ID

17006

Description

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

Link

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

Keywords

  1. 8/20/16 8/20/16 -
Uploaded on

August 20, 2016

DOI

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License

Creative Commons BY-NC 3.0

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Vital Signs: CRF QMCR University of Alberta

Vital Signs: CRF QMCR University of Alberta

General Information
Description

General Information

Study Name
Description

Study Name

Data type

text

Site Number
Description

Site Number

Data type

integer

Pt_ID
Description

Pt_ID

Data type

integer

Visit Date
Description

Visit Date

Data type

date

Visit Type
Description

Visit Type

Data type

text

1. Time
Description

1. Time

Data type

time

Time
Description

Time

Data type

text

2. Heart Rate
Description

2. Heart Rate

Data type

integer

Measurement units
  • bpm
bpm
Heart Rate - not done
Description

Heart Rate - not done

Data type

boolean

3. Blood pressure (systolic)
Description

3. Blood pressure

Data type

integer

Blood pressure (diastolic)
Description

Blood pressure

Data type

integer

Blood pressure - not done
Description

Blood pressure - not done

Data type

boolean

3.a BP position
Description

3.a BP position

Data type

text

4. Temperature
Description

4. Temperature

Data type

integer

Temperature
Description

Temperature

Data type

text

Temperature - not done
Description

Temperature

Data type

boolean

5. Respiratory Rate
Description

5. Respiratory Rate

Data type

integer

Measurement units
  • _/min
_/min
Respiratory Rate - not done
Description

Respiratory Rate

Data type

boolean

6. Weight
Description

6. Weight

Data type

integer

Weight
Description

Weight

Data type

text

Weight - Estimated?
Description

Weight

Data type

boolean

Weight - not done
Description

Weight

Data type

boolean

7. Height
Description

7. Height

Data type

integer

Height
Description

Height

Data type

text

Height - Estimated?
Description

Height

Data type

boolean

Height - not done
Description

Height

Data type

boolean

Similar models

Vital Signs: CRF QMCR University of Alberta

Name
Type
Description | Question | Decode (Coded Value)
Data type
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
Visit Type
text
Code List
Visit Type
CL Item
Screening (1)
CL Item
Baseline (2)
CL Item
Visit 1 (3)
CL Item
Visit 2 (4)
CL Item
Visit 3 (5)
CL Item
Visit 4 (6)
CL Item
Visit 5 (7)
CL Item
Completion Visit (8)
1. Time
Item
1. Time
time
Item
Time
text
Code List
Time
CL Item
AM (1)
CL Item
PM (2)
2. Heart Rate
Item
2. Heart Rate
integer
Heart Rate - not done
Item
Heart Rate - not done
boolean
3. Blood pressure
Item
3. Blood pressure (systolic)
integer
Blood pressure
Item
Blood pressure (diastolic)
integer
Blood pressure - not done
Item
Blood pressure - not done
boolean
Item
3.a BP position
text
Code List
3.a BP position
CL Item
Sitting (1)
CL Item
Supine (2)
CL Item
Standing (3)
4. Temperature
Item
4. Temperature
integer
Item
Temperature
text
Code List
Temperature
CL Item
°F (1)
CL Item
°C (2)
Temperature
Item
Temperature - not done
boolean
5. Respiratory Rate
Item
5. Respiratory Rate
integer
Respiratory Rate
Item
Respiratory Rate - not done
boolean
6. Weight
Item
6. Weight
integer
Item
Weight
text
Code List
Weight
CL Item
pounds (1)
CL Item
kilograms (2)
Weight
Item
Weight - Estimated?
boolean
Weight
Item
Weight - not done
boolean
7. Height
Item
7. Height
integer
Item
Height
text
Code List
Height
CL Item
inches (1)
CL Item
centimeters (2)
Height
Item
Height - Estimated?
boolean
Height
Item
Height - not done
boolean

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