ID

18729

Description

ODM Form derived from: https://ictr.wisc.edu/CaseReptTempt. Template Name: Eligibility Criteria. 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)
  1. 22/07/2016 22/07/2016 -
  2. 17/11/2016 17/11/2016 -
Téléchargé le

17 novembre 2016

DOI

Pour une demande vous connecter.

Licence

Creative Commons BY-NC 3.0
Modèle Commentaires :

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Eligibility Criteria: CRF Wisconsin Madison

Anglais

Eligibility Criteria: CRF Wisconsin Madison

1 Formulaires  
Header
Description

Header

PI Name
Description

PI Name

Type de données

text

Alias
UMLS CUI [1,1]
C0027365
UMLS CUI [1,2]
C1521895
Protocol or IRB Number
Description

Protocol or IRB Number

Type de données

integer

Alias
UMLS CUI [1]
C2348563
Protocol Short Title
Description

Protocol Short Title

Type de données

text

Alias
UMLS CUI [1,1]
C2348563
UMLS CUI [1,2]
C1705824
Subject Initials
Description

Subject Initials

Type de données

text

Alias
UMLS CUI [1]
C2986440
Subject ID
Description

Subject ID

Type de données

text

Alias
UMLS CUI [1]
C2348585
Date
Description

Date

Type de données

date

Alias
UMLS CUI [1]
C0011008
Eligibility Criteria - Inclusion Criteria
Description

Eligibility Criteria - Inclusion Criteria

Inclusion Criteria
Description

Patients who meet all of the following criteria are eligible for enrollment as study participants!

Type de données

text

Alias
UMLS CUI [1]
C1512693
Does this criteria apply?
Description

Criteria

Type de données

boolean

Alias
UMLS CUI [1,1]
C0243161
UMLS CUI [1,2]
C4048755
Eligibility Criteria - Exclusion Criteria
Description

Eligibility Criteria - Exclusion Criteria

Exclusion Criteria
Description

Patients who meet any of these criteria are not eligible for enrollment as study participants!

Type de données

text

Alias
UMLS CUI [1]
C0680251
Does this criteria apply?
Description

Criteria

Type de données

boolean

Alias
UMLS CUI [1,1]
C0243161
UMLS CUI [1,2]
C4048755
undefined itemgroup
Description

undefined itemgroup

Form Completed by
Description

Form Completed by

Type de données

text

Alias
UMLS CUI [1]
C1550483
Date
Description

Date

Type de données

date

Alias
UMLS CUI [1]
C0011008
Site Pl Signature
Description

Site Pl Signature

Type de données

text

Alias
UMLS CUI [1,1]
C1519316
UMLS CUI [1,2]
C1521895
Date
Description

Date

Type de données

date

Alias
UMLS CUI [1]
C0011008
Retour au début de la page

Similar models

Eligibility Criteria: CRF Wisconsin Madison

1 Formulaires
Name
Type
Description | Question | Decode (Coded Value)
Type de données
Alias
Item Group
Header
PI Name
Item
PI Name
text
C0027365 (UMLS CUI [1,1])
C1521895 (UMLS CUI [1,2])
Protocol or IRB Number
Item
Protocol or IRB Number
integer
C2348563 (UMLS CUI [1])
Protocol Short Title
Item
Protocol Short Title
text
C2348563 (UMLS CUI [1,1])
C1705824 (UMLS CUI [1,2])
Subject Initials
Item
Subject Initials
text
C2986440 (UMLS CUI [1])
Subject ID
Item
Subject ID
text
C2348585 (UMLS CUI [1])
Date
Item
Date
date
C0011008 (UMLS CUI [1])
Item Group
Eligibility Criteria - Inclusion Criteria
Inclusion Criteria
Item
Inclusion Criteria
text
C1512693 (UMLS CUI [1])
Criteria
Item
Does this criteria apply?
boolean
C0243161 (UMLS CUI [1,1])
C4048755 (UMLS CUI [1,2])
Item Group
Eligibility Criteria - Exclusion Criteria
Exclusion criteria
Item
Exclusion Criteria
text
C0680251 (UMLS CUI [1])
Criteria
Item
Does this criteria apply?
boolean
C0243161 (UMLS CUI [1,1])
C4048755 (UMLS CUI [1,2])
Form Completed by
Item
Form Completed by
text
C1550483 (UMLS CUI [1])
Date
Item
Date
date
C0011008 (UMLS CUI [1])
Site Pl Signature
Item
Site Pl Signature
text
C1519316 (UMLS CUI [1,1])
C1521895 (UMLS CUI [1,2])
Date
Item
Date
date
C0011008 (UMLS CUI [1])
Retour au début de la page 

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