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Ropinirole Case Report Form GSK RRL100013

9 forms  
Administrative documentation
Description

Administrative documentation

Alias
UMLS CUI-1
C1320722
STUDY NO.
Description

Study Identifier

Data type

text

Alias
UMLS CUI [1]
C2826693
Subject No.:
Description

Subject No.

Data type

text

Alias
UMLS CUI [1]
C2348585
Panel ID:
Description

Panel ID

Data type

integer

Alias
UMLS CUI [1]
C0086373
Visit:
Description

Visit

Data type

integer

Alias
UMLS CUI [1]
C1549755
Date:
Description

DD/MON/YY

Data type

date

Alias
UMLS CUI [1]
C0011008
Other medication
Description

Other medication

Has the subject taken any prescribed medication within 14 days prior to first dosing day or any OTC medicine within 7 days before the first study day?
Description

If 'YES', please record the medications below.

Data type

boolean

Alias
UMLS CUI [1]
C3166216
UMLS CUI [2]
C0013231
Prior Medication
Description

Prior Medication

Alias
UMLS CUI-1
C2826257
DRUG NAME
Description

(Trade Name Preferred)

Data type

text

Alias
UMLS CUI [1]
C2360065
Single Dose/Unit
Description

(e.g.500 mg)

Data type

integer

Alias
UMLS CUI [1]
C1960417
Frequency of this Dose (e.g.BID, PR)
Description

Frequency of this Dose

Data type

integer

Alias
UMLS CUI [1]
C3476109
Route
Description

Route

Data type

text

Alias
UMLS CUI [1]
C0013153
Indication
Description

Indication

Data type

text

Alias
UMLS CUI [1,1]
C3146298
UMLS CUI [1,2]
C0013227
Duration of therapy
Description

(e.g.6 years)

Data type

integer

Alias
UMLS CUI [1]
C0444917
End Date
Description

Day/Month/Year

Data type

date

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0806020
Continuing at end of study?
Description

Continuing at end of study

Data type

boolean

Alias
UMLS CUI [1]
C1562611
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Similar models

Ropinirole Case Report Form GSK RRL100013

9 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Administrative documentation
C1320722 (UMLS CUI-1)
Study Identifier
Item
STUDY NO.
text
C2826693 (UMLS CUI [1])
Subject No.
Item
Subject No.:
text
C2348585 (UMLS CUI [1])
Panel ID
Item
Panel ID:
integer
C0086373 (UMLS CUI [1])
Visit
Item
Visit:
integer
C1549755 (UMLS CUI [1])
Date
Item
Date:
date
C0011008 (UMLS CUI [1])
Item Group
Other medication
Prescribed or OTC medication
Item
Has the subject taken any prescribed medication within 14 days prior to first dosing day or any OTC medicine within 7 days before the first study day?
boolean
C3166216 (UMLS CUI [1])
C0013231 (UMLS CUI [2])
Item Group
Prior Medication
C2826257 (UMLS CUI-1)
DRUG NAME
Item
DRUG NAME
text
C2360065 (UMLS CUI [1])
Single Dose/Unit
Item
Single Dose/Unit
integer
C1960417 (UMLS CUI [1])
Frequency of this Dose
Item
Frequency of this Dose (e.g.BID, PR)
integer
C3476109 (UMLS CUI [1])
Route
Item
Route
text
C0013153 (UMLS CUI [1])
Indication
Item
Indication
text
C3146298 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
Duration of therapy
Item
Duration of therapy
integer
C0444917 (UMLS CUI [1])
End Date
Item
End Date
date
C0013227 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
Continuing at end of study
Item
Continuing at end of study?
boolean
C1562611 (UMLS CUI [1])
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