Englisch

GENERAL MEDICAL HISTORY AND BASELINE CONDITIONS (SCREENING) CRFs Roche FVF4170G Macular Edema NCT-Nummer: NCT00473382

1 Formulare  
Patient administration
Beschreibung

Patient administration

Subject Number
Beschreibung

PT

Datentyp

integer

Alias
UMLS CUI [1]
C2348585
Subject Initials:
Beschreibung

PTINIT

Datentyp

text

Alias
UMLS CUI [1,1]
C1997894
UMLS CUI [1,2]
C2986440
Report Date:
Beschreibung

VDT

Datentyp

date

Alias
UMLS CUI [1,1]
C1302584
GENERAL MEDICAL HISTORY AND BASELINE CONDITIONS (SCREENING)
Beschreibung

GENERAL MEDICAL HISTORY AND BASELINE CONDITIONS (SCREENING)

Does the subject have any other medical history or baseline conditions, not specified on a Targeted Medical History CRF?
Beschreibung

If Yes, record each diagnosis and its status below. Do not record diagnoses / physical findings already captured on the Targeted Medical History CRF. The following Systems / Categories should be reviewed by the investigator: Neurologic / Psychiatric • Gastrointestinal • Endocrine • Ophthalmologic • Genitourinary / Reproductive • Hematologic • Ears, Nose, Throat • Musculoskeletal • Allergies / Drug Sensitivities • Cardiovascular • Dermatologic • Malignancy • Respiratory

Datentyp

boolean

Alias
UMLS CUI [1]
C0262926
Other Medical History
Beschreibung

Other Medical History

Line Number
Beschreibung

LINE_NUMBER [LN]

Datentyp

integer

Alias
UMLS CUI [1,1]
C0449788
UMLS CUI [1,2]
C0087111
Diagnosis
Beschreibung

MED_HX_DESCRIPTION [HXDES]

Datentyp

text

Alias
UMLS CUI [1]
C0011900
Condition Currently Active?
Beschreibung

MED_HX_ACTIVE [HXACT]

Datentyp

boolean

Alias
UMLS CUI [1]
C2707252
Onset Date
Beschreibung

MED_HX_DT [HXDT]

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0574845
UMLS CUI [1,2]
C0439673
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Ähnliche Modelle

GENERAL MEDICAL HISTORY AND BASELINE CONDITIONS (SCREENING) CRFs Roche FVF4170G Macular Edema NCT-Nummer: NCT00473382

1 Formulare
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Patient administration
PT
Item
Subject Number
integer
C2348585 (UMLS CUI [1])
PTINIT
Item
Subject Initials:
text
C1997894 (UMLS CUI [1,1])
C2986440 (UMLS CUI [1,2])
VDT
Item
Report Date:
date
C1302584 (UMLS CUI [1,1])
Item Group
GENERAL MEDICAL HISTORY AND BASELINE CONDITIONS (SCREENING)
MED_HX_RECORDS
Item
Does the subject have any other medical history or baseline conditions, not specified on a Targeted Medical History CRF?
boolean
C0262926 (UMLS CUI [1])
Item Group
Other Medical History
LINE_NUMBER [LN]
Item
Line Number
integer
C0449788 (UMLS CUI [1,1])
C0087111 (UMLS CUI [1,2])
MED_HX_DESCRIPTION [HXDES]
Item
Diagnosis
text
C0011900 (UMLS CUI [1])
MED_HX_ACTIVE [HXACT]
Item
Condition Currently Active?
boolean
C2707252 (UMLS CUI [1])
MED_HX_DT [HXDT]
Item
Onset Date
boolean
C0574845 (UMLS CUI [1,1])
C0439673 (UMLS CUI [1,2])
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