Engelsk

Diary Card: Concomitant Medication

1 Formulär  
Administrative data
Beskrivning

Administrative data

Subject Number
Beskrivning

Subject Number

Datatyp

integer

Dose
Beskrivning

Dose

Datatyp

text

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

Have any medications/treatments been administered during study period?

Datatyp

boolean

Medication
Beskrivning

Medication

Trade Name/Generic Name
Beskrivning

Trade Name/Generic Name

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

Medical Indication
Beskrivning

Medical Indication

Datatyp

text

If Other, specify
Beskrivning

If Other, specify

Datatyp

text

Route
Beskrivning

Route

Datatyp

text

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Similar models

Diary Card: Concomitant Medication

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 1 (1)
Have any medications/treatments been administered during study period?
Item
Have any medications/treatments been administered during study period?
boolean
Item Group
Medication
Trade Name/Generic Name
Item
Trade Name/Generic Name
text
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
Medical Indication
text
Medical Indication
Code List
Medical Indication
CL Item
Prophylactic (1)
CL Item
Other (2)
If Other, specify
Item
If Other, specify
text
Item
Route
text
Route
Code List
Route
CL Item
External (1)
CL Item
Intradermal (2)
CL Item
Inhalation (3)
CL Item
Intramuscular (4)
CL Item
Intraarticular (5)
CL Item
Intrathecal (6)
CL Item
Intravenous (7)
CL Item
Intranasal (8)
CL Item
Other (9)
CL Item
Parenteral (10)
CL Item
Oral (11)
CL Item
Rectal (12)
CL Item
Subcutaneous (13)
CL Item
Sublingual (14)
CL Item
Transdermal (15)
CL Item
Topical (16)
CL Item
Unknown (17)
CL Item
Vaginal (18)
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