ID
18726
Beschreibung
ODM Form derived from: https://ictr.wisc.edu/CaseReptTempt. Template Name: Demographics. Case Report Form (CRF)/Source Document templates were created for University of Wisconsin-Madison researchers. These templates are consistent with the FDA's CDASH (Clinical Data Acquisition Standards Harmonization) standards. The CDASH standards identify those elements that should be captured on a Case Report Form (CRF). The forms serve only as templates, and must be edited to meet the study data collection needs as described in the protocol.
Link
https://ictr.wisc.edu/CaseReptTempt
Stichworte
Versionen (2)
- 22.07.16 22.07.16 -
- 17.11.16 17.11.16 -
Hochgeladen am
17. November 2016
DOI
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Lizenz
Creative Commons BY-NC 3.0
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Demographics: CRF Wisconsin Madison
Demographics: CRF Wisconsin Madison
- StudyEvent: ODM
Beschreibung
Demographics
Beschreibung
Subject UWHC Medical Record Number
Datentyp
integer
Alias
- UMLS CUI [1]
- C1301894
Beschreibung
First Name
Datentyp
text
Alias
- UMLS CUI [1]
- C1443235
Beschreibung
Middle Name (or initial)
Datentyp
text
Alias
- UMLS CUI [1]
- C2598119
Beschreibung
Last Name
Datentyp
text
Alias
- UMLS CUI [1]
- C1301584
Beschreibung
Birthdate
Datentyp
date
Alias
- UMLS CUI [1]
- C0421451
Beschreibung
Gender
Datentyp
text
Alias
- UMLS CUI [1]
- C0079399
Beschreibung
Ethnicity
Datentyp
text
Alias
- UMLS CUI [1]
- C0015031
Beschreibung
Race
Datentyp
boolean
Alias
- UMLS CUI [1,1]
- C0002460
- UMLS CUI [1,2]
- C0682125
Beschreibung
Race
Datentyp
boolean
Alias
- UMLS CUI [1]
- C0078988
Beschreibung
Race
Datentyp
boolean
Alias
- UMLS CUI [1]
- C0085756
Beschreibung
Race
Datentyp
boolean
Alias
- UMLS CUI [1]
- C3845561
Beschreibung
Race
Datentyp
boolean
Alias
- UMLS CUI [1]
- C0043157
Beschreibung
Race
Datentyp
boolean
Alias
- UMLS CUI [1]
- C0439673
Beschreibung
Other Medical Record Number(s)
Beschreibung
Contact Information
Beschreibung
Address
Datentyp
text
Alias
- UMLS CUI [1]
- C0421449
Beschreibung
Unit number
Datentyp
integer
Alias
- UMLS CUI [1]
- C0439148
Beschreibung
City
Datentyp
text
Alias
- UMLS CUI [1]
- C0008848
Beschreibung
State
Datentyp
text
Alias
- UMLS CUI [1]
- C1442792
Beschreibung
Zip
Datentyp
integer
Alias
- UMLS CUI [1]
- C1521842
Beschreibung
Phone number
Datentyp
integer
Alias
- UMLS CUI [1]
- C1515258
Beschreibung
Phone number
Datentyp
text
Alias
- UMLS CUI [1,1]
- C1515258
- UMLS CUI [1,2]
- C0332307
Beschreibung
Alternate Phone Number
Datentyp
integer
Alias
- UMLS CUI [1,1]
- C1515258
- UMLS CUI [1,2]
- C1523987
Beschreibung
Alternate Phone Number
Datentyp
text
Alias
- UMLS CUI [1,1]
- C1515258
- UMLS CUI [1,2]
- C0332307
Beschreibung
Email address
Datentyp
text
Alias
- UMLS CUI [1]
- C1705961
Beschreibung
Preferred method of contact
Datentyp
text
Alias
- UMLS CUI [1]
- C1997600
Beschreibung
Emergency contact
Beschreibung
Name
Datentyp
text
Alias
- UMLS CUI [1]
- C0027365
Beschreibung
Address
Datentyp
text
Alias
- UMLS CUI [1]
- C0421449
Beschreibung
Unit number
Datentyp
integer
Alias
- UMLS CUI [1]
- C0439148
Beschreibung
City
Datentyp
text
Alias
- UMLS CUI [1]
- C0008848
Beschreibung
State
Datentyp
text
Alias
- UMLS CUI [1]
- C1442792
Beschreibung
Zip
Datentyp
integer
Alias
- UMLS CUI [1]
- C1521842
Beschreibung
Phone Number
Datentyp
integer
Alias
- UMLS CUI [1]
- C1515258
Beschreibung
Phone number
Datentyp
text
Alias
- UMLS CUI [1,1]
- C1515258
- UMLS CUI [1,2]
- C0332307
Beschreibung
Alternate Phone Number
Datentyp
integer
Alias
- UMLS CUI [1,1]
- C1515258
- UMLS CUI [1,2]
- C1523987
Beschreibung
Alternate Phone Number
Datentyp
text
Alias
- UMLS CUI [1,1]
- C1515258
- UMLS CUI [1,2]
- C0332307
Beschreibung
Email address
Datentyp
text
Alias
- UMLS CUI [1]
- C1705961
Beschreibung
Form completed By
Datentyp
text
Beschreibung
Date
Datentyp
date
Alias
- UMLS CUI [1]
- C0011008
Ähnliche Modelle
Demographics: CRF Wisconsin Madison
- StudyEvent: ODM
C0600091 (UMLS CUI [1,2])
C1555582 (UMLS CUI [1,2])
C0682125 (UMLS CUI [1,2])
C0332307 (UMLS CUI [1,2])
C1523987 (UMLS CUI [1,2])
C0332307 (UMLS CUI [1,2])
C0332307 (UMLS CUI [1,2])
C1523987 (UMLS CUI [1,2])
C0332307 (UMLS CUI [1,2])