ID

18735

Description

ODM Form derived from: https://ictr.wisc.edu/CaseReptTempt. Template Name: Vital Sign Measurements (Standard). 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

Keywords

Versions (2)
  1. 7/23/16 7/23/16 -
  2. 11/17/16 11/17/16 -
Uploaded on

November 17, 2016

DOI

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License

Creative Commons BY-NC 3.0
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Vital Sign Measurements (Standard): CRF Wisconsin Madison

English

Vital Sign Measurements (Standard): CRF Wisconsin Madison

1 forms  
Header
Description

Header

PI Name
Description

PI Name

Data type

text

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

Protocol or IRB Number

Data type

integer

Alias
UMLS CUI [1]
C2348563
Protocol Short Title
Description

Protocol Short Title

Data type

text

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

Subject Initials

Data type

text

Alias
UMLS CUI [1]
C2986440
Subject ID
Description

Subject ID

Data type

integer

Alias
UMLS CUI [1]
C2348585
Exam Date
Description

Exam Date

Data type

date

Alias
UMLS CUI [1]
C2826643
Vital Sign Measurements (Standard)
Description

Vital Sign Measurements (Standard)

Vital Sign Measurement not performed
Description

Vital Sign Measurement not performed

Data type

boolean

Alias
UMLS CUI [1,1]
C2963216
UMLS CUI [1,2]
C0445106
Visit Number
Description

Visit Number

Data type

text

Alias
UMLS CUI [1]
C1549755
Height
Description

Height

Data type

float

Measurement units
  • inches
Alias
UMLS CUI [1]
C0005890
inches
Height not measured
Description

Height

Data type

boolean

Alias
UMLS CUI [1]
C0005890
Weight
Description

Weight

Data type

float

Measurement units
  • lbs
Alias
UMLS CUI [1]
C0005910
lbs
Weight not measured
Description

Weight

Data type

boolean

Alias
UMLS CUI [1]
C0005910
Time
Description

Time

Data type

time

Alias
UMLS CUI [1]
C0040223
Temperature
Description

Temperature

Data type

float

Measurement units
  • Farenheit
Alias
UMLS CUI [1]
C0005903
Farenheit
Temperature not measured
Description

Temperature

Data type

boolean

Alias
UMLS CUI [1]
C0005903
Method
Description

Method

Data type

text

Alias
UMLS CUI [1]
C0871511
Respiratory Rate
Description

Respiratory Rate

Data type

integer

Measurement units
  • breaths/min
Alias
UMLS CUI [1]
C0231832
breaths/min
Respiratory Rate not measured
Description

Respiratory Rate

Data type

boolean

Alias
UMLS CUI [1]
C0231832
Heart Rate
Description

Heart Rate

Data type

integer

Measurement units
  • beats/min
Alias
UMLS CUI [1]
C0018810
beats/min
Heart Rate not measured
Description

Heart Rate

Data type

boolean

Alias
UMLS CUI [1]
C0018810
Systolic Blood Pressure
Description

Systolic Blood Pressure

Data type

integer

Measurement units
  • mmHg
Alias
UMLS CUI [1]
C0871470
mmHg
Blood Pressure not measured
Description

Systolic Blood Pressure

Data type

boolean

Alias
UMLS CUI [1]
C0871470
Diastolic Blood Pressure
Description

Diastolic Blood Pressure

Data type

integer

Measurement units
  • mmHg
Alias
UMLS CUI [1]
C0428883
mmHg
Method
Description

Method

Data type

text

Alias
UMLS CUI [1]
C0871511
Location
Description

Location

Data type

text

Alias
UMLS CUI [1]
C0450429
Position
Description

Position

Data type

text

Alias
UMLS CUI [1]
C0733755
Additional Notes
Description

Additional Notes

Data type

text

Alias
UMLS CUI [1]
C0947611
Vital Sign Measurements obtained by
Description

Vital Sign Measurements obtained by

Data type

text

Alias
UMLS CUI [1,1]
C2963216
UMLS CUI [1,2]
C1301820
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Similar models

Vital Sign Measurements (Standard): CRF Wisconsin Madison

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
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
integer
C2348585 (UMLS CUI [1])
Exam Date
Item
Exam Date
date
C2826643 (UMLS CUI [1])
Item Group
Vital Sign Measurements (Standard)
Vital Sign Measurement not performed
Item
Vital Sign Measurement not performed
boolean
C2963216 (UMLS CUI [1,1])
C0445106 (UMLS CUI [1,2])
Item
Visit Number
text
C1549755 (UMLS CUI [1])
Visit Number
Code List
Visit Number
CL Item
Visit # (1)
CL Item
Visit # (2)
CL Item
Visit # (3)
CL Item
Visit # (4)
CL Item
Visit # (5)
CL Item
Visit # (6)
Height
Item
Height
float
C0005890 (UMLS CUI [1])
Height
Item
Height not measured
boolean
C0005890 (UMLS CUI [1])
Weight
Item
Weight
float
C0005910 (UMLS CUI [1])
Weight
Item
Weight not measured
boolean
C0005910 (UMLS CUI [1])
Time
Item
Time
time
C0040223 (UMLS CUI [1])
Temperature
Item
Temperature
float
C0005903 (UMLS CUI [1])
Temperature
Item
Temperature not measured
boolean
C0005903 (UMLS CUI [1])
Item
Method
text
C0871511 (UMLS CUI [1])
Method
Code List
Method
CL Item
Oral (1)
CL Item
Axillary (2)
CL Item
Tympanic (3)
Respiratory Rate
Item
Respiratory Rate
integer
C0231832 (UMLS CUI [1])
Respiratory Rate
Item
Respiratory Rate not measured
boolean
C0231832 (UMLS CUI [1])
Heart Rate
Item
Heart Rate
integer
C0018810 (UMLS CUI [1])
Heart Rate
Item
Heart Rate not measured
boolean
C0018810 (UMLS CUI [1])
Systolic Blood Pressure
Item
Systolic Blood Pressure
integer
C0871470 (UMLS CUI [1])
Systolic Blood Pressure
Item
Blood Pressure not measured
boolean
C0871470 (UMLS CUI [1])
Diastolic Blood Pressure
Item
Diastolic Blood Pressure
integer
C0428883 (UMLS CUI [1])
Item
Method
text
C0871511 (UMLS CUI [1])
Method
Code List
Method
CL Item
Manual (1)
CL Item
Automated (2)
Item
Location
text
C0450429 (UMLS CUI [1])
Location
Code List
Location
CL Item
Left Arm (1)
CL Item
Right Arm (2)
Item
Position
text
C0733755 (UMLS CUI [1])
Position
Code List
Position
CL Item
Sitting (1)
CL Item
Supine (2)
CL Item
Standing (3)
Additional Notes
Item
Additional Notes
text
C0947611 (UMLS CUI [1])
Vital Sign Measurements obtained by
Item
Vital Sign Measurements obtained by
text
C2963216 (UMLS CUI [1,1])
C1301820 (UMLS CUI [1,2])
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