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Reason for Non Participation - Tracking Form

1 forms  
Administrative data
Description

Administrative data

Alias
UMLS CUI-1
C1320722
Center Number
Description

Center number

Data type

integer

Alias
UMLS CUI [1,1]
C0600091
UMLS CUI [1,2]
C0019994
Reason for non participation
Description

Reason for non participation

Alias
UMLS CUI-1
C0566251
UMLS CUI-2
C0558080
UMLS CUI-3
C2348568
Subject Number
Description

Subject Number

Data type

integer

Alias
UMLS CUI [1]
C2348585
Subject could not be reached due to
Description

Reason subject not reached

Data type

text

Alias
UMLS CUI [1,1]
C0332158
UMLS CUI [1,2]
C0681850
UMLS CUI [1,3]
C1272705
Subject could be contacted
Description

Subject contacted

Data type

text

Alias
UMLS CUI [1,1]
C0332158
UMLS CUI [1,2]
C0681850
Record eligibility criteria that was failed
Description

if applies

Data type

text

Alias
UMLS CUI [1,1]
C1516637
UMLS CUI [1,2]
C0231175
Subject is eligible but not willing to participate due to
Description

if applies

Data type

text

Alias
UMLS CUI [1,1]
C3846156
UMLS CUI [1,2]
C0392360
Day of contact
Description

In case of death, date of contact not requested

Data type

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C1705415
Investigator's Signature
Description

Investigator's Signature

Alias
UMLS CUI-1
C2346576
Investigator's name (in Print)
Description

Investigator's name

Data type

text

Alias
UMLS CUI [1]
C2826892
Investigator's Signature
Description

Investigator's Signature

Data type

text

Alias
UMLS CUI [1]
C2346576
Date
Description

Date

Data type

date

Alias
UMLS CUI [1]
C0011008
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Similar models

Reason for Non Participation - Tracking Form

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Administrative data
C1320722 (UMLS CUI-1)
Center number
Item
Center Number
integer
C0600091 (UMLS CUI [1,1])
C0019994 (UMLS CUI [1,2])
Item Group
Reason for non participation
C0566251 (UMLS CUI-1)
C0558080 (UMLS CUI-2)
C2348568 (UMLS CUI-3)
Subject Number
Item
Subject Number
integer
C2348585 (UMLS CUI [1])
Item
Subject could not be reached due to
text
C0332158 (UMLS CUI [1,1])
C0681850 (UMLS CUI [1,2])
C1272705 (UMLS CUI [1,3])
Subject could not be reached due to
Code List
Subject could not be reached due to
CL Item
Lost to follow-up (LFU)
CL Item
Migrated/moved from study area (MIG)
CL Item
Death (DEA)
Item
Subject could be contacted
text
C0332158 (UMLS CUI [1,1])
C0681850 (UMLS CUI [1,2])
Subject could be contacted
Code List
Subject could be contacted
CL Item
Not eligible (record criteria) (NEL)
CL Item
Eligible but not willing to participate (record reason for it) (ELU)
Eligibility criteria that was failed
Item
Record eligibility criteria that was failed
text
C1516637 (UMLS CUI [1,1])
C0231175 (UMLS CUI [1,2])
Item
Subject is eligible but not willing to participate due to
text
C3846156 (UMLS CUI [1,1])
C0392360 (UMLS CUI [1,2])
Subject is eligible but not willing to participate due to
Code List
Subject is eligible but not willing to participate due to
CL Item
Consent withdrawal not due to an AE (CWS)
CL Item
Serious adverse event (SAE)
CL Item
Adverse event (AEX)
CL Item
Other (OTH)
Day of contact
Item
Day of contact
date
C0011008 (UMLS CUI [1,1])
C1705415 (UMLS CUI [1,2])
Item Group
Investigator's Signature
C2346576 (UMLS CUI-1)
Investigator's name
Item
Investigator's name (in Print)
text
C2826892 (UMLS CUI [1])
Investigator's Signature
Item
Investigator's Signature
text
C2346576 (UMLS CUI [1])
Date
Item
Date
date
C0011008 (UMLS CUI [1])
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