Patient number
Item
Patient number
integer
C1830427 (UMLS CUI [1])
Center Number
Item
Center Number
integer
C1301943 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
Medical Procedures
Item
Have any non-medication, therapeutic, diagnostic or surgical procedures been performed since the start of this study?
boolean
C0199171 (UMLS CUI [1])
C0087111 (UMLS CUI [2])
C0430022 (UMLS CUI [3])
C0543467 (UMLS CUI [4])
Procedure
Item
Procedure
text
C0199171 (UMLS CUI [1])
Indication
Item
Indication
text
C3146298 (UMLS CUI [1])
Start Date
Item
Procedure start date
date
C0808070 (UMLS CUI [1])
End Date
Item
Procedure end date
date
C0806020 (UMLS CUI [1])
Concomitant medication
Item
Mark box below or complete page with concomitant medication details (Please print clearly).
boolean
C2347852 (UMLS CUI [1])
Drug Name
Item
Drug Name (Trade Name Preferred)
text
C0013227 (UMLS CUI [1])
Total Daily Dose
Item
Total Daily Dose (eg 500mg)
integer
C2348070 (UMLS CUI [1])
Medical Illness/Diagnosis
Item
Medical Illness/Diagnosis (or symptom in absence of diagnosis)
text
C0011900 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
C3146298 (UMLS CUI [1,3])
Start Date
Item
Start Date (be as precise as possible)
date
C0013227 (UMLS CUI [1,1])
C0808070 (UMLS CUI [1,2])
End Date
Item
End Date (or if Continuing mark box)
integer
C0013227 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
Continuous medication
Item
If Continuing mark box
boolean
C0013227 (UMLS CUI [1,1])
C0549178 (UMLS CUI [1,2])