Englisch

Long Term Follow-Up

1 Formulare  
  1. StudyEvent: ODM
    1. Long Term Follow-Up
Long Term Follow-Up (Year 14)
Beschreibung

Long Term Follow-Up (Year 14)

Center
Beschreibung

Center Number

Datentyp

integer

Visit
Beschreibung

Visit Type

Datentyp

text

Visit Date
Beschreibung

Visit Date

Datentyp

date

Alias
UMLS CUI [1]
C1320303
Subject number
Beschreibung

Subject number

Datentyp

integer

Alias
UMLS CUI [1]
C2348585
BLOOD SAMPLING
Beschreibung

BLOOD SAMPLING

I certify that Informed Consent has been obtained prior to any study procedure.
Beschreibung

Consent

Datentyp

boolean

Informed Consent Date :
Beschreibung

Informed Consent Date

Datentyp

date

DEMOGRAPHICS
Beschreibung

DEMOGRAPHICS

Date of birth:
Beschreibung

Birth Date

Datentyp

date

Subject Initials
Beschreibung

Subject Initials

Datentyp

text

Maßeinheiten
  • _ _ First Name / _ _ Family Name
Alias
UMLS CUI [1]
C2986440
_ _ First Name / _ _ Family Name
LABORATORY TESTS
Beschreibung

LABORATORY TESTS

Has a blood sample been taken ?
Beschreibung

BLOOD SAMPLE

Datentyp

boolean

INVESTIGATOR SIGNATURE
Beschreibung

INVESTIGATOR SIGNATURE

Date
Beschreibung

Date

Datentyp

date

Investigator signature :
Beschreibung

Investigator signature

Datentyp

text

Long Term Follow-Up (Year 15)
Beschreibung

Long Term Follow-Up (Year 15)

Center
Beschreibung

Center Number

Datentyp

integer

Subject Initials
Beschreibung

First Name, Family Name

Datentyp

text

Subject Number
Beschreibung

Subject Number

Datentyp

integer

BLOOD SAMPLING
Beschreibung

BLOOD SAMPLING

I certify that Informed Consent has been obtained prior to any study procedure.
Beschreibung

Consent

Datentyp

boolean

Informed Consent Date:
Beschreibung

Informed Consent Date

Datentyp

date

DEMOGRAPHICS
Beschreibung

DEMOGRAPHICS

Date of birth:
Beschreibung

Birth Date

Datentyp

date

Subject Initials
Beschreibung

Subject Initials

Datentyp

text

Maßeinheiten
  • _ _ First Name / _ _ Family Name
Alias
UMLS CUI [1]
C2986440
_ _ First Name / _ _ Family Name
LABORATORY TESTS
Beschreibung

LABORATORY TESTS

Has a blood sample been taken?
Beschreibung

BLOOD SAMPLE

Datentyp

boolean

INVESTIGATOR SIGNATURE
Beschreibung

INVESTIGATOR SIGNATURE

Date
Beschreibung

Date

Datentyp

date

Investigator signature :
Beschreibung

Investigator signature

Datentyp

text

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Ähnliche Modelle

Long Term Follow-Up

1 Formulare
  1. StudyEvent: ODM
    1. Long Term Follow-Up
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Long Term Follow-Up (Year 14)
Center Number
Item
Center
integer
Item
Visit
text
Visit Type
Code List
Visit
CL Item
Blood Sampling (Year 14) (1)
Visit Date
Item
Visit Date
date
C1320303 (UMLS CUI [1])
Subject number
Item
Subject number
integer
C2348585 (UMLS CUI [1])
Item Group
BLOOD SAMPLING
Consent
Item
I certify that Informed Consent has been obtained prior to any study procedure.
boolean
Informed Consent Date
Item
Informed Consent Date :
date
Item Group
DEMOGRAPHICS
Birth Date
Item
Date of birth:
date
Subject Initials
Item
Subject Initials
text
C2986440 (UMLS CUI [1])
Item Group
LABORATORY TESTS
BLOOD SAMPLE
Item
Has a blood sample been taken ?
boolean
Item Group
INVESTIGATOR SIGNATURE
Date
Item
Date
date
Investigator signature
Item
Investigator signature :
text
Item Group
Long Term Follow-Up (Year 15)
Center Number
Item
Center
integer
Subject identification
Item
Subject Initials
text
Subject Number
Item
Subject Number
integer
Item Group
BLOOD SAMPLING
Consent
Item
I certify that Informed Consent has been obtained prior to any study procedure.
boolean
Informed Consent Date
Item
Informed Consent Date:
date
Item Group
DEMOGRAPHICS
Birth Date
Item
Date of birth:
date
Subject Initials
Item
Subject Initials
text
C2986440 (UMLS CUI [1])
Item Group
LABORATORY TESTS
BLOOD SAMPLE
Item
Has a blood sample been taken?
boolean
Item Group
INVESTIGATOR SIGNATURE
Date
Item
Date
date
Investigator signature
Item
Investigator signature :
text
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