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Study conclusion

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  1. StudyEvent: ODM
    1. Study conclusion
Study conclusion
Beschrijving

Study conclusion

Date of last contact
Beschrijving

Date of last contact

Datatype

date

Was the subject withdrawn from the study?
Beschrijving

Was the subject withdrawn from the study?

Datatype

text

if "Yes" choose one primary reason for withdrawal:
Beschrijving

if "Yes" choose one primary reason for withdrawal:

Datatype

text

Date of decision to withdraw
Beschrijving

Date of decision to withdraw

Datatype

date

Investigator comment log
Beschrijving

Investigator comment log

Only use this form to record explanatory information on anomalies such as missing data, departures from planned investigational product administration or missed visits.
Beschrijving

Only use this form to record explanatory information on anomalies such as missing data, departures from planned investigational product administration or missed visits.

Datatype

text

CRF page number
Beschrijving

if applicable

Datatype

integer

Comment
Beschrijving

Comment

Datatype

text

Investigator's signature
Beschrijving

Investigator's signature

Investigator's signature
Beschrijving

I confirm that I have reviewed the data in this Case Report Form for this subject. All information entered by myself or my colleagues is, to the best of my knowledge, complete and accurate, as of the date below

Datatype

text

Investigator's name
Beschrijving

Print

Datatype

text

Date
Beschrijving

Date

Datatype

date

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Similar models

Study conclusion

1 Formulieren
  1. StudyEvent: ODM
    1. Study conclusion
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Study conclusion
Date of last contact
Item
Date of last contact
date
Item
Was the subject withdrawn from the study?
text
Was the subject withdrawn from the study?
Code List
Was the subject withdrawn from the study?
CL Item
Yes (1)
CL Item
No (2)
Item
if "Yes" choose one primary reason for withdrawal:
text
if "Yes" choose one primary reason for withdrawal:
Code List
if "Yes" choose one primary reason for withdrawal:
CL Item
[1] Adverse event -> Record retails on the Non-Serious Adverse Events or Serious Adverse Events pages as appropriate (1)
CL Item
[3] Protocol deviation (2)
CL Item
[5] Study closed/terminated (3)
CL Item
[6] Lost to follow-up (4)
CL Item
[8] Withdrew consent (Only choose when none of the primary reasons are appropriate) (5)
Date of decision to withdraw
Item
Date of decision to withdraw
date
Item Group
Investigator comment log
Only use this form to record explanatory information on anomalies such as missing data, departures from planned investigational product administration or missed visits.
Item
Only use this form to record explanatory information on anomalies such as missing data, departures from planned investigational product administration or missed visits.
text
CRF page number
Item
CRF page number
integer
Comment
Item
Comment
text
Item Group
Investigator's signature
Investigator's signature
Item
Investigator's signature
text
Investigator's name
Item
Investigator's name
text
Date
Item
Date
date
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