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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.

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

GlaxoSmithKline

Uploaded on

October 18, 2017

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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
    Back to the top of the page

    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])
    Back to the top of the page 

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