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1 Formulär  
  1. StudyEvent: Concomitant Medications Excluding Antiretroviral Therapy - RF09
    1. No Instruction available.
Ccrr Module For Concomitant Medications Excluding Antiretroviral Therapy - Rf09
Beskrivning

Ccrr Module For Concomitant Medications Excluding Antiretroviral Therapy - Rf09

Patient Initials
Beskrivning

PatientInitials

Datatyp

text

Study#
Beskrivning

Study#

Datatyp

text

Site#
Beskrivning

Site#

Datatyp

text

ID#
Beskrivning

ID#

Datatyp

text

Cycle #
Beskrivning

Cycle#

Datatyp

text

First day of cycle
Beskrivning

Firstdayofcycle

Datatyp

text

During this cycle, has the subject started or stopped any medications?
Beskrivning

Duringthiscycle,hasthesubjectstartedorstoppedanymedications?

Datatyp

text

Medication (Generic Name Only)
Beskrivning

Medication(GenericNameOnly)

Datatyp

text

ACTG Drug Code
Beskrivning

ACTGDrugCode

Datatyp

text

Amount
Beskrivning

Amount

Datatyp

text

Units
Beskrivning

Units

Datatyp

text

Frequency (per day)
Beskrivning

Frequency(perday)

Datatyp

text

Started prior to study?
Beskrivning

Startedpriortostudy?

Datatyp

text

Date Started
Beskrivning

DateStarted

Datatyp

text

Stopped?
Beskrivning

Stopped?

Datatyp

text

Date Stopped
Beskrivning

DateStopped

Datatyp

text

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Similar models

No Instruction available.

1 Formulär
  1. StudyEvent: Concomitant Medications Excluding Antiretroviral Therapy - RF09
    1. No Instruction available.
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
Ccrr Module For Concomitant Medications Excluding Antiretroviral Therapy - Rf09
PatientInitials
Item
Patient Initials
text
Study#
Item
Study#
text
Site#
Item
Site#
text
ID#
Item
ID#
text
Cycle#
Item
Cycle #
text
Firstdayofcycle
Item
First day of cycle
text
Item
During this cycle, has the subject started or stopped any medications?
text
CL.1
Code List
During this cycle, has the subject started or stopped any medications?
CL Item
Yes (Yes)
CL Item
No (No)
Medication(GenericNameOnly)
Item
Medication (Generic Name Only)
text
ACTGDrugCode
Item
ACTG Drug Code
text
Amount
Item
Amount
text
Units
Item
Units
text
Frequency(perday)
Item
Frequency (per day)
text
Item
Started prior to study?
text
CL.2
Code List
Started prior to study?
CL Item
Yes (Yes)
CL Item
No (No)
DateStarted
Item
Date Started
text
Item
Stopped?
text
CL.3
Code List
Stopped?
CL Item
Yes (Yes)
CL Item
No (No)
DateStopped
Item
Date Stopped
text
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