ID

18744

Beskrivning

ODM Form derived from: https://ictr.wisc.edu/CaseReptTempt. Template Name: Drug Dispension & Accountability 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.

Länk

https://ictr.wisc.edu/CaseReptTempt

Nyckelord

Versioner (2)
  1. 2016-07-26 2016-07-26 -
  2. 2016-11-18 2016-11-18 -
Uppladdad den

18 november 2016

DOI

För en begäran logga in.

Licens

Creative Commons BY-NC 3.0
Modellkommentarer :

Här kan du kommentera modellen. Med hjälp av pratbubblor i Item-grupperna och Item kan du lägga in specifika kommentarer.

Tillbaka till modellkommentarer
Itemgroup-kommentar för :

Item-kommentar för :

Du måste vara inloggad för att kunna ladda ner formulär. Var vänlig logga in eller registrera dig utan kostnad.

Drug Dispension & Accountability Log: CRF Wisconsin Madison

Engelsk

Drug Dispension & Accountability Log: CRF Wisconsin Madison

1 Formulär  
Header
Beskrivning

Header

PI Name
Beskrivning

PI Name

Datatyp

text

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

Protocol or IRB Number

Datatyp

integer

Alias
UMLS CUI [1]
C2348563
Protocol Short Title
Beskrivning

Protocol Short Title

Datatyp

text

Alias
UMLS CUI [1,1]
C2348563
UMLS CUI [1,2]
C1705824
Number of Pages
Beskrivning

Number of Pages

Datatyp

integer

Alias
UMLS CUI [1,1]
C1704732
UMLS CUI [1,2]
C0449788
Total Number of Pages
Beskrivning

Total Number of Pages

Datatyp

integer

Alias
UMLS CUI [1,1]
C1704732
UMLS CUI [1,2]
C0449788
Drug Dispensation & Accountability Log
Beskrivning

Drug Dispensation & Accountability Log

Subject Initials
Beskrivning

Subject Initials

Datatyp

text

Alias
UMLS CUI [1]
C2986440
Subject Study ID
Beskrivning

Subject Study ID

Datatyp

integer

Alias
UMLS CUI [1]
C2348585
Lot Number(s)
Beskrivning

Lot Number(s)

Datatyp

integer

Alias
UMLS CUI [1]
C1115660
Unit Dose (e.g. mg)
Beskrivning

Unit Dose

Datatyp

text

Alias
UMLS CUI [1]
C0869039
Drug Dispensation & Accountability Log: Dispensed to Subject
Beskrivning

Drug Dispensation & Accountability Log: Dispensed to Subject

Number of Containers Dispensed
Beskrivning

Number of Containers Dispensed

Datatyp

integer

Alias
UMLS CUI [1,1]
C0449788
UMLS CUI [1,2]
C0180098
UMLS CUI [1,3]
C0805077
Number of Units Dispensed
Beskrivning

Number of Units Dispensed

Datatyp

integer

Alias
UMLS CUI [1]
C0805077
Date Dispensed
Beskrivning

Date Dispensed

Datatyp

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0947323
Dispensed by (staff initials)
Beskrivning

Dispensed by (staff initials)

Datatyp

text

Alias
UMLS CUI [1,1]
C0947323
UMLS CUI [1,2]
C2986440
Drug Dispensation & Accountability Log: Returned by Subject
Beskrivning

Drug Dispensation & Accountability Log: Returned by Subject

Number of Containers Returned
Beskrivning

Number of Containers Returned

Datatyp

integer

Alias
UMLS CUI [1,1]
C0449788
UMLS CUI [1,2]
C0180098
UMLS CUI [1,3]
C0332156
Number of units returned
Beskrivning

Number of units returned

Datatyp

integer

Alias
UMLS CUI [1]
C2981651
Date Returned
Beskrivning

Date Returned

Datatyp

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0332156
Verified by (staff initials)
Beskrivning

Verified by (staff initials)

Datatyp

text

Alias
UMLS CUI [1,1]
C1547321
UMLS CUI [1,2]
C2986440
Drug Dispensation & Accountability Log: Compliance
Beskrivning

Drug Dispensation & Accountability Log: Compliance

Expected number of units to be used/taken
Beskrivning

Expected number of units to be used/taken

Datatyp

integer

Alias
UMLS CUI [1,1]
C0449961
UMLS CUI [1,2]
C1517001
Actual number of units used/taken
Beskrivning

Actual number of units used/taken

Datatyp

integer

Alias
UMLS CUI [1,1]
C0449961
UMLS CUI [1,2]
C0237400
% compliance
Beskrivning

% compliance

Datatyp

integer

Alias
UMLS CUI [1]
C3714738
Tillbaka till toppen

Similar models

Drug Dispension & Accountability Log: CRF Wisconsin Madison

1 Formulär
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
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])
Number of Pages
Item
Number of Pages
integer
C1704732 (UMLS CUI [1,1])
C0449788 (UMLS CUI [1,2])
Total Number of Pages
Item
Total Number of Pages
integer
C1704732 (UMLS CUI [1,1])
C0449788 (UMLS CUI [1,2])
Item Group
Drug Dispensation & Accountability Log
Subject Initials
Item
Subject Initials
text
C2986440 (UMLS CUI [1])
Subject Study ID
Item
Subject Study ID
integer
C2348585 (UMLS CUI [1])
Lot Number(s)
Item
Lot Number(s)
integer
C1115660 (UMLS CUI [1])
Unit Dose
Item
Unit Dose (e.g. mg)
text
C0869039 (UMLS CUI [1])
Item Group
Drug Dispensation & Accountability Log: Dispensed to Subject
Number of Containers Dispensed
Item
Number of Containers Dispensed
integer
C0449788 (UMLS CUI [1,1])
C0180098 (UMLS CUI [1,2])
C0805077 (UMLS CUI [1,3])
Number of Units Dispensed
Item
Number of Units Dispensed
integer
C0805077 (UMLS CUI [1])
Date Dispensed
Item
Date Dispensed
date
C0011008 (UMLS CUI [1,1])
C0947323 (UMLS CUI [1,2])
Dispensed by (staff initials)
Item
Dispensed by (staff initials)
text
C0947323 (UMLS CUI [1,1])
C2986440 (UMLS CUI [1,2])
Item Group
Drug Dispensation & Accountability Log: Returned by Subject
Number of Containers Returned
Item
Number of Containers Returned
integer
C0449788 (UMLS CUI [1,1])
C0180098 (UMLS CUI [1,2])
C0332156 (UMLS CUI [1,3])
Number of units returned
Item
Number of units returned
integer
C2981651 (UMLS CUI [1])
Date Returned
Item
Date Returned
date
C0011008 (UMLS CUI [1,1])
C0332156 (UMLS CUI [1,2])
Verified by (staff initials)
Item
Verified by (staff initials)
text
C1547321 (UMLS CUI [1,1])
C2986440 (UMLS CUI [1,2])
Item Group
Drug Dispensation & Accountability Log: Compliance
Expected number of units to be used/taken
Item
Expected number of units to be used/taken
integer
C0449961 (UMLS CUI [1,1])
C1517001 (UMLS CUI [1,2])
Actual number of units used/taken
Item
Actual number of units used/taken
integer
C0449961 (UMLS CUI [1,1])
C0237400 (UMLS CUI [1,2])
% compliance
Item
% compliance
integer
C3714738 (UMLS CUI [1])
Tillbaka till toppen 

Kontakt

Använd detta formulär för feedback, frågor och förslag på förbättringar.

Fält markerade med * är obligatoriska.

Hjälp

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial