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SAE Additional/Follow-Up Information

1 moduli  
Administrative data
Descrizione

Administrative data

Subject Identifier
Descrizione

Subject Identifier

Tipo di dati

integer

Centre Number
Descrizione

Centre Number

Tipo di dati

integer

Randomisation Number
Descrizione

Randomisation Number

Tipo di dati

integer

Section 12 SAE Additional/Follow-Up Information
Descrizione

Section 12 SAE Additional/Follow-Up Information

Use this page to provide any additional details on the SAE not already captured on the previous pages
Descrizione

Use this page to provide any additional details on the SAE not already captured on the previous pages

Tipo di dati

text

Investigator's signature
Descrizione

confirming that the data on this page is accurate and complete

Tipo di dati

text

Investigator's name (print)
Descrizione

Investigator's name (print)

Tipo di dati

text

Date
Descrizione

Date

Tipo di dati

date

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Similar models

SAE Additional/Follow-Up Information

1 moduli
Name
genere
Description | Question | Decode (Coded Value)
Tipo di dati
Alias
Item Group
Administrative data
Subject Identifier
Item
Subject Identifier
integer
Centre Number
Item
Centre Number
integer
Randomisation Number
Item
Randomisation Number
integer
Item Group
Section 12 SAE Additional/Follow-Up Information
Use this page to provide any additional details on the SAE not already captured on the previous pages
Item
Use this page to provide any additional details on the SAE not already captured on the previous pages
text
Investigator's signature
Item
Investigator's signature
text
Investigator's name (print)
Item
Investigator's name (print)
text
Date
Item
Date
date
Ritorna all'inizio della pagina