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End of study Telephone contact GSK study Chronic Coronary Heart Disease NCT00799903

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End of study contact form
Beschrijving

End of study contact form

1. Was subject contacted?
Beschrijving

subject contact

Datatype

boolean

Type of contact
Beschrijving

Type of contact

Datatype

integer

If telephone: Time of contact
Beschrijving

Time of contact

Datatype

time

If telephone: Site staff who conducted call
Beschrijving

ensure documented in source notes

Datatype

text

If telephone: Reason why visit was not perfomed in the clinic
Beschrijving

Reason visit was not perfomed in clinic

Datatype

text

Other, specify
Beschrijving

Reason visit was not perfomed in clinic specification

Datatype

text

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Similar models

End of study Telephone contact GSK study Chronic Coronary Heart Disease NCT00799903

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Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
End of study contact form
subject contact
Item
1. Was subject contacted?
boolean
Item
Type of contact
integer
Type of contact
Code List
Type of contact
CL Item
Clinic visit (1)
CL Item
Telephone (2)
Time of contact
Item
If telephone: Time of contact
time
Item
If telephone: Site staff who conducted call
text
Site staff who conducted call
Code List
If telephone: Site staff who conducted call
CL Item
Physician (34)
CL Item
Nurse (35)
CL Item
Other (OT)
Item
If telephone: Reason why visit was not perfomed in the clinic
text
Reason visit was not perfomed in clinic
Code List
If telephone: Reason why visit was not perfomed in the clinic
CL Item
Subject refused (1)
CL Item
Subject not able to visit clinic (2)
CL Item
Other (OT)
Reason visit was not perfomed in clinic specification
Item
Other, specify
text
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