Inglese

Concomitant Medication Form

1 moduli  
Administrative data
Descrizione

Administrative data

Subject Number
Descrizione

Subject Number

Tipo di dati

integer

Concomitant Medication
Descrizione

Concomitant Medication

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

Have any medications/treatments been administered during study period?

Tipo di dati

boolean

If Yes, please complete the following table
Descrizione

If Yes, please complete the following table

Tipo di dati

text

List of Medications
Descrizione

List of Medications

Trade/Generic Name
Descrizione

Trade/Generic Name

Tipo di dati

text

Medical Indication
Descrizione

Medical Indication

Tipo di dati

text

Total daily dose
Descrizione

Total daily dose

Tipo di dati

text

Route
Descrizione

Route

Tipo di dati

text

Start date
Descrizione

Start date

Tipo di dati

date

End date
Descrizione

End date

Tipo di dati

date

Ongoing at the end of study?
Descrizione

Ongoing at the end of study?

Tipo di dati

boolean

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Similar models

Concomitant Medication Form

1 moduli
Name
genere
Description | Question | Decode (Coded Value)
Tipo di dati
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
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