Inglese

Medical History

1 moduli  
  1. StudyEvent: ODM
    1. Medical History
Administrative data
Descrizione

Administrative data

Visit Number
Descrizione

Visit Number

Tipo di dati

text

Date of Visit
Descrizione

Date of Visit

Tipo di dati

date

Subject Number
Descrizione

Subject Number

Tipo di dati

integer

General Medical History / Physical Examination
Descrizione

General Medical History / Physical Examination

Are you aware of any pre-existing conditions or signs and/or symptoms present in the subject prior to the start of the study?
Descrizione

Are you aware of any pre-existing conditions or signs and/or symptoms present in the subject prior to the start of the study?

Tipo di dati

text

Cutaneous
Descrizione

Cutaneous

Tipo di dati

text

Diagnosis
Descrizione

Diagnosis

Tipo di dati

text

Eyes
Descrizione

Eyes

Tipo di dati

text

Diagnosis
Descrizione

Diagnosis

Tipo di dati

text

Ears-Nose-Throat
Descrizione

Ears-Nose-Throat

Tipo di dati

text

Diagnosis
Descrizione

Diagnosis

Tipo di dati

text

Cardiovascular
Descrizione

Cardiovascular

Tipo di dati

text

Diagnosis
Descrizione

Diagnosis

Tipo di dati

text

Respiratory
Descrizione

Respiratory

Tipo di dati

text

Gastrointestinal
Descrizione

Gastrointestinal

Tipo di dati

text

Muskuloskeletal
Descrizione

Muskuloskeletal

Tipo di dati

text

Neurological
Descrizione

Neurological

Tipo di dati

text

Genitourinary
Descrizione

Genitourinary

Tipo di dati

text

Haematology
Descrizione

Haematology

Tipo di dati

text

Allergies
Descrizione

Allergies

Tipo di dati

text

Endocrine
Descrizione

Endocrine

Tipo di dati

text

Other, specify
Descrizione

Other, specify

Tipo di dati

text

Concomitant Medications
Descrizione

Concomitant Medications

Please report medication(s) as specified in the protocol and fill in the Medication section
Descrizione

Please report medication(s) as specified in the protocol and fill in the Medication section

Tipo di dati

text

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Similar models

Medical History

1 moduli
  1. StudyEvent: ODM
    1. Medical History
Name
genere
Description | Question | Decode (Coded Value)
Tipo di dati
Alias
Item Group
Administrative data
Item
Visit Number
text
Visit Number
Code List
Visit Number
CL Item
Visit 1 (1)
Date of Visit
Item
Date of Visit
date
Subject Number
Item
Subject Number
integer
Item Group
General Medical History / Physical Examination
Item
Are you aware of any pre-existing conditions or signs and/or symptoms present in the subject prior to the start of the study?
text
Are you aware of any pre-existing conditions or signs and/or symptoms present in the subject prior to the start of the study?
Code List
Are you aware of any pre-existing conditions or signs and/or symptoms present in the subject prior to the start of the study?
CL Item
No (1)
CL Item
Yes -> please tick appropriate box(es) and give diagnosis (2)
Item
Cutaneous
text
Cutaneous
Code List
Cutaneous
CL Item
Current (1)
CL Item
Past (2)
Diagnosis
Item
Diagnosis
text
Item
Eyes
text
Eyes
Code List
Eyes
CL Item
Current (1)
CL Item
Past (2)
Diagnosis
Item
Diagnosis
text
Item
Ears-Nose-Throat
text
Ears-Nose-Throat
Code List
Ears-Nose-Throat
CL Item
Current (1)
CL Item
Past (2)
Diagnosis
Item
Diagnosis
text
Item
Cardiovascular
text
Cardiovascular
Code List
Cardiovascular
CL Item
Current (1)
CL Item
Past (2)
Diagnosis
Item
Diagnosis
text
Item
Respiratory
text
Respiratory
Code List
Respiratory
CL Item
Current (1)
CL Item
Past (2)
Item
Gastrointestinal
text
Gastrointestinal
Code List
Gastrointestinal
CL Item
Current (1)
CL Item
Past (2)
Item
Muskuloskeletal
text
Muskuloskeletal
Code List
Muskuloskeletal
CL Item
Current (1)
CL Item
Past (2)
Item
Neurological
text
Neurological
Code List
Neurological
CL Item
Current (1)
CL Item
Past (2)
Item
Genitourinary
text
Genitourinary
Code List
Genitourinary
CL Item
Current (1)
CL Item
Past (2)
Item
Haematology
text
Haematology
Code List
Haematology
CL Item
Current (1)
CL Item
Past (2)
Item
Allergies
text
Allergies
Code List
Allergies
CL Item
Current (1)
CL Item
Past (2)
Item
Endocrine
text
Endocrine
Code List
Endocrine
CL Item
Current (1)
CL Item
Past (2)
Other, specify
Item
Other, specify
text
Item Group
Concomitant Medications
Please report medication(s) as specified in the protocol and fill in the Medication section
Item
Please report medication(s) as specified in the protocol and fill in the Medication section
text
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