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

Mots-clés

Versions (1)
  1. 06/03/2019 06/03/2019 -
Détendeur de droits

GlaxoSmithKline

Téléchargé le

6 mars 2019

DOI

Pour une demande vous connecter.

Licence

Creative Commons BY-NC 3.0
Modèle Commentaires :

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

Anglais

Patient Enrollment Form

1 Formulaires  
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

Type de données

text

Alias
UMLS CUI [1]
C2347796
Fax No.
Description

Clinical Study Sponsor, Fax Number

Type de données

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

Type de données

integer

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

Person Initials

Type de données

text

Alias
UMLS CUI [1]
C2986440
Patient Number
Description

Clinical Trial Subject Unique Identifier

Type de données

integer

Alias
UMLS CUI [1]
C2348585
Centre Number
Description

Study Coordinating Center, Identification number

Type de données

integer

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

Enrollment, Date in time

Type de données

date

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

Investigator Signature

Type de données

text

Alias
UMLS CUI [1]
C2346576
Date
Description

Investigator Signature, Date in time

Type de données

date

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

Investigator Name

Type de données

text

Alias
UMLS CUI [1]
C2826892
Institution
Description

Institution name

Type de données

text

Alias
UMLS CUI [1]
C1301943
Retour au début de la page

Similar models

Patient Enrollment Form

1 Formulaires
Name
Type
Description | Question | Decode (Coded Value)
Type de données
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])
Retour au début de la page 

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