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Screening Visit: General Medical History

1 Formulär  
Administrative data
Beskrivning

Administrative data

Study Name
Beskrivning

Study Name

Datatyp

text

Site
Beskrivning

Site

Datatyp

text

Subject
Beskrivning

Subject

Datatyp

text

Visit Name
Beskrivning

Visit Name

Datatyp

text

DCI Name/Shortname
Beskrivning

DCI Name/Shortname

Datatyp

text

Status
Beskrivning

Status

Datatyp

text

Doc#
Beskrivning

Doc#

Datatyp

integer

Visit #
Beskrivning

Visit #

Datatyp

float

Visit Date
Beskrivning

Visit Date

Datatyp

date

Relevant Medical Conditions
Beskrivning

Relevant Medical Conditions

Specific Condition
Beskrivning

Specific Condition

Datatyp

text

Status
Beskrivning

Status

Datatyp

text

Start Date
Beskrivning

Start Date

Datatyp

date

End Date
Beskrivning

End Date

Datatyp

date

Body System Code
Beskrivning

check the corresponding option

Datatyp

text

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Similar models

Screening Visit: General Medical History

1 Formulär
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
Administrative data
Study Name
Item
Study Name
text
Site
Item
Site
text
Subject
Item
Subject
text
Visit Name
Item
Visit Name
text
DCI Name/Shortname
Item
DCI Name/Shortname
text
Status
Item
Status
text
Doc#
Item
Doc#
integer
Visit #
Item
Visit #
float
Visit Date
Item
Visit Date
date
Item Group
Relevant Medical Conditions
Specific Condition
Item
Specific Condition
text
Item
Status
text
Status
Code List
Status
CL Item
Current (1)
CL Item
Past (2)
CL Item
No medical condition (3)
Start Date
Item
Start Date
date
End Date
Item
End Date
date
Item
Body System Code
text
Body System Code
Code List
Body System Code
CL Item
blood and lymphatic system disorders (1)
CL Item
ear and labyrinth disorders (2)
CL Item
endocrine disorders (3)
CL Item
eye disorders (4)
CL Item
immune system disorders (including allergies) (5)
CL Item
metabolism and nutrition disorders  (6)
CL Item
musculoskeletal and connective tissue disorders (7)
CL Item
neoplasms benign, malignant and unspecified (including cysts and polyps) (8)
CL Item
nervous system disorders (9)
CL Item
psychiatric disorders (10)
CL Item
renal and urinary disorders (11)
CL Item
reproductive system and breast disorders (12)
CL Item
respiratory, thoracic, and mediastinal disorders (including asthma) (13)
CL Item
infections and Infestations (14)
CL Item
congenital, familial and genetic disorders (15)
CL Item
general disorders and administration site conditions (16)
CL Item
injury, poisoning, and procedural complications (17)
CL Item
cardiovascular disorder (18)
CL Item
gastrointestinal disorder (19)
CL Item
hepatobiliary disorders (20)
CL Item
skin and subcutaneous tissue disorders (21)
CL Item
vascular disorders (22)
CL Item
vascular disorders (23)
CL Item
Other (24)
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