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End of study contact GSK study Chronic Coronary Heart Disease NCT00799903

1 forms  
End of study contact form
Description

End of study contact form

1. Was subject contacted?
Description

Please select No if continued attempts to contact subject have failed and 3 month EOS period had come to an end. If contact only made with Third party designee instead of subject please complete a THIRD PARTY form.

Data type

boolean

Type of contact
Description

Type of contact

Data type

integer

If telephone: Time of contact
Description

Time of contact

Data type

time

If telephone: Site staff who conducted call
Description

ensure documented in source notes

Data type

text

If telephone: Reason why visit was not perfomed in the clinic
Description

Reason visit was not perfomed in clinic

Data type

text

Other, specify
Description

Reason visit was not perfomed in clinic specification

Data type

text

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End of study contact GSK study Chronic Coronary Heart Disease NCT00799903

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
End of study contact form
subject contact
Item
1. Was subject contacted?
boolean
Item
Type of contact
integer
Type of contact
Code List
Type of contact
CL Item
Clinic visit (1)
CL Item
Telephone (2)
Time of contact
Item
If telephone: Time of contact
time
Item
If telephone: Site staff who conducted call
text
Site staff who conducted call
Code List
If telephone: Site staff who conducted call
CL Item
Physician (34)
CL Item
Nurse (35)
CL Item
Other (OT)
Item
If telephone: Reason why visit was not perfomed in the clinic
text
Reason visit was not perfomed in clinic
Code List
If telephone: Reason why visit was not perfomed in the clinic
CL Item
Subject refused (1)
CL Item
Subject not able to visit clinic (2)
CL Item
Other (OT)
Reason visit was not perfomed in clinic specification
Item
Other, specify
text
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