Engelsk

Visit 4: Study Continuation Check

1 Formulär  
Administrative data
Beskrivning

Administrative data

Subject Number
Beskrivning

Subject Number

Datatyp

integer

Protocol Number
Beskrivning

Protocol 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 No, please select ONE most appropriate reason
Beskrivning

If No, please select ONE most appropriate reason

Datatyp

text

If SAE, please specify SAE number
Beskrivning

If SAE, please specify SAE number

Datatyp

integer

If Non-SAE, please specify Non-SAE number
Beskrivning

If Non-SAE, please specify Non-SAE number

Datatyp

integer

If Other, please specify
Beskrivning

If Other, please specify

Datatyp

text

Please specify who took the decision
Beskrivning

Who took the decision

Datatyp

integer

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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
Protocol Number
Item
Protocol Number
integer
Item Group
Check for Study Continuation
Did the subject return for visit 4?
Item
Did the subject return for visit 4?
boolean
Item
If No, please select ONE most appropriate reason
text
If No, please select ONE most appropriate reason
Code List
If No, please select ONE most appropriate reason
CL Item
Serious Adverse Event (1)
CL Item
Non-Serious Adverse Event (2)
CL Item
Other (3)
If SAE, please specify SAE number
Item
If SAE, please specify SAE number
integer
If Non-SAE, please specify Non-SAE number
Item
If Non-SAE, please specify Non-SAE number
integer
If Other, please specify
Item
If Other, please specify
text
Item
Please specify who took the decision
integer
Who took the decision
Code List
Please specify who took the decision
CL Item
Investigator (1)
CL Item
Parents/Guardian (2)
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