Administrative data
Study Name
text
Site
Subject
Visit Name
DCI Name/Shortname
Status
Doc#
integer
Visit #
float
Prior Medications and Therapies
Did the subject participate in any Non-Drug Therapies or take Concomitant medications within 30 days prior to screening and/or during the study?
boolean
If Yes, add details on next page (includes over-the counter and prescription drugs) below
Trade name peferred
Unit Dose
Unit
Frequency
Route
if SAE/AE enter Event Term
If applicable
Start date
date
Stop Date
Mark if continuing
Taken prior to study