Inglés

Concomitant Medication Form

1 formularios  
Administrative data
Descripción

Administrative data

Subject Identifier
Descripción

Subject Identifier

Tipo de datos

integer

Were any concomitant medications taken by the subject prior to screening and/or during the study?
Descripción

If YES, record each medication on a separate line using Trade Names where possible. If the medication is related to a Non-Serious Adverse Event or Serious Adverse Event, details should be expressed using the same terminology.

Tipo de datos

boolean

Concomitant Medications
Descripción

Concomitant Medications

Drug Name
Descripción

Trade name preferred e.g., Aspirin

Tipo de datos

integer

Unit Dose
Descripción

Unit Dose

Tipo de datos

integer

Units
Descripción

Units

Tipo de datos

text

Unidades de medida
  • Units
Units
Frequency
Descripción

Frequency

Tipo de datos

text

Route
Descripción

Route

Tipo de datos

text

Reason for Medication
Descripción

e.g., Headache

Tipo de datos

text

Start Date
Descripción

Start Date

Tipo de datos

date

Start Time
Descripción

Start Time

Tipo de datos

time

Taken prior to study
Descripción

Taken prior to study

Tipo de datos

boolean

Stop Date
Descripción

Stop Date

Tipo de datos

date

Stop Time
Descripción

Stop Time

Tipo de datos

time

Ongoing medication?
Descripción

Ongoing medication?

Tipo de datos

boolean

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Similar models

Concomitant Medication Form

1 formularios
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
Administrative data
Subject Identifier
Item
Subject Identifier
integer
Were any concomitant medications taken by the subject prior to screening and/or during the study?
Item
Were any concomitant medications taken by the subject prior to screening and/or during the study?
boolean
Item Group
Concomitant Medications
Item
Drug Name
integer
Drug Name
Code List
Drug Name
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
Unit Dose
Item
Unit Dose
integer
Units
Item
text
Frequency
Item
Frequency
text
Route
Item
Route
text
Reason for Medication
Item
Reason for Medication
text
Start Date
Item
Start Date
date
Start Time
Item
Start Time
time
Taken prior to study
Item
Taken prior to study
boolean
Stop Date
Item
Stop Date
date
Stop Time
Item
Stop Time
time
Ongoing medication?
Item
Ongoing medication?
boolean
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