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Screen Failure Form

1 forms  
  1. StudyEvent: ODM
    1. Screen Failure Form
Screen Failure Data
Description

Screen Failure Data

Was this subject a screen failure?
Description

Was this subject a screen failure?

Data type

boolean

Screen Failure Date
Description

Screen Failure Date

Data type

date

If YES, please select reason
Description

If YES, please select reason

Data type

text

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Similar models

Screen Failure Form

1 forms
  1. StudyEvent: ODM
    1. Screen Failure Form
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Screen Failure Data
Was this subject a screen failure?
Item
Was this subject a screen failure?
boolean
Screen Failure Date
Item
Screen Failure Date
date
Item
If YES, please select reason
text
If YES, please select reason
Code List
If YES, please select reason
CL Item
Did not meet inclusion/exclusion criteria (1)
CL Item
Adverse Event (unspecified) (2)
CL Item
Study closed/terminated  (3)
CL Item
Investigator discretion, specify_____ (4)
CL Item
withdrew consent, specify______ (5)
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