Patient Enrollment Form

Patient Enrollment
Description

Patient Enrollment

Alias
UMLS CUI-1
C4041024
Received By
Description

Received By

Data type

text

Alias
UMLS CUI [1]
C1709850
Fax No.:
Description

Fax Number

Data type

integer

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

study subject participation status

Data type

integer

Alias
UMLS CUI [1]
C2348568
Patient Initials
Description

Patient Initials

Data type

text

Alias
UMLS CUI [1]
C2986440
Patient Number
Description

Patient Number

Data type

integer

Alias
UMLS CUI [1]
C1830427
Centre Number
Description

Centre Number

Data type

integer

Alias
UMLS CUI [1,1]
C0600091
UMLS CUI [1,2]
C0019994
Date of enrollment:
Description

Date of enrollment

Data type

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0679646
UMLS CUI [1,3]
C1516879
Signed:
Description

Signed

Data type

text

Alias
UMLS CUI [1]
C1561610
Date:
Description

Date

Data type

date

Alias
UMLS CUI [1]
C0011008
Please print name:
Description

print name

Data type

text

Alias
UMLS CUI [1]
C0027365
Institution:
Description

Institution

Data type

text

Alias
UMLS CUI [1]
C1301943

Similar models

Patient Enrollment Form

Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Patient Enrollment
C4041024 (UMLS CUI-1)
Received By
Item
Received By
text
C1709850 (UMLS CUI [1])
Fax Number
Item
Fax No.:
integer
C1549619 (UMLS CUI [1])
study subject participation status
Item
The following patient has been enroled in study: 101468/
integer
C2348568 (UMLS CUI [1])
Patient Initials
Item
Patient Initials
text
C2986440 (UMLS CUI [1])
Patient Number
Item
Patient Number
integer
C1830427 (UMLS CUI [1])
Centre Number
Item
Centre Number
integer
C0600091 (UMLS CUI [1,1])
C0019994 (UMLS CUI [1,2])
Date of enrollment
Item
Date of enrollment:
date
C0011008 (UMLS CUI [1,1])
C0679646 (UMLS CUI [1,2])
C1516879 (UMLS CUI [1,3])
Signed
Item
Signed:
text
C1561610 (UMLS CUI [1])
Date
Item
Date:
date
C0011008 (UMLS CUI [1])
print name
Item
Please print name:
text
C0027365 (UMLS CUI [1])
Institution
Item
Institution:
text
C1301943 (UMLS CUI [1])