Englisch

Unscheduled Visit DM-ASP1941-1941-CL-0004 NCT01071850

1 Formulare  
Unscheduled Visit Checklist
Beschreibung

Unscheduled Visit Checklist

Alias
UMLS CUI-1
C1548404
Date
Beschreibung

Assessment Date

Datentyp

date

Alias
UMLS CUI [1]
C2985720
Physical Examination?
Beschreibung

Physical Examination

Datentyp

boolean

Alias
UMLS CUI [1]
C0031809
Orthostatic Vital Signs?
Beschreibung

Orthostatic Vital Signs

Datentyp

boolean

Alias
UMLS CUI [1]
C0518766
ECG: 12 Lead ECG 1?
Beschreibung

ECG: 12 Lead ECG 1

Datentyp

boolean

Alias
UMLS CUI [1]
C0013798
Weight?
Beschreibung

Weight

Datentyp

boolean

Alias
UMLS CUI [1]
C0005910
Study drug Accountability?
Beschreibung

Study drug Accountability

Datentyp

boolean

Alias
UMLS CUI [1]
C2981453
Physical Examination
Beschreibung

Physical Examination

Alias
UMLS CUI-1
C0031809
Was the physical examination performed? Record any abnormal findings/conditions identified during the exam on the appropriate form.
Beschreibung

Physical Examination

Datentyp

boolean

Alias
UMLS CUI [1]
C0031809
Assessment Date
Beschreibung

Assessment Date

Datentyp

date

Alias
UMLS CUI [1,1]
C0031809
UMLS CUI [1,2]
C2985720
Orthostatic vital signs
Beschreibung

Orthostatic vital signs

Alias
UMLS CUI-1
C0518766
Not Done:
Beschreibung

Assessment

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0518766
UMLS CUI [1,2]
C1516048
Assessment Date
Beschreibung

Assessment Date

Datentyp

date

Alias
UMLS CUI [1,1]
C0518766
UMLS CUI [1,2]
C1516048
UMLS CUI [1,3]
C2985720
Assessment Time
Beschreibung

Assessment Time

Datentyp

time

Alias
UMLS CUI [1,1]
C0518766
UMLS CUI [1,2]
C1516048
UMLS CUI [1,3]
C0040223
Position
Beschreibung

Vital Signs

Datentyp

integer

Alias
UMLS CUI [1]
C0518766
Location of blood pressure measurement
Beschreibung

Location of blood pressure measurement

Datentyp

integer

Alias
UMLS CUI [1]
C0005823
Systolic blood pressure
Beschreibung

Systolic blood pressure

Datentyp

text

Maßeinheiten
  • mmHg
Alias
UMLS CUI [1]
C0871470
mmHg
Diastolic Blood Pressure
Beschreibung

Diastolic Blood Pressure

Datentyp

text

Maßeinheiten
  • mmHg
Alias
UMLS CUI [1]
C0428883
mmHg
Pulse Rate
Beschreibung

Pulse Rate

Datentyp

text

Maßeinheiten
  • Beats/min
Alias
UMLS CUI [1]
C0232117
Beats/min
12 Lead ECG 1
Beschreibung

12 Lead ECG 1

Alias
UMLS CUI-1
C0013798
Date ECG was performed
Beschreibung

ECG Date

Datentyp

date

Alias
UMLS CUI [1,1]
C0013798
UMLS CUI [1,2]
C0011008
ECG Time performed
Beschreibung

ECG time

Datentyp

time

Alias
UMLS CUI [1,1]
C0013798
UMLS CUI [1,2]
C0040223
ECG Interpretation
Beschreibung

ECG Interpretation

Datentyp

text

Alias
UMLS CUI [1,1]
C1623258
UMLS CUI [1,2]
C0459471
Weight
Beschreibung

Weight

Alias
UMLS CUI-1
C0005910
Assessment Date
Beschreibung

Assessment Date

Datentyp

date

Alias
UMLS CUI [1,1]
C0005910
UMLS CUI [1,2]
C2985720
Body weight
Beschreibung

Weight

Datentyp

text

Maßeinheiten
  • kg
Alias
UMLS CUI [1]
C0005910
kg
Study Drug: Accountability - Unscheduled
Beschreibung

Study Drug: Accountability - Unscheduled

Alias
UMLS CUI-1
C0013175
UMLS CUI-2
C0078889
Dispensed Date
Beschreibung

Dispensed Date

Datentyp

date

Alias
UMLS CUI [1]
C3173309
Replacement Kit Number
Beschreibung

Replacement Kit Number

Datentyp

text

Alias
UMLS CUI [1,1]
C2981406
UMLS CUI [1,2]
C0559956
No. of capsules dispensed
Beschreibung

Amount dispensed

Datentyp

text

Alias
UMLS CUI [1]
C0805077
Were any of the wallets within the kit returned?
Beschreibung

