Inglés

End of Re-Enrollment Titration Period Ropinirole in Parkinson's Disease GSK 101468/196

1 formularios  
Patient Information
Descripción

Patient Information

Alias
UMLS CUI-1
C1955348
Patient No.
Descripción

Patient Number

Tipo de datos

text

Alias
UMLS CUI [1]
C1830427
Date of Visit
Descripción

Date of Visit

Tipo de datos

date

Unidades de medida
  • dd-mmm-yyyy
Alias
UMLS CUI [1]
C1320303
dd-mmm-yyyy
End of Re-Enrollment Titration Period
Descripción

End of Re-Enrollment Titration Period

Alias
UMLS CUI-1
C1516879
UMLS CUI-2
C1272693
UMLS CUI-3
C2983683
Dose of Study Medication prescribed for Maintenance period:
Descripción

Dosage of study drug

Tipo de datos

float

Unidades de medida
  • mg/d
Alias
UMLS CUI [1,1]
C0178602
UMLS CUI [1,2]
C0304229
mg/d
At which week did Titration end?
Descripción

End Date of Titration

Tipo de datos

float

Unidades de medida
  • week
Alias
UMLS CUI [1,1]
C2983683
UMLS CUI [1,2]
C0806020
week
Investigator Signature
Descripción

Investigator Signature

Alias
UMLS CUI-1
C2346576
To be completed by the Principal Investigator: I have assumed responsibility for completeness and accurancy of all data recorded on these Titration Case Report Forms. Signature
Descripción

Signature

Tipo de datos

text

Alias
UMLS CUI [1]
C1519316
To be completed by the Principal Investigator: I have assumed responsibility for completeness and accurancy of all data recorded on these Titration Case Report Forms. Print Name:
Descripción

Investigator's Name

Tipo de datos

text

Alias
UMLS CUI [1]
C2826892
Date
Descripción

Date of Report

Tipo de datos

date

Unidades de medida
  • dd-mmm-yyyy
Alias
UMLS CUI [1]
C1302584
dd-mmm-yyyy
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Similar models

End of Re-Enrollment Titration Period Ropinirole in Parkinson's Disease GSK 101468/196

1 formularios
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
Patient Information
C1955348 (UMLS CUI-1)
Patient Number
Item
Patient No.
text
C1830427 (UMLS CUI [1])
Date of Visit
Item
Date of Visit
date
C1320303 (UMLS CUI [1])
Item Group
End of Re-Enrollment Titration Period
C1516879 (UMLS CUI-1)
C1272693 (UMLS CUI-2)
C2983683 (UMLS CUI-3)
Dosage of study drug
Item
Dose of Study Medication prescribed for Maintenance period:
float
C0178602 (UMLS CUI [1,1])
C0304229 (UMLS CUI [1,2])
End Date of Titration
Item
At which week did Titration end?
float
C2983683 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
Item Group
Investigator Signature
C2346576 (UMLS CUI-1)
Signature
Item
To be completed by the Principal Investigator: I have assumed responsibility for completeness and accurancy of all data recorded on these Titration Case Report Forms. Signature
text
C1519316 (UMLS CUI [1])
Investigator's Name
Item
To be completed by the Principal Investigator: I have assumed responsibility for completeness and accurancy of all data recorded on these Titration Case Report Forms. Print Name:
text
C2826892 (UMLS CUI [1])
Date of Report
Item
Date
date
C1302584 (UMLS CUI [1])
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