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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

Alias
UMLS CUI [1,1]
C0332158
UMLS CUI [1,2]
C0681850
Type of contact
Description

Type of contact

Data type

integer

Alias
UMLS CUI [1]
C0332158
If telephone: Time of contact
Description

Time of contact

Data type

time

Alias
UMLS CUI [1]
C0805839
If telephone: Site staff who conducted call
Description

ensure documented in source notes

Data type

text

Alias
UMLS CUI [1]
C0302186
If telephone: Reason why visit was not perfomed in the clinic
Description

Reason visit was not perfomed in clinic

Data type

text

Alias
UMLS CUI [1,1]
C0566251
UMLS CUI [1,2]
C3838685
Other, specify
Description

Reason visit was not perfomed in clinic specification

Data type

text

Alias
UMLS CUI [1,1]
C0566251
UMLS CUI [1,2]
C3838685
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Similar models

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
C0332158 (UMLS CUI [1,1])
C0681850 (UMLS CUI [1,2])
Item
Type of contact
integer
C0332158 (UMLS CUI [1])
Type of contact
Code List
Type of contact
CL Item
Clinic visit (1)
C0008952 (UMLS CUI-1)
(Comment:en)
CL Item
Telephone (2)
C1515258 (UMLS CUI-1)
(Comment:en)
Time of contact
Item
If telephone: Time of contact
time
C0805839 (UMLS CUI [1])
Item
If telephone: Site staff who conducted call
text
C0302186 (UMLS CUI [1])
Site staff who conducted call
Code List
If telephone: Site staff who conducted call
CL Item
Physician (34)
C0031831 (UMLS CUI-1)
(Comment:en)
CL Item
Nurse (35)
C0028661 (UMLS CUI-1)
(Comment:en)
CL Item
Other (OT)
C0205394 (UMLS CUI-1)
(Comment:en)
Item
If telephone: Reason why visit was not perfomed in the clinic
text
C0566251 (UMLS CUI [1,1])
C3838685 (UMLS CUI [1,2])
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)
C1705116 (UMLS CUI-1)
(Comment:en)
CL Item
Subject not able to visit clinic (2)
C3838685 (UMLS CUI-1)
C0545082 (UMLS CUI-2)
(Comment:en)
CL Item
Other (OT)
(Comment:en)
Reason visit was not perfomed in clinic specification
Item
Other, specify
text
C0566251 (UMLS CUI [1,1])
C3838685 (UMLS CUI [1,2])
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