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L-dopa controlled study of ropinirole, neuroprotective effect and ophthalmological safety in early Parkinson’s disease 101468/125 Module 1 Patient Continuation / Withdrawal

1 moduli  
Patient continuation / withdrawal
Descrizione

Patient continuation / withdrawal

Is the patient continuing in the study?
Descrizione

Is the patient continuing in the study?

Tipo di dati

integer

Reason for withdrawal
Descrizione

Reason for withdrawal

Tipo di dati

integer

If other reason for withdrawal, please specify
Descrizione

Specification of other reason for withdrawal

Tipo di dati

text

Date of last dose
Descrizione

Date of last dose

Tipo di dati

date

Investigator´s signature
Descrizione

I certify that I have reviewed the data in this module and that all the information is complete and accurate.

Tipo di dati

text

Date
Descrizione

Date

Tipo di dati

date

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L-dopa controlled study of ropinirole, neuroprotective effect and ophthalmological safety in early Parkinson’s disease 101468/125 Module 1 Patient Continuation / Withdrawal

1 moduli
Name
genere
Description | Question | Decode (Coded Value)
Tipo di dati
Alias
Item Group
Patient continuation / withdrawal
Item
Is the patient continuing in the study?
integer
Is the patient continuing in the study?
Code List
Is the patient continuing in the study?
CL Item
Yes (1)
CL Item
No (If "No" mark the one most appropriate reason below, and record the date the patient last took the study medication) (2)
Item
Reason for withdrawal
integer
Reason for withdrawal
Code List
Reason for withdrawal
CL Item
Adverse experience (complete Adverse Experience section) (1)
CL Item
Lack of Efficacy  (2)
CL Item
Deviation from protocol (including non-compliance/protocol violation) (3)
CL Item
Lost to follow-up (4)
CL Item
Other (please specify below) (5)
Specification of other reason for withdrawal
Item
If other reason for withdrawal, please specify
text
Date of last dose
Item
Date of last dose
date
Investigator´s signature
Item
Investigator´s signature
text
Date
Item
Date
date
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