Anglais

Visit 4: Study Continuation Check

1 Formulaires  
Administrative data
Description

Administrative data

Subject Number
Description

Subject Number

Type de données

integer

Protocol Number
Description

Protocol Number

Type de données

integer

Check for Study Continuation
Description

Check for Study Continuation

Did the subject return for visit 4?
Description

Did the subject return for visit 4?

Type de données

boolean

If No, please select ONE most appropriate reason
Description

If No, please select ONE most appropriate reason

Type de données

text

If SAE, please specify SAE number
Description

If SAE, please specify SAE number

Type de données

integer

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

If Non-SAE, please specify Non-SAE number

Type de données

integer

If Other, please specify
Description

If Other, please specify

Type de données

text

Please specify who took the decision
Description

Who took the decision

Type de données

integer

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Similar models

Visit 4: Study Continuation Check

1 Formulaires
Name
Type
Description | Question | Decode (Coded Value)
Type de données
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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