Engelsk

Visit 2: Study Continuation Check

1 Formulär  
Administrative data
Beskrivning

Administrative data

Protocol Number
Beskrivning

Protocol Number

Datatyp

integer

Subject Number
Beskrivning

Subject Number

Datatyp

integer

Date of Visit
Beskrivning

Date of Visit

Datatyp

date

Check for Study Continuation
Beskrivning

Check for Study Continuation

Did the subject return for visit 2?
Beskrivning

Did the subject return for visit 2?

Datatyp

boolean

If No, please tick one most appropriate reason
Beskrivning

If No, please tick one most appropriate reason

Datatyp

text

If Serious adverse event, please specify the SAE number
Beskrivning

If Serious adverse event, please specify the SAE number

Datatyp

integer

If Other, please specify
Beskrivning

If Other, please specify

Datatyp

text

Please tick who took the decision
Beskrivning

Please tick who took the decision

Datatyp

text

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Similar models

Visit 2: Study Continuation Check

1 Formulär
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
Administrative data
Protocol Number
Item
Protocol Number
integer
Subject Number
Item
Subject Number
integer
Date of Visit
Item
Date of Visit
date
Item Group
Check for Study Continuation
Did the subject return for visit 2?
Item
Did the subject return for visit 2?
boolean
Item
If No, please tick one most appropriate reason
text
If No, please tick one most appropriate reason
Code List
If No, please tick one most appropriate reason
CL Item
Serious adverse event (1)
CL Item
Other (2)
If Serious adverse event, please specify the SAE number
Item
If Serious adverse event, please specify the SAE number
integer
If Other, please specify
Item
If Other, please specify
text
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 (I)
CL Item
Parents/Guardians (P)
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