Inglés

Visit 3: Study Continuation Check

1 formularios  
Administrative data
Descripción

Administrative data

Subject Number
Descripción

Subject Number

Tipo de datos

integer

Date of Visit
Descripción

Date of Visit

Tipo de datos

date

Protocol Number
Descripción

Protocol Number

Tipo de datos

integer

Check for Study Continuation
Descripción

Check for Study Continuation

Did the subject come for Visit 3?
Descripción

Did the subject come for Visit 3?

Tipo de datos

boolean

If no, please choose the reason
Descripción

If no, please choose the reason

Tipo de datos

text

If Other, please specify
Descripción

If Other, please specify

Tipo de datos

text

If SAE, please record the number
Descripción

If SAE, please record the number

Tipo de datos

integer

If Non-SAE, please record the number
Descripción

If Non-SAE, please record the number

Tipo de datos

integer

Please tick who took the decision
Descripción

Please tick who took the decision

Tipo de datos

text

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Similar models

Visit 3: Study Continuation Check

1 formularios
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
Administrative data
Subject Number
Item
Subject Number
integer
Date of Visit
Item
Date of Visit
date
Protocol Number
Item
Protocol Number
integer
Item Group
Check for Study Continuation
Did the subject come for Visit 3?
Item
Did the subject come for Visit 3?
boolean
Item
If no, please choose the reason
text
If no, please choose the reason
Code List
If no, please choose the reason
CL Item
same reason or decision as previous visit (1)
CL Item
Serious Adverse Event (2)
CL Item
Non-Serious Adverse Event (3)
CL Item
Other (4)
If Other, please specify
Item
If Other, please specify
text
If SAE, please record the number
Item
If SAE, please record the number
integer
If Non-SAE, please record the number
Item
If Non-SAE, please record the number
integer
Item
Please tick who took the decision
text
Please tick who took the decision
Code List
Please tick who took the decision
CL Item
Investigator (1)
CL Item
Parents/Guardians (2)
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