Significant Medical/Surgical History
If Yes, list below one diagnosis per line. (Please print clearly) Only in the absence of a diagnosis, record the signs and symptoms on separate lines.
text
Diagnosis
text
Investigator Use
text
Month/Year
partialDate
Diagnosis from past
boolean
Ongoing disease
boolean
Physical Examination
day month year
date
"Physical Examination should be performed and any relevant findings must be described on the Medical History form (for findings of the past), or on the Baseline Sign/Symptom form (for findings presently occurring, events existing prior to drug administration). IMPORTANT: these findings, or events, must have a complete starting date that is at, or before, the date of the assessment (so that these are clearly pre-treatment findings, or events)." If any clinically significant abnormalities are present, DO NOT INCLUDE the subject.
text
Findings, specification
integer
Other findings
text