Informations:
Erreur:
ID
18736
Description
ODM Form derived from: https://ictr.wisc.edu/CaseReptTempt. Template Name: Electrocardiogram Results. 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)
- 23/07/2016 23/07/2016 -
- 18/11/2016 18/11/2016 -
Téléchargé le
18 novembre 2016
DOI
Pour une demande vous connecter.
Licence
Creative Commons BY-NC 3.0
Modèle Commentaires :
Ici, vous pouvez faire des commentaires sur le modèle. À partir des bulles de texte, vous pouvez laisser des commentaires spécifiques sur les groupes Item et les Item.
Groupe Item commentaires pour :
Item commentaires pour :
Vous devez être connecté pour pouvoir télécharger des formulaires. Veuillez vous connecter ou s’inscrire gratuitement.
Electrocardiogram Results: CRF Wisconsin Madison
Electrocardiogram Results: CRF Wisconsin Madison
- StudyEvent: ODM
Similar models
Electrocardiogram Results: CRF Wisconsin Madison
- StudyEvent: ODM
Name
Type
Description | Question | Decode (Coded Value)
Type de données
Alias
PI Name
Item
PI Name
text
C0027365 (UMLS CUI [1,1])
C1521895 (UMLS CUI [1,2])
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])
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])
Date
Item
Date
date
C0011008 (UMLS CUI [1])
Electrocardiogram not performed
Item
Electrocardiogram not performed
boolean
C0420795 (UMLS CUI [1])
Time
Item
Time
time
C0040223 (UMLS CUI [1])
CL Item
Visit # (1)
CL Item
Visit # (2)
CL Item
Visit # (3)
CL Item
Visit # (4)
CL Item
Visit # (5)
CL Item
Visit # (6)
CL Item
Visit # (7)
CL Item
Visit # (8)
CL Item
Visit # (9)
CL Item
Sitting (1)
CL Item
Supine (2)
ECG Measurement/ Result: Heart Rate
Item
ECG Measurement/ Result: Heart Rate
integer
C3642352 (UMLS CUI [1,1])
C0018810 (UMLS CUI [1,2])
C0018810 (UMLS CUI [1,2])
Item
ECG Measurement/ Result: Heart Rate
text
C3642352 (UMLS CUI [1,1])
C0018810 (UMLS CUI [1,2])
C0018810 (UMLS CUI [1,2])
CL Item
Normal (1)
CL Item
Abnormal (2)
ECG Measurement/ Result: Heart Rate
Item
ECG Measurement/ Result: Heart Rate Clinically significant
boolean
C3642352 (UMLS CUI [1,1])
C0018810 (UMLS CUI [1,2])
C2826293 (UMLS CUI [1,3])
C0018810 (UMLS CUI [1,2])
C2826293 (UMLS CUI [1,3])
ECG Measurement/ Result: PR Interval
Item
ECG Measurement/ Result: PR Interval
integer
C0429087 (UMLS CUI [1])
Item
ECG Measurement/ Result: PR Interval
text
C0429087 (UMLS CUI [1])
CL Item
Normal (1)
CL Item
Abnormal (2)
ECG Measurement/ Result: PR Interval
Item
ECG Measurement/ Result: PR Interval Clinically significant
boolean
C0429087 (UMLS CUI [1,1])
C2826293 (UMLS CUI [1,2])
C2826293 (UMLS CUI [1,2])
ECG Measurement/ Result: QRS Duration
Item
ECG Measurement/ Result: QRS Duration
integer
C3642352 (UMLS CUI [1,1])
C0429025 (UMLS CUI [1,2])
C0429025 (UMLS CUI [1,2])
Item
ECG Measurement/ Result: QRS Duration
text
C3642352 (UMLS CUI [1,1])
C0429025 (UMLS CUI [1,2])
C0429025 (UMLS CUI [1,2])
CL Item
Normal (1)
CL Item
Abnormal (2)
ECG Measurement/ Result: QRS Duration
Item
ECG Measurement/ Result: QRS Duration Clinically significant
boolean
C3642352 (UMLS CUI [1,1])
C0429025 (UMLS CUI [1,2])
C2826293 (UMLS CUI [1,3])
C0429025 (UMLS CUI [1,2])
C2826293 (UMLS CUI [1,3])
ECG Measurement/ Result: QTc Interval
Item
ECG Measurement/ Result: QTc Interval
integer
C3642352 (UMLS CUI [1,1])
C0489625 (UMLS CUI [1,2])
C0489625 (UMLS CUI [1,2])
Item
ECG Measurement/ Result: QTc Interval
text
C3642352 (UMLS CUI [1,1])
C0489625 (UMLS CUI [1,2])
C0489625 (UMLS CUI [1,2])
CL Item
Normal (1)
CL Item
Abnormal (2)
ECG Measurement/ Result: QTc Interval
Item
ECG Measurement/ Result: QTc Interval Clinically significant
boolean
C3642352 (UMLS CUI [1,1])
C0489625 (UMLS CUI [1,2])
C2826293 (UMLS CUI [1,3])
C0489625 (UMLS CUI [1,2])
C2826293 (UMLS CUI [1,3])
CL Item
Normal Sinus Rhythm (1)
CL Item
Atrial Fibrillation (2)
CL Item
First-degree Av Block (3)
CL Item
Ventricular Tachycardia (4)
CL Item
Sinus Bradycardia (5)
CL Item
Atrial Flutter (6)
CL Item
Type I Second Degree Av Block (7)
CL Item
Type II Second Degree AV Block (8)
CL Item
Ventricular Fibrillation (9)
CL Item
Other: (specify) (10)
CL Item
Sinus Tachycardia (11)
CL Item
Supra Ventricular Tachycardia (12)
CL Item
Third Degree AV Block (13)
CL Item
Paced Rhythm (14)
CL Item
Other: (specify) (15)
Cardiac Rhythm
Item
Cardiac Rhythm: If Other, please specify
text
C0232187 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,2])
CL Item
Normal (1)
CL Item
Abnormal (2)
Overall assessment
Item
Overall assessment: Clinically significant
boolean
C0220825 (UMLS CUI [1,1])
C2826293 (UMLS CUI [1,2])
C2826293 (UMLS CUI [1,2])
ECG done by
Item
ECG done by
text
C0013798 (UMLS CUI [1,1])
C1550369 (UMLS CUI [1,2])
C1550369 (UMLS CUI [1,2])
ECG read by
Item
ECG read by
text
C0013798 (UMLS CUI [1,1])
C0034754 (UMLS CUI [1,2])
C0034754 (UMLS CUI [1,2])
Comments
Item
Comments
text
C0947611 (UMLS CUI [1])