Engelsk

Diary Card 3: Concomitant Medications

1 Formulär  
Administrative data
Beskrivning

Administrative data

Subject Number
Beskrivning

Subject Number

Datatyp

integer

Dose
Beskrivning

Dose

Datatyp

text

Medication
Beskrivning

Medication

Trade Name/Generic Name
Beskrivning

Trade Name/Generic Name

Datatyp

text

Reason
Beskrivning

Reason

Datatyp

text

Total Daily Dose?
Beskrivning

Total Daily Dose?

Datatyp

text

Start Date
Beskrivning

Start Date

Datatyp

date

End Date
Beskrivning

End Date

Datatyp

date

Ongoing?
Beskrivning

Ongoing?

Datatyp

boolean

Reminder
Beskrivning

Reminder

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

fill the date below

Datatyp

date

In case of hospitalisation, please inform
Beskrivning

fill the name below

Datatyp

text

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Similar models

Diary Card 3: Concomitant Medications

1 Formulär
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
Administrative data
Subject Number
Item
Subject Number
integer
Item
Dose
text
Dose
Code List
Dose
CL Item
Dose 3 (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
Tillbaka till toppen