Englisch

Concomitant Medications Form

1 Formulare  
Concomitant Medication Details
Beschreibung

Concomitant Medication Details

Sequence Number
Beschreibung

Sequence Number

Datentyp

text

Drug Name
Beschreibung

Trade Name Preferred

Datentyp

text

Unit Dose
Beschreibung

Unit Dose

Datentyp

integer

Units
Beschreibung

Units

Datentyp

text

Frequency
Beschreibung

Frequency

Datentyp

text

Route
Beschreibung

Route

Datentyp

text

Reason for Medication
Beschreibung

Reason for Medication

Datentyp

text

Generic dispensed?
Beschreibung

Generic dispensed?

Datentyp

boolean

Prescription or OTC?
Beschreibung

Prescription or OTC?

Datentyp

text

Start Date
Beschreibung

Start Date

Datentyp

date

Taken prior to study?
Beschreibung

Taken prior to study?

Datentyp

boolean

Ongoing?
Beschreibung

Ongoing?

Datentyp

boolean

If NO, record the End Date
Beschreibung

If NO, record the End Date

Datentyp

date

Device Used to Administer Medication
Beschreibung

Device Used to Administer Medication

Datentyp

text

Total Daily Dose
Beschreibung

Total Daily Dose

Datentyp

text

Was drug administered for an exacerbation?
Beschreibung

Was drug administered for an exacerbation?

Datentyp

boolean

Was drug administered as a rescue medication?
Beschreibung

Was drug administered as a rescue medication?

Datentyp

boolean

Cumulative Dose Used?
Beschreibung

Cumulative Dose Used?

Datentyp

text

Was drug ever used?
Beschreibung

Was drug ever used?

Datentyp

boolean

Total duration
Beschreibung

Total duration

Datentyp

text

Duration Unit
Beschreibung

Duration Unit

Datentyp

text

Medication Type
Beschreibung

Medication Type

Datentyp

text

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Ähnliche Modelle

Concomitant Medications Form

1 Formulare
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Concomitant Medication Details
Sequence Number
Item
Sequence Number
text
Drug Name
Item
Drug Name
text
Unit Dose
Item
Unit Dose
integer
Units
Item
Units
text
Frequency
Item
Frequency
text
Route
Item
Route
text
Reason for Medication
Item
Reason for Medication
text
Generic dispensed?
Item
Generic dispensed?
boolean
Item
Prescription or OTC?
text
Prescription of OTC?
Code List
Prescription or OTC?
CL Item
Prescription (1)
CL Item
OTC (2)
Start Date
Item
Start Date
date
Taken prior to study?
Item
Taken prior to study?
boolean
Ongoing?
Item
Ongoing?
boolean
If NO, record the End Date
Item
If NO, record the End Date
date
Device Used to Administer Medication
Item
Device Used to Administer Medication
text
Total Daily Dose
Item
Total Daily Dose
text
Was drug administered for an exacerbation?
Item
Was drug administered for an exacerbation?
boolean
Was drug administered as a rescue medication?
Item
Was drug administered as a rescue medication?
boolean
Cumulative Dose Used?
Item
Cumulative Dose Used?
text
Was drug ever used?
Item
Was drug ever used?
boolean
Total duration
Item
Total duration
text
Item
Duration Unit
text
Duration Unit
Code List
Duration Unit
CL Item
Days (1)
CL Item
Months (2)
CL Item
Weeks (3)
CL Item
Years (4)
Item
Medication Type
text
Medication Type
Code List
Medication Type
CL Item
Non-Asthma (1)
CL Item
Asthma (2)
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