12-Lead ECG
Date and Time of ECG
datetime
12-Lead ECG - Hart rate
integer
PR Intreval
integer
QRS Duration
integer
Uncorrected QT Interval
integer
QTc Interval
integer
Method of QTc Calculation
integer
Result of the ECG
integer
Summary Holter
Start Date and Time of Holter
datetime
Stop Date and Time of Holter
datetime
Interpretation of Holter
integer
Holter monitoring method
integer
Summary Holter Abnormalities
Start Date and Time of Holter
datetime
Stop Date and Time of Holter
datetime
Check all that apply
text
Other abnormal rhythm
text
Other morphology
text
Other conduction
text
Other myocardial infarction
text
Other depolarisation/repolarisation
text
Other abnormality/ Cardiologist comments
text
Vital Signs - Pre-Baseline Scan
Vital Signs - Actual date/time
datetime
Systolic Blood pressure
integer
Diastolic Blood pressure
integer
Temperature
text
Vital signs - Heart rate
integer
Respiration rate
integer
Electronically Transerred Lab Data
Haematology Date and time sample taken
datetime
Haematology sample not taken
integer
Clinical Chemistry Date and time sample taken
datetime
Clinical Chemistry sample not taken
integer
Serum Prolactin Date and time sample taken
datetime
Serum Prolactin sample not taken
integer
TSH Date and time sample taken
datetime
TSH sample not taken
integer
Testosterone Date and time sample taken
datetime
Testosterone sample not taken
integer
Urinalysis - Dipstick Details
Urinalysis Date and time sample taken
datetime
Urinalysis Sample not taken
integer
Urinalysis Dipstick - pH
integer
Urinalysis Dipstick - pHN umeric Result