Englisch

Concomitant Medication Form

1 Formulare  
Administrative data
Beschreibung

Administrative data

Subject Number
Beschreibung

Subject Number

Datentyp

integer

Concomitant Medication
Beschreibung

Concomitant Medication

Have any medications/treatments been administered during study period?
Beschreibung

Have any medications/treatments been administered during study period?

Datentyp

boolean

If Yes, please complete the following table
Beschreibung

If Yes, please complete the following table

Datentyp

text

List of Medications
Beschreibung

List of Medications

Trade/Generic Name
Beschreibung

Trade/Generic Name

Datentyp

text

Medical Indication
Beschreibung

Medical Indication

Datentyp

text

Total daily dose
Beschreibung

Total daily dose

Datentyp

text

Route
Beschreibung

Route

Datentyp

text

Start date
Beschreibung

Start date

Datentyp

date

End date
Beschreibung

End date

Datentyp

date

Ongoing at the end of study?
Beschreibung

Ongoing at the end of study?

Datentyp

boolean

Zum Seitenanfang zurückkehren

Ähnliche Modelle

Concomitant Medication Form

1 Formulare
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Administrative data
Subject Number
Item
Subject Number
integer
Item Group
Concomitant Medication
Have any medications/treatments been administered during study period?
Item
Have any medications/treatments been administered during study period?
boolean
If Yes, please complete the following table
Item
If Yes, please complete the following table
text
Item Group
List of Medications
Trade/Generic Name
Item
Trade/Generic Name
text
Item
Medical Indication
text
Medical Indication
Code List
Medical Indication
CL Item
Prophylactic (1)
Total daily dose
Item
Total daily dose
text
Route
Item
Route
text
Start date
Item
Start date
date
End date
Item
End date
date
Ongoing at the end of study?
Item
Ongoing at the end of study?
boolean
Zum Seitenanfang zurückkehren