Any Containers Returned

Datentyp

boolean

Alias
UMLS CUI [1]
C0180098
Returned Date
Beschreibung

Returned Date

Datentyp

date

Alias
UMLS CUI [1,1]
C0180098
UMLS CUI [1,2]
C1547350
No. of Capsules / Tablets returned
Beschreibung

Amount Returned

Datentyp

text

Alias
UMLS CUI [1]
C2699071
Comment
Beschreibung

Comment

Datentyp

text

Alias
UMLS CUI [1,1]
C0078889
UMLS CUI [1,2]
C0947611
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Ähnliche Modelle

Unscheduled Visit DM-ASP1941-1941-CL-0004 NCT01071850

1 Formulare
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Unscheduled Visit Checklist
C1548404 (UMLS CUI-1)
Assessment Date
Item
Date
date
C2985720 (UMLS CUI [1])
Physical Examination
Item
Physical Examination?
boolean
C0031809 (UMLS CUI [1])
Orthostatic Vital Signs
Item
Orthostatic Vital Signs?
boolean
C0518766 (UMLS CUI [1])
ECG: 12 Lead ECG 1
Item
ECG: 12 Lead ECG 1?
boolean
C0013798 (UMLS CUI [1])
Weight
Item
Weight?
boolean
C0005910 (UMLS CUI [1])
Study drug Accountability
Item
Study drug Accountability?
boolean
C2981453 (UMLS CUI [1])
Item Group
Physical Examination
C0031809 (UMLS CUI-1)
Physical Examination
Item
Was the physical examination performed? Record any abnormal findings/conditions identified during the exam on the appropriate form.
boolean
C0031809 (UMLS CUI [1])
Assessment Date
Item
Assessment Date
date
C0031809 (UMLS CUI [1,1])
C2985720 (UMLS CUI [1,2])
Item Group
Orthostatic vital signs
C0518766 (UMLS CUI-1)
Assessment
Item
Not Done:
boolean
C0518766 (UMLS CUI [1,1])
C1516048 (UMLS CUI [1,2])
Assessment Date
Item
Assessment Date
date
C0518766 (UMLS CUI [1,1])
C1516048 (UMLS CUI [1,2])
C2985720 (UMLS CUI [1,3])
Assessment Time
Item
Assessment Time
time
C0518766 (UMLS CUI [1,1])
C1516048 (UMLS CUI [1,2])
C0040223 (UMLS CUI [1,3])
Item
Position
integer
C0518766 (UMLS CUI [1])
Vital Signs
Code List
Position
CL Item
Sitting  (1)
CL Item
Standing (2)
Item
integer
C0005823 (UMLS CUI [1])
Location of blood pressure measurement
Code List
Location of blood pressure measurement
CL Item
Right Arm (1)
CL Item
Left Arm (2)
Systolic blood pressure
Item
Systolic blood pressure
text
C0871470 (UMLS CUI [1])
Diastolic Blood Pressure
Item
Diastolic Blood Pressure
text
C0428883 (UMLS CUI [1])
Pulse Rate
Item
Pulse Rate
text
C0232117 (UMLS CUI [1])
Item Group
12 Lead ECG 1
C0013798 (UMLS CUI-1)
ECG Date
Item
Date ECG was performed
date
C0013798 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
ECG time
Item
ECG Time performed
time
C0013798 (UMLS CUI [1,1])
C0040223 (UMLS CUI [1,2])
Item
ECG Interpretation
text
C1623258 (UMLS CUI [1,1])
C0459471 (UMLS CUI [1,2])
ECG Interpretation
Code List
ECG Interpretation
CL Item
Normal  (0 )
CL Item
Abnormal - not clinically significant  (1 )
CL Item
Abnormal - clinically significant (2 )
Item Group
Weight
C0005910 (UMLS CUI-1)
Assessment Date
Item
Assessment Date
date
C0005910 (UMLS CUI [1,1])
C2985720 (UMLS CUI [1,2])
Weight
Item
Body weight
text
C0005910 (UMLS CUI [1])
Item Group
Study Drug: Accountability - Unscheduled
C0013175 (UMLS CUI-1)
C0078889 (UMLS CUI-2)
Dispensed Date
Item
Dispensed Date
date
C3173309 (UMLS CUI [1])
Replacement Kit Number
Item
Replacement Kit Number
text
C2981406 (UMLS CUI [1,1])
C0559956 (UMLS CUI [1,2])
Amount dispensed
Item
No. of capsules dispensed
text
C0805077 (UMLS CUI [1])
Any Containers Returned
Item
Were any of the wallets within the kit returned?
boolean
C0180098 (UMLS CUI [1])
Returned Date
Item
Returned Date
date
C0180098 (UMLS CUI [1,1])
C1547350 (UMLS CUI [1,2])
Amount Returned
Item
No. of Capsules / Tablets returned
text
C2699071 (UMLS CUI [1])
Comment
Item
Comment
text
C0078889 (UMLS CUI [1,1])
C0947611 (UMLS CUI [1,2])
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