Engelsk

Visit 4: Study Continuation Check

1 Formulär  
Administrative data
Beskrivning

Administrative data

Subject Number
Beskrivning

Subject Number

Datatyp

integer

Check for Study Continuation
Beskrivning

Check for Study Continuation

Did the subject return for visit 4?
Beskrivning

Did the subject return for visit 4?

Datatyp

boolean

If yes, please complete all forms for Visit 4
Beskrivning

If yes, please complete all forms for Visit 4

Datatyp

text

If No, record ONE most appropriate reason and skip the following pages of this visit
Beskrivning

If No, record ONE most appropriate reason and skip the following pages of this visit

Datatyp

text

If SAE, record the SAE number
Beskrivning

If SAE, record the SAE number

Datatyp

integer

If Non-SAE, record the unsolicited AE number
Beskrivning

If Non-SAE, record the unsolicited AE number

Datatyp

integer

If Other, specify
Beskrivning

e.g., consent withdrawal, protocol violation, etc.

Datatyp

text

Who took the decision?
Beskrivning

Who took the decision?

Datatyp

text

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Similar models

Visit 4: Study Continuation Check

1 Formulär
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
Administrative data
Subject Number
Item
Subject Number
integer
Item Group
Check for Study Continuation
Did the subject return for visit 4?
Item
Did the subject return for visit 4?
boolean
If yes, please complete all forms for Visit 4
Item
If yes, please complete all forms for Visit 4
text
Item
If No, record ONE most appropriate reason and skip the following pages of this visit
text
If No, record ONE most appropriate reason and skip the following pages of this visit
Code List
If No, record ONE most appropriate reason and skip the following pages of this visit
CL Item
Serious Adverse Event (1)
CL Item
Non-Serious adverse event (2)
CL Item
Other (3)
If SAE, record the SAE number
Item
If SAE, record the SAE number
integer
If Non-SAE, record the unsolicited AE number
Item
If Non-SAE, record the unsolicited AE number
integer
If Other, specify
Item
If Other, specify
text
Item
Who took the decision?
text
Who took the decision?
Code List
Who took the decision?
CL Item
Investigator (1)
CL Item
Parents/Guardians (2)
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