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Concomitant Medication Ropinirole in Parkinson's Disease GSK 101468/196

1 forms  
Patient Information
Description

Patient Information

Alias
UMLS CUI-1
C1955348
Patient No.
Description

Patient Number

Data type

text

Alias
UMLS CUI [1]
C1830427
Other (Non-Study) Medications
Description

Other (Non-Study) Medications

Alias
UMLS CUI-1
C2347852
Has the patient taken any concomitant medication(s) (other than study drug) from the Re-Enrollment Screening Visit through the end of the Treatment Period? This CRF will only be used by subjects who have re-enrolled in the study after completion at 36 months.
Description

Concomitant Medication

Data type

boolean

Alias
UMLS CUI [1]
C2347852
Medication (Use Generic Name)
Description

Medication Name

Data type

text

Alias
UMLS CUI [1]
C2360065
Date started
Description

Start Date

Data type

date

Measurement units
  • dd-mmm-yyyy
Alias
UMLS CUI [1]
C0808070
dd-mmm-yyyy
Date stopped
Description

End Date

Data type

date

Measurement units
  • dd-mmm-yyyy
Alias
UMLS CUI [1]
C0806020
dd-mmm-yyyy
Continuing
Description

Ongoing Medication

Data type

boolean

Alias
UMLS CUI [1]
C2826666
Dose (e.g. 10 mg)
Description

Dosage

Data type

text

Alias
UMLS CUI [1]
C0178602
Frequency (e.g. tid)
Description

Medication Frequency

Data type

text

Alias
UMLS CUI [1]
C3476109
Route
Description

Administration Route

Data type

text

Route: If Other, Specify:
Description

Administration Route: Specification

Data type

text

Alias
UMLS CUI [1,1]
C0013153
UMLS CUI [1,2]
C2348235
Indication
Description

Indication

Data type

text

Alias
UMLS CUI [1]
C3146298
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Similar models

Concomitant Medication Ropinirole in Parkinson's Disease GSK 101468/196

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Patient Information
C1955348 (UMLS CUI-1)
Patient Number
Item
Patient No.
text
C1830427 (UMLS CUI [1])
Item Group
Other (Non-Study) Medications
C2347852 (UMLS CUI-1)
Concomitant Medication
Item
Has the patient taken any concomitant medication(s) (other than study drug) from the Re-Enrollment Screening Visit through the end of the Treatment Period? This CRF will only be used by subjects who have re-enrolled in the study after completion at 36 months.
boolean
C2347852 (UMLS CUI [1])
Medication Name
Item
Medication (Use Generic Name)
text
C2360065 (UMLS CUI [1])
Start Date
Item
Date started
date
C0808070 (UMLS CUI [1])
End Date
Item
Date stopped
date
C0806020 (UMLS CUI [1])
Ongoing Medication
Item
Continuing
boolean
C2826666 (UMLS CUI [1])
Dosage
Item
Dose (e.g. 10 mg)
text
C0178602 (UMLS CUI [1])
Medication Frequency
Item
Frequency (e.g. tid)
text
C3476109 (UMLS CUI [1])
Item
Route
text
Administration Route
Code List
Route
CL Item
IV (IV)
CL Item
IM (IM)
CL Item
PO (PO)
CL Item
SC (SC)
CL Item
PR (PR)
CL Item
Sublingual (Sublingual)
CL Item
Inhaled (Inhaled)
CL Item
Topical (Topical)
CL Item
Other (Other)
Item
Route: If Other, Specify:
text
C0013153 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
Administration Route
Code List
Route: If Other, Specify:
Indication
Item
Indication
text
C3146298 (UMLS CUI [1])
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