ID

35478

Descripción

Study ID: 101468/194 Clinical Study ID: 101468/194 Study Title: A 12 Week, Double-Blind, Placebo-Controlled, Parallel Group Study to Assess the Efficacy and Safety of Ropinirole in Patients Suffering from Restless Legs Syndrome (RLS). Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: Sponsor: GlaxoSmithKline Collaborators: N/A Phase: phase 3 Study Recruitment Status: Completed Generic Name: ropinirole Trade Name: requip Study Indication: Restless Legs Syndrome

Palabras clave

Versiones (1)
  1. 6/3/19 6/3/19 -
Titular de derechos de autor

GlaxoSmithKline

Subido en

6 de marzo de 2019

DOI

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Licencia

Creative Commons BY-NC 3.0
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Ropinirole in Patients with Restless Legs Syndrome (Study ID: 101468/194)

Inglés

Patient Enrollment Form

1 formularios  
Patient Enrollment Form
Descripción

Patient Enrollment Form

Alias
UMLS CUI-1
C1516879
To
Descripción

Please fax this form to the sponsor study contact when the patient has been enroled

Tipo de datos

text

Alias
UMLS CUI [1]
C2347796
Fax No.
Descripción

Clinical Study Sponsor, Fax Number

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C2347796
UMLS CUI [1,2]
C1549619
The following patient has been enroled in study: 101468/
Descripción

Enrollment, Study Identifier

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C1516879
UMLS CUI [1,2]
C2826693
Patient Initials
Descripción

Person Initials

Tipo de datos

text

Alias
UMLS CUI [1]
C2986440
Patient Number
Descripción

Clinical Trial Subject Unique Identifier

Tipo de datos

integer

Alias
UMLS CUI [1]
C2348585
Centre Number
Descripción

Study Coordinating Center, Identification number

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C2825181
UMLS CUI [1,2]
C1300638
Date of Enrollment
Descripción

Enrollment, Date in time

Tipo de datos

date

Alias
UMLS CUI [1,1]
C1516879
UMLS CUI [1,2]
C0011008
Signed
Descripción

Investigator Signature

Tipo de datos

text

Alias
UMLS CUI [1]
C2346576
Date
Descripción

Investigator Signature, Date in time

Tipo de datos

date

Alias
UMLS CUI [1,1]
C2346576
UMLS CUI [1,2]
C0011008
Please print name
Descripción

Investigator Name

Tipo de datos

text

Alias
UMLS CUI [1]
C2826892
Institution
Descripción

Institution name

Tipo de datos

text

Alias
UMLS CUI [1]
C1301943
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Similar models

Patient Enrollment Form

1 formularios
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
Patient Enrollment Form
C1516879 (UMLS CUI-1)
Clinical Study Sponsor
Item
To
text
C2347796 (UMLS CUI [1])
Clinical Study Sponsor, Fax Number
Item
Fax No.
integer
C2347796 (UMLS CUI [1,1])
C1549619 (UMLS CUI [1,2])
Enrollment, Study Identifier
Item
The following patient has been enroled in study: 101468/
integer
C1516879 (UMLS CUI [1,1])
C2826693 (UMLS CUI [1,2])
Person Initials
Item
Patient Initials
text
C2986440 (UMLS CUI [1])
Clinical Trial Subject Unique Identifier
Item
Patient Number
integer
C2348585 (UMLS CUI [1])
Study Coordinating Center, Identification number
Item
Centre Number
integer
C2825181 (UMLS CUI [1,1])
C1300638 (UMLS CUI [1,2])
Enrollment, Date in time
Item
Date of Enrollment
date
C1516879 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Investigator Signature
Item
Signed
text
C2346576 (UMLS CUI [1])
Investigator Signature, Date in time
Item
Date
date
C2346576 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Investigator Name
Item
Please print name
text
C2826892 (UMLS CUI [1])
Institution name
Item
Institution
text
C1301943 (UMLS CUI [1])
Volver a la parte superior de la página 

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