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L-dopa controlled study of ropinirole, neuroprotective effect and ophthalmological safety in early Parkinson’s disease 101468/125 Module 1 Visit 3 Week 2 (optional visit)

1 forms  
Vital signs
Description

Vital signs

Sitting blood pressure (systolic)
Description

Sitting blood pressure (systolic)

Data type

integer

Measurement units
  • mmHg
mmHg
Sitting blood pressure (diastolic)
Description

Sitting blood pressure (diastolic)

Data type

integer

Measurement units
  • mmHg
mmHg
Sitting Heart Rate
Description

Sitting Heart Rate

Data type

integer

Measurement units
  • beats/min
beats/min
Concomitant medication
Description

Concomitant medication

Concomitant medication
Description

Record any change in the patient´s concomitant medication since the last visit in the Concomitant Medication section towards the back of this module.

Data type

text

Adverse Experiences
Description

Adverse Experiences

Adverse Experiences
Description

Have there been any adverse experiences observed or elicited by the following direct question to the patient: "Have you felt different in any way since your last visit"? Transcribe any ongoing Baseline Adverse Experiences recorded on page 10, record any changes to ongoing Baseline Adverse Experiences section towards the back of this module.

Data type

text

Study Medication Compliance
Description

Study Medication Compliance

Record the date on which the patient started to take study medication in the space provided at the top of page 18. Has the patient been compliant with study medication? (Compliance is defined as taking between approximately 80%-120% of medication)
Description

Study Medication Compliance

Data type

boolean

Patient continuation
Description

Patient continuation

Remind the patient of the date and time of their next visit.
Description

Patients continuing

Data type

boolean

Complete the Patient Continuation/Withdrawal section at the back of this module.
Description

Patients withdrawing

Data type

boolean

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Similar models

L-dopa controlled study of ropinirole, neuroprotective effect and ophthalmological safety in early Parkinson’s disease 101468/125 Module 1 Visit 3 Week 2 (optional visit)

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Vital signs
Sitting blood pressure (systolic)
Item
Sitting blood pressure (systolic)
integer
Sitting blood pressure (diastolic)
Item
Sitting blood pressure (diastolic)
integer
Sitting Heart Rate
Item
Sitting Heart Rate
integer
Item Group
Concomitant medication
Concomitant medication
Item
Concomitant medication
text
Item Group
Adverse Experiences
Adverse Experiences
Item
text
Item Group
Study Medication Compliance
Study Medication Compliance
Item
Record the date on which the patient started to take study medication in the space provided at the top of page 18. Has the patient been compliant with study medication? (Compliance is defined as taking between approximately 80%-120% of medication)
boolean
Item Group
Patient continuation
Patients continuing
Item
Remind the patient of the date and time of their next visit.
boolean
Patients withdrawing
Item
Complete the Patient Continuation/Withdrawal section at the back of this module.
boolean
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