ID

18729

Beschrijving

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.

Link

https://ictr.wisc.edu/CaseReptTempt

Trefwoorden

Versies (2)
  1. 22-07-16 22-07-16 -
  2. 17-11-16 17-11-16 -
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17 november 2016

DOI

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Creative Commons BY-NC 3.0
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Eligibility Criteria: CRF Wisconsin Madison

Engels

Eligibility Criteria: CRF Wisconsin Madison

1 Formulieren  
Header
Beschrijving

Header

PI Name
Beschrijving

PI Name

Datatype

text

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

Protocol or IRB Number

Datatype

integer

Alias
UMLS CUI [1]
C2348563
Protocol Short Title
Beschrijving

Protocol Short Title

Datatype

text

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

Subject Initials

Datatype

text

Alias
UMLS CUI [1]
C2986440
Subject ID
Beschrijving

Subject ID

Datatype

text

Alias
UMLS CUI [1]
C2348585
Date
Beschrijving

Date

Datatype

date

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

Eligibility Criteria - Inclusion Criteria

Inclusion Criteria
Beschrijving

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

Datatype

text

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

Criteria

Datatype

boolean

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

Eligibility Criteria - Exclusion Criteria

Exclusion Criteria
Beschrijving

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

Datatype

text

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

Criteria

Datatype

boolean

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

undefined itemgroup

Form Completed by
Beschrijving

Form Completed by

Datatype

text

Alias
UMLS CUI [1]
C1550483
Date
Beschrijving

Date

Datatype

date

Alias
UMLS CUI [1]
C0011008
Site Pl Signature
Beschrijving

Site Pl Signature

Datatype

text

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

Date

Datatype

date

Alias
UMLS CUI [1]
C0011008
Terug naar het begin van de pagina

Similar models

Eligibility Criteria: CRF Wisconsin Madison

1 Formulieren
Name
Type
Description | Question | Decode (Coded Value)
Datatype
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])
Terug naar het begin van de pagina 

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