Supportive Therapy Transfusion
If Yes to Supportive Therapy (Including Erythropoietin)
Type of transfusions
text
Transfusions (Number of Units)
text
Erythropoietin Dose
float
Date
date
Supportive Anti-Infective Therapy
If Yes to Supportive Anti-Infective Therapy
If a treatment is recorded here, do not record on the Concomitant Medication section.
text
Total Daily Dose
text
For Route, see general instructions for acceptable abbreviations.
text
Where appropriate, medical conditions should be recorded in the Adverse Experiences section, utilizing the same terminology.
text
Record PM for anti-infectives administered prophylactically, EM for anti-infectives used for symptomatic treatment, and TX for anti-infectives administered for a confirmed infection in the column provided.
text
Start Date
date
End Date
date
If Continuing to Medication
boolean
Concominant Medication
Record all concomitant medication taken during this course. Record PM for prophylactic treatment with Medical Condition for prophylactically administered medications. If a medication was marked 'Continuing' at the initial visit, it must be recorded below. Where appropriate, medical conditions should be recorded on the Adverse Experience Form, utilizing the same terminology
text
Total Daily Dose
text
For Route, see General Instructions for acceptable abbreviations
text
Medical Condition
text
Start Date
date
End Date
date
If Continung to Medication
boolean