Centre Number
Item
Centre Number
text
C0600091 (UMLS CUI [1,1])
C0019994 (UMLS CUI [1,2])
Subject Number
Item
Subject Number
text
C2348585 (UMLS CUI [1])
Date
Item
Date of Comment
text
C0011008 (UMLS CUI [1,1])
C0947611 (UMLS CUI [1,2])
Page Number
Item
CRF page number if applicable
integer
C0237753 (UMLS CUI [1,1])
C1516308 (UMLS CUI [1,2])
C1515022 (UMLS CUI [1,3])
Comment
Item
Comment
text
C0947611 (UMLS CUI [1])
Item
Investigator´s Checklist (tick when done)
text
C1707357 (UMLS CUI [1])
Code List
Investigator´s Checklist (tick when done)
CL Item
Check all Adverse Event forms are up to date and complete (Check all Adverse Event forms are up to date and complete)
CL Item
Check that the Concomitant Medication form is up to date (Check that the Concomitant Medication form is up to date)
CL Item
Check that all appropriate pages are signed (thus indicating completion) and dated (Check that all appropriate pages are signed (thus indicating completion) and dated)
CL Item
Check that laboratory results are included (Check that laboratory results are included)
Investigator Signature
Item
I certify that the observations and findings are recorded correctly and completely in this CRF.
text
C2346576 (UMLS CUI [1])
Investigator Signature Date
Item
Investigator Signature Date
date
C2346576 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])