Assessments completed at this visit

Datatyp

boolean

Assessments completed at this visit: Inclusion/Exclusion Criteria
Beskrivning

Assessments completed at this visit

Datatyp

boolean

Assessments completed at this visit: Randomization and Enrollment
Beskrivning

Assessments completed at this visit

Datatyp

boolean

3. Is the participant continuing in the study?
Beskrivning

3. Is the participant continuing in the study?

Datatyp

text

Comments
Beskrivning

Comments

Datatyp

text

Similar models

Visit Checklist: CRF QMCR University of Alberta

Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
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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