Vital signs
Height
integer
Weight
float
Body mass index
float
Of Examination
date
Of Examination
text
of Examination
time
Systolic Blood pressure
integer
Diastolic Blood pressure
integer
Subject Position
integer
Heart rate
integer
Medical conditions
Physical examination
physical examination
boolean
physical examination finding
boolean
Physical examination abnormal
text
Laboratory Result Data Haematology
Date sample taken
date
Time sample taken
time
fasting
boolean
haemoglobin
float
haematocrit
float
red blood cell
float
WBC
float
platelet count
float
Differential WBC count
float
Mean cell haemoglobin (MCH)
float
Mean cell haemoglobin concentration (MCHC)
float
Laboratory Result Data Clinical Chemistry
Date sample taken
date
Time sample taken
time
fasting
boolean
Sodium
float
Potassium
float
Urea
float
Creatinine
float
Total Protein
float
Albumin
float
Albumin/globulin ratio
float
Total bilirubin
float
AST (SGOT)
float
ALT (SGPT)
float
Alkaline phosphatase
float
Alkaline phosphatase (AP)
float
Gamma glutamyl transferase (GGT)
float
Calcium
float
Phosphate
float
Cholesterol
float
Triglycerides
float
Glucose
float
Creatine phosphokinase
float
Iron
float
Total Iron Binding Capacity
float
Ferritin
float
Transferrin
float
Chloride
float
(females only)
float
Urinalysis, Dipstick Test
Urine sample date
date
Urine sample time
time
Result of dipstick
integer
Urine Dipstick: Proteins
integer
Urine Dipstick: Glucose
integer
Urine Dipstick: pH
integer
Urine Dipstick: Bilirubin
integer
Urine Dipstick: Blood
integer
Urine Dipstick: Specific gravity
integer
sedimentary microscopy
boolean
casts
text
Cells
text
Serology
Date blood sample taken
date
HIV antibodies
text
Hepatitis B surface antigen
text
Hepatitis C screening
text
Drug Screen
Date urine sample taken
date
Time sample taken
time
Cocaine
text
Amphetamines
text
Benzodiazepines
text
Cannabis
text
Opiates
text
Barbiturates
text
Tricyclic antidepressants
text
Morphine
text
Morphine Derivatives
text
Alcohol Breath Test
Pregnancy test
12-lead ECG
Start Date of ECG
date
Planned Relative Time ECG
text
Start Time of ECG
time
Ventricular Rate
integer
PR Interval
float
QRS Duration
float
Uncorrected QT Interval
float
QTc Interval
float
Result of the ECG
integer
ECG Abnormalities
Start Date of ECG
date
Start Time of ECG
time
Record clinically significant abnormalities below. Check all that apply:
integer
Rhythm Abnormalities
text
Record clinically significant abnormalities below. Check all that apply:
integer
P-Wave and QRS Morphology Abnormalities
text
Conduction Abnormalities
integer
Conduction Abnormalities
text
Myocardial Infarction
integer
Myocardial Infarction
text
Repolarisation Abnormalities
integer
Repolarisation Abnormalities
text
Other ECG Abnormalities
boolean
Other ECG Abnormalities
text
Eligibility Question
entry criteria
boolean
Check the boxes corresponding to any of the inclusion criteria the subject failed.
integer
Check the boxes corresponding to any of the exclusion criteria that disqualified the subject from entry.
integer