Englisch

Part 2 - Screening Visit - Urine Screen + Serology

1 Formulare  
Administrative data
Beschreibung

Administrative data

Subject Identifier
Beschreibung

Subject Identifier

Datentyp

integer

Urine Drug, Alcohol and Cotinine Screen
Beschreibung

Urine Drug, Alcohol and Cotinine Screen

Date of sample taken
Beschreibung

Date of sample taken

Datentyp

date

Time of sample taken
Beschreibung

Time of sample taken

Datentyp

time

Mark appropriate box(es)
Beschreibung

Mark appropriate box(es)

Cocaine
Beschreibung

Cocaine

Datentyp

text

Amphetamines
Beschreibung

Amphetamines

Datentyp

text

Benzodiazepines
Beschreibung

Benzodiazepines

Datentyp

text

Cannabinoids
Beschreibung

Cannabinoids

Datentyp

text

Opiates
Beschreibung

Opiates

Datentyp

text

Barbiturates
Beschreibung

Barbiturates

Datentyp

text

Alcohol
Beschreibung

Alcohol

Datentyp

text

Cotinine
Beschreibung

Cotinine

Datentyp

text

If any of the above are positive, exclude subject from the study.
Beschreibung

If any of the above are positive, exclude subject from the study.

Datentyp

text

Serology - HIV, Hepatitis B & C Screen
Beschreibung

Serology - HIV, Hepatitis B & C Screen

Date sample taken
Beschreibung

Date sample taken

Datentyp

date

HIV antibody
Beschreibung

HIV antibody

Datentyp

text

Hepatitis B surface antigen
Beschreibung

Hepatitis B surface antigen

Datentyp

text

Hepatitis C antibody
Beschreibung

Hepatitis C antibody

Datentyp

text

If any of the above are positive, exclude subject from the study.
Beschreibung

If any of the above are positive, exclude subject from the study.

Datentyp

text

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Ähnliche Modelle

Part 2 - Screening Visit - Urine Screen + Serology

1 Formulare
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Administrative data
Subject Identifier
Item
Subject Identifier
integer
Item Group
Urine Drug, Alcohol and Cotinine Screen
Date of sample taken
Item
Date of sample taken
date
Time of sample taken
Item
Time of sample taken
time
Item Group
Mark appropriate box(es)
Item
Cocaine
text
Cocaine
Code List
Cocaine
CL Item
Positive (1)
CL Item
Negative (2)
Item
Amphetamines
text
Amphetamines
Code List
Amphetamines
CL Item
Positive (1)
CL Item
Negative (2)
Item
Benzodiazepines
text
Benzodiazepines
Code List
Benzodiazepines
CL Item
Positive (1)
CL Item
Negative (2)
Item
Cannabinoids
text
Cannabinoids
Code List
Cannabinoids
CL Item
Positive (1)
CL Item
Negative (2)
Item
Opiates
text
Opiates
Code List
Opiates
CL Item
Positive (1)
CL Item
Negative (2)
Item
Barbiturates
text
Barbiturates
Code List
Barbiturates
CL Item
Positive (1)
CL Item
Negative (2)
Item
Alcohol
text
Alcohol
Code List
Alcohol
CL Item
Positive (1)
CL Item
Negative (2)
Item
Cotinine
text
Cotinine
Code List
Cotinine
CL Item
Positive (1)
CL Item
Negative (2)
If any of the above are positive, exclude subject from the study.
Item
If any of the above are positive, exclude subject from the study.
text
Item Group
Serology - HIV, Hepatitis B & C Screen
Date sample taken
Item
Date sample taken
date
Item
HIV antibody
text
HIV antibody
Code List
HIV antibody
CL Item
Positive (1)
CL Item
Negative (2)
Item
Hepatitis B surface antigen
text
Hepatitis B surface antigen
Code List
Hepatitis B surface antigen
CL Item
Positive (1)
CL Item
Negative (2)
Item
Hepatitis C antibody
text
Hepatitis C antibody
Code List
Hepatitis C antibody
CL Item
Positive (1)
CL Item
Negative (2)
If any of the above are positive, exclude subject from the study.
Item
If any of the above are positive, exclude subject from the study.
text
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