Anglais

Diary Card 2: Concomitant Medications

1 Formulaires  
Administrative data
Description

Administrative data

Subject Number
Description

Subject Number

Type de données

integer

Dose
Description

Dose

Type de données

text

Medication
Description

Medication

Trade Name/Generic Name
Description

Trade Name/Generic Name

Type de données

text

Reason
Description

Reason

Type de données

text

Total Daily Dose?
Description

Total Daily Dose?

Type de données

text

Start Date
Description

Start Date

Type de données

date

End Date
Description

End Date

Type de données

date

Ongoing?
Description

Ongoing?

Type de données

boolean

Reminder
Description

Reminder

Please do not forget to bring back the diary card on
Description

fill the date below

Type de données

date

In case of hospitalisation, please inform
Description

fill the name below

Type de données

text

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Similar models

Diary Card 2: Concomitant Medications

1 Formulaires
Name
Type
Description | Question | Decode (Coded Value)
Type de données
Alias
Item Group
Administrative data
Subject Number
Item
Subject Number
integer
Item
Dose
text
Dose
Code List
Dose
CL Item
Dose 2 (1)
Item Group
Medication
Trade Name/Generic Name
Item
Trade Name/Generic Name
text
Item
Reason
text
Intensity
Code List
Reason
Total Daily Dose?
Item
Total Daily Dose?
text
Start Date
Item
Start Date
date
End Date
Item
End Date
date
Ongoing?
Item
Ongoing?
boolean
Item Group
Reminder
Please do not forget to bring back the diary card on
Item
Please do not forget to bring back the diary card on
date
In case of hospitalisation, please inform
Item
In case of hospitalisation, please inform
text
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