ID

35478

Beschrijving

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

Trefwoorden

Versies (1)
  1. 06-03-19 06-03-19 -
Houder van rechten

GlaxoSmithKline

Geüploaded op

6 maart 2019

DOI

Voor een aanvraag inloggen.

Licentie

Creative Commons BY-NC 3.0
Model Commentaren :

Hier kunt u commentaar leveren op het model. U kunt de tekstballonnen bij de itemgroepen en items gebruiken om er specifiek commentaar op te geven.

Terug naar het model Commentaren
Itemgroep Commentaren voor :

Item Commentaren voor :

U moet ingelogd zijn om formulieren te downloaden. AUB inloggen of schrijf u gratis in.

Ropinirole in Patients with Restless Legs Syndrome (Study ID: 101468/194)

Engels

Patient Enrollment Form

1 Formulieren  
Patient Enrollment Form
Beschrijving

Patient Enrollment Form

Alias
UMLS CUI-1
C1516879
To
Beschrijving

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

Datatype

text

Alias
UMLS CUI [1]
C2347796
Fax No.
Beschrijving

Clinical Study Sponsor, Fax Number

Datatype

integer

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

Enrollment, Study Identifier

Datatype

integer

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

Person Initials

Datatype

text

Alias
UMLS CUI [1]
C2986440
Patient Number
Beschrijving

Clinical Trial Subject Unique Identifier

Datatype

integer

Alias
UMLS CUI [1]
C2348585
Centre Number
Beschrijving

Study Coordinating Center, Identification number

Datatype

integer

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

Enrollment, Date in time

Datatype

date

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

Investigator Signature

Datatype

text

Alias
UMLS CUI [1]
C2346576
Date
Beschrijving

Investigator Signature, Date in time

Datatype

date

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

Investigator Name

Datatype

text

Alias
UMLS CUI [1]
C2826892
Institution
Beschrijving

Institution name

Datatype

text

Alias
UMLS CUI [1]
C1301943
Terug naar het begin van de pagina

Similar models

Patient Enrollment Form

1 Formulieren
Name
Type
Description | Question | Decode (Coded Value)
Datatype
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])
Terug naar het begin van de pagina 

Contact

Gebruik dit formulier voor feedback, vragen en verbeteringsvoorstellen.

Velden gemarkeerd met een * zijn verplicht.

Help

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial