ID

35478

Description

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

Keywords

Versions (1)
  1. 3/6/19 3/6/19 -
Copyright Holder

GlaxoSmithKline

Uploaded on

March 6, 2019

DOI

To request one please log in.

License

Creative Commons BY-NC 3.0
Model comments :

You can comment on the data model here. Via the speech bubbles at the itemgroups and items you can add comments to those specificially.

Back to model comments
Itemgroup comments for :

Item comments for :

In order to download data models you must be logged in. Please log in or register for free.

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

English

Patient Enrollment Form

1 forms  
Patient Enrollment Form
Description

Patient Enrollment Form

Alias
UMLS CUI-1
C1516879
To
Description

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

Data type

text

Alias
UMLS CUI [1]
C2347796
Fax No.
Description

Clinical Study Sponsor, Fax Number

Data type

integer

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

Enrollment, Study Identifier

Data type

integer

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

Person Initials

Data type

text

Alias
UMLS CUI [1]
C2986440
Patient Number
Description

Clinical Trial Subject Unique Identifier

Data type

integer

Alias
UMLS CUI [1]
C2348585
Centre Number
Description

Study Coordinating Center, Identification number

Data type

integer

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

Enrollment, Date in time

Data type

date

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

Investigator Signature

Data type

text

Alias
UMLS CUI [1]
C2346576
Date
Description

Investigator Signature, Date in time

Data type

date

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

Investigator Name

Data type

text

Alias
UMLS CUI [1]
C2826892
Institution
Description

Institution name

Data type

text

Alias
UMLS CUI [1]
C1301943
Back to the top of the page

Similar models

Patient Enrollment Form

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
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])
Back to the top of the page 

Contact

Please use this form for feedback, questions and suggestions for improvements.

Fields marked with * are required.

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