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Part 2: Treatment Period 1 - Physical Examination Form

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Administrative data
Beschrijving

Administrative data

Subject Identifier
Beschrijving

Subject Identifier

Datatype

integer

Physical Examination - Part 2 - Day 1
Beschrijving

Physical Examination - Part 2 - Day 1

Indicate current physical findings by ticking the appropriate box(es) below
Beschrijving

if ABNORMAL, describe concisely: [different findings should be separated by either a (;) or (/)].

Datatype

text

Date of Assessment
Beschrijving

Date of Assessment

Datatype

date

Hair and Skin
Beschrijving

Hair and Skin

Datatype

text

Lymph nodes
Beschrijving

Lymph nodes

Datatype

text

Eyes
Beschrijving

Eyes

Datatype

text

Ears, Nose, and Throat
Beschrijving

Ears, Nose, and Throat

Datatype

text

Breasts
Beschrijving

Breasts

Datatype

text

Respiratory
Beschrijving

Respiratory

Datatype

text

Cardiovascular
Beschrijving

Cardiovascular

Datatype

text

Abdomen
Beschrijving

Abdomen

Datatype

text

Urogenital
Beschrijving

Urogenital

Datatype

text

Pelvic
Beschrijving

Pelvic

Datatype

text

Rectal
Beschrijving

Rectal

Datatype

text

Musculoskeletal
Beschrijving

Musculoskeletal

Datatype

text

Neurological
Beschrijving

Neurological

Datatype

text

Mental Status
Beschrijving

Mental Status

Datatype

text

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Similar models

Part 2: Treatment Period 1 - Physical Examination Form

1 Formulieren
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Administrative data
Subject Identifier
Item
Subject Identifier
integer
Item Group
Physical Examination - Part 2 - Day 1
Indicate current physical findings by ticking the appropriate box(es) below
Item
Indicate current physical findings by ticking the appropriate box(es) below
text
Date of Assessment
Item
Date of Assessment
date
Item
Hair and Skin
text
Hair and Skin
Code List
Hair and Skin
CL Item
Normal (Normal)
CL Item
Abnormal (Abnormal)
Item
Lymph nodes
text
Lymph nodes
Code List
Lymph nodes
CL Item
Normal (Normal)
CL Item
Abnormal (Abnormal)
Item
Eyes
text
Eyes
Code List
Eyes
CL Item
Normal (Normal)
CL Item
Abnormal (Abnormal)
Item
Ears, Nose, and Throat
text
Ears, Nose, and Throat
Code List
Ears, Nose, and Throat
CL Item
Normal (Normal)
CL Item
Abnormal (Abnormal)
Item
Breasts
text
Breasts
Code List
Breasts
CL Item
Normal (Normal)
CL Item
Abnormal (Abnormal)
CL Item
Not Done (Not Done)
Item
Respiratory
text
Respiratory
Code List
Respiratory
CL Item
Normal (Normal)
CL Item
Abnormal (Abnormal)
Item
Cardiovascular
text
Cardiovascular
Code List
Cardiovascular
CL Item
Normal (Normal)
CL Item
Abnormal (Abnormal)
Item
Abdomen
text
Abdomen
Code List
Abdomen
CL Item
Normal (Normal)
CL Item
Abnormal (Abnormal)
Item
Urogenital
text
Urogenital
Code List
Urogenital
CL Item
Normal (Normal)
CL Item
Abnormal (Abnormal)
CL Item
Not Done (Not Done)
Item
Pelvic
text
Pelvic
Code List
Pelvic
CL Item
Normal (Normal)
CL Item
Abnormal (Abnormal)
CL Item
Not Done (Not Done)
Item
Rectal
text
Rectal
Code List
Rectal
CL Item
Normal (Normal)
CL Item
Abnormal (Abnormal)
CL Item
Not Done (Not Done)
Item
Musculoskeletal
text
Musculoskeletal
Code List
Musculoskeletal
CL Item
Normal (Normal)
CL Item
Abnormal (Abnormal)
Item
Neurological
text
Neurological
Code List
Neurological
CL Item
Normal (Normal)
CL Item
Abnormal (Abnormal)
Item
Mental Status
text
Mental Status
Code List
Mental Status
CL Item
Normal (Normal)
CL Item
Abnormal (Abnormal)
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