ID
18726
Description
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.
Lien
https://ictr.wisc.edu/CaseReptTempt
Mots-clés
Versions (2)
- 22/07/2016 22/07/2016 -
- 17/11/2016 17/11/2016 -
Téléchargé le
17 novembre 2016
DOI
Pour une demande vous connecter.
Licence
Creative Commons BY-NC 3.0
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Demographics: CRF Wisconsin Madison
Demographics: CRF Wisconsin Madison
- StudyEvent: ODM
Description
Demographics
Description
Subject UWHC Medical Record Number
Type de données
integer
Alias
- UMLS CUI [1]
- C1301894
Description
First Name
Type de données
text
Alias
- UMLS CUI [1]
- C1443235
Description
Middle Name (or initial)
Type de données
text
Alias
- UMLS CUI [1]
- C2598119
Description
Last Name
Type de données
text
Alias
- UMLS CUI [1]
- C1301584
Description
Birthdate
Type de données
date
Alias
- UMLS CUI [1]
- C0421451
Description
Gender
Type de données
text
Alias
- UMLS CUI [1]
- C0079399
Description
Ethnicity
Type de données
text
Alias
- UMLS CUI [1]
- C0015031
Description
Race
Type de données
boolean
Alias
- UMLS CUI [1,1]
- C0002460
- UMLS CUI [1,2]
- C0682125
Description
Race
Type de données
boolean
Alias
- UMLS CUI [1]
- C0078988
Description
Race
Type de données
boolean
Alias
- UMLS CUI [1]
- C0085756
Description
Race
Type de données
boolean
Alias
- UMLS CUI [1]
- C3845561
Description
Race
Type de données
boolean
Alias
- UMLS CUI [1]
- C0043157
Description
Race
Type de données
boolean
Alias
- UMLS CUI [1]
- C0439673
Description
Other Medical Record Number(s)
Description
Contact Information
Description
Address
Type de données
text
Alias
- UMLS CUI [1]
- C0421449
Description
Unit number
Type de données
integer
Alias
- UMLS CUI [1]
- C0439148
Description
City
Type de données
text
Alias
- UMLS CUI [1]
- C0008848
Description
State
Type de données
text
Alias
- UMLS CUI [1]
- C1442792
Description
Zip
Type de données
integer
Alias
- UMLS CUI [1]
- C1521842
Description
Phone number
Type de données
integer
Alias
- UMLS CUI [1]
- C1515258
Description
Phone number
Type de données
text
Alias
- UMLS CUI [1,1]
- C1515258
- UMLS CUI [1,2]
- C0332307
Description
Alternate Phone Number
Type de données
integer
Alias
- UMLS CUI [1,1]
- C1515258
- UMLS CUI [1,2]
- C1523987
Description
Alternate Phone Number
Type de données
text
Alias
- UMLS CUI [1,1]
- C1515258
- UMLS CUI [1,2]
- C0332307
Description
Email address
Type de données
text
Alias
- UMLS CUI [1]
- C1705961
Description
Preferred method of contact
Type de données
text
Alias
- UMLS CUI [1]
- C1997600
Description
Emergency contact
Description
Name
Type de données
text
Alias
- UMLS CUI [1]
- C0027365
Description
Address
Type de données
text
Alias
- UMLS CUI [1]
- C0421449
Description
Unit number
Type de données
integer
Alias
- UMLS CUI [1]
- C0439148
Description
City
Type de données
text
Alias
- UMLS CUI [1]
- C0008848
Description
State
Type de données
text
Alias
- UMLS CUI [1]
- C1442792
Description
Zip
Type de données
integer
Alias
- UMLS CUI [1]
- C1521842
Description
Phone Number
Type de données
integer
Alias
- UMLS CUI [1]
- C1515258
Description
Phone number
Type de données
text
Alias
- UMLS CUI [1,1]
- C1515258
- UMLS CUI [1,2]
- C0332307
Description
Alternate Phone Number
Type de données
integer
Alias
- UMLS CUI [1,1]
- C1515258
- UMLS CUI [1,2]
- C1523987
Description
Alternate Phone Number
Type de données
text
Alias
- UMLS CUI [1,1]
- C1515258
- UMLS CUI [1,2]
- C0332307
Description
Email address
Type de données
text
Alias
- UMLS CUI [1]
- C1705961
Description
Form completed By
Type de données
text
Description
Date
Type de données
date
Alias
- UMLS CUI [1]
- C0011008
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Demographics: CRF Wisconsin Madison
- StudyEvent: ODM
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