ID

26477

Description

Study ID: 101468/190 Clinical Study ID: SKF-101468/190 Study Title:A 12 Week, Double-Blind, Placebo-Controlled, Parallel Group Study to Assess the Efficacy and Safety of Ropinirole in Patients Suffering from Restless Legs Syndrome (RLS). Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: Sponsor: GlaxoSmithKline Collaborators: N/A Phase: phase 3 Study Recruitment Status: Completed Generic Name: ropinirole Trade Name: Requip Study Indication: Restless Legs Syndrome This is the Patient enrollment form.

Keywords

Versions (2)
  1. 10/4/17 10/4/17 -
  2. 10/18/17 10/18/17 -
Copyright Holder

GlaxoSmithKline

Uploaded on

October 18, 2017

DOI

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License

Creative Commons BY-NC 3.0
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Patient enrollment form GSK Ropinirole in Patients Suffering from Restless Legs Syndrome 101468/190

English

Patient enrollment form GSK Ropinirole in Patients Suffering from Restless Legs Syndrome 101468/190

1 forms  
Patient enrollment
Description

Patient enrollment

Alias
UMLS CUI-1
C1516879
sponsor study contact
Description

sponsor study contact

Data type

text

Alias
UMLS CUI [1]
C4288370
sponsor study contact fax
Description

sponsor study contact fax

Data type

text

Alias
UMLS CUI [1,1]
C4288370
UMLS CUI [1,2]
C1549619
enroled in study:
Description

enroled in study:

Data type

integer

Alias
UMLS CUI [1]
C1516879
Patient Initials
Description

Patient Initials

Data type

text

Alias
UMLS CUI [1]
C2986440
Patient Number
Description

Patient Number

Data type

text

Alias
UMLS CUI [1]
C1830427
Centre Number
Description

Centre Number

Data type

text

Alias
UMLS CUI [1,1]
C0600091
UMLS CUI [1,2]
C0019994
Date of enrollment
Description

Date of enrollment

Data type

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0679646
UMLS CUI [1,3]
C1516879
Signed:
Description

Signed

Data type

text

Alias
UMLS CUI [1]
C1519316
Signed Date
Description

Signed Date

Data type

date

Alias
UMLS CUI [1,1]
C1519316
UMLS CUI [1,2]
C0011008
Institution
Description

Institution

Data type

text

Alias
UMLS CUI [1]
C1301943
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Similar models

Patient enrollment form GSK Ropinirole in Patients Suffering from Restless Legs Syndrome 101468/190

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Patient enrollment
C1516879 (UMLS CUI-1)
sponsor study contact
Item
sponsor study contact
text
C4288370 (UMLS CUI [1])
sponsor study contact fax
Item
sponsor study contact fax
text
C4288370 (UMLS CUI [1,1])
C1549619 (UMLS CUI [1,2])
enroled in study:
Item
enroled in study:
integer
C1516879 (UMLS CUI [1])
Patient Initials
Item
Patient Initials
text
C2986440 (UMLS CUI [1])
Patient Number
Item
Patient Number
text
C1830427 (UMLS CUI [1])
Centre Number
Item
Centre Number
text
C0600091 (UMLS CUI [1,1])
C0019994 (UMLS CUI [1,2])
Date of enrollment
Item
Date of enrollment
date
C0011008 (UMLS CUI [1,1])
C0679646 (UMLS CUI [1,2])
C1516879 (UMLS CUI [1,3])
Signed
Item
Signed:
text
C1519316 (UMLS CUI [1])
Signed Date
Item
Signed Date
date
C1519316 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Institution
Item
Institution
text
C1301943 (UMLS CUI [1])
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