Englisch

Visit 4: Study Continuation Check

1 Formulare  
Administrative data
Beschreibung

Administrative data

Subject Number
Beschreibung

Subject Number

Datentyp

integer

Protocol Number
Beschreibung

Protocol Number

Datentyp

integer

Check for Study Continuation
Beschreibung

Check for Study Continuation

Did the subject return for visit 4?
Beschreibung

Did the subject return for visit 4?

Datentyp

boolean

If No, please select ONE most appropriate reason
Beschreibung

If No, please select ONE most appropriate reason

Datentyp

text

If SAE, please specify SAE number
Beschreibung

If SAE, please specify SAE number

Datentyp

integer

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

If Non-SAE, please specify Non-SAE number

Datentyp

integer

If Other, please specify
Beschreibung

If Other, please specify

Datentyp

text

Please specify who took the decision
Beschreibung

Who took the decision

Datentyp

integer

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Ähnliche Modelle

Visit 4: Study Continuation Check

1 Formulare
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
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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