ID
18733
Beschrijving
ODM Form derived from: https://ictr.wisc.edu/CaseReptTempt. Template Name: Concomitant Medication Log. 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)
- 23-07-16 23-07-16 -
- 17-11-16 17-11-16 -
Geüploaded op
17 november 2016
DOI
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Licentie
Creative Commons BY-NC 3.0
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Concomitant Medication Log: CRF Wisconsin Madison
Concomitant Medication Log: CRF Wisconsin Madison
- StudyEvent: ODM
Beschrijving
Concomitant Medication Log
Beschrijving
#
Datatype
integer
Beschrijving
Medication/ Non-drug Therapy
Datatype
text
Alias
- UMLS CUI [1]
- C0013227
- UMLS CUI [2]
- C0087111
Beschrijving
Indication
Datatype
text
Alias
- UMLS CUI [1]
- C3146298
Beschrijving
Medication Dose
Datatype
float
Alias
- UMLS CUI [1]
- C3174092
Beschrijving
1= g 2= mg 3= ug 4= L 5= mL 6= IU 7= Other
Datatype
text
Alias
- UMLS CUI [1,1]
- C0178602
- UMLS CUI [1,2]
- C1519795
Beschrijving
1= QD (once a day) 2= BID (twice a day) 3= TID (three times a day) 4= QID (four times a day) 5= QOD (every other day) 6= QM (every month) 7= QOM (every other month) 8= QH (every hour) 9= AC (before meals) 10= PC (after meals) 11= PRN (as needed) 12= Other
Datatype
text
Alias
- UMLS CUI [1]
- C0013154
- UMLS CUI [2]
- C0439603
Beschrijving
1= Tablet 2= Capsule 3= Ointment 4=Suppository 5=Aerosol 6=Spray 7=Suspension 8= Patch 9=Gas 10=Gel 11=Cream 12=Powder
Datatype
text
Alias
- UMLS CUI [1]
- C0013058
Beschrijving
1= Oral 2= Topical 3= Subcutaneous 4= Intradermal 5= Transdermal 6= Intraocular 7= Intramuscular 8= Inhalation 9= Intravenous 10= Intraperitoneal 11= Nasal 12= Vaginal 13= Rectal 14= Other
Datatype
text
Alias
- UMLS CUI [1]
- C3469597
Beschrijving
Start Date
Datatype
date
Alias
- UMLS CUI [1]
- C0808070
Beschrijving
End Date
Datatype
date
Alias
- UMLS CUI [1]
- C0806020
Beschrijving
Baseline Med
Datatype
boolean
Alias
- UMLS CUI [1,1]
- C0013227
- UMLS CUI [1,2]
- C1442488
Beschrijving
Continuing at end of study
Datatype
boolean
Alias
- UMLS CUI [1]
- C1553904
Similar models
Concomitant Medication Log: CRF Wisconsin Madison
- StudyEvent: ODM
C1521895 (UMLS CUI [1,2])
C1705824 (UMLS CUI [1,2])
C0449788 (UMLS CUI [1,2])
C0449788 (UMLS CUI [1,2])
C0087111 (UMLS CUI [2])
C1519795 (UMLS CUI [1,2])
C0439603 (UMLS CUI [2])
C1442488 (UMLS CUI [1,2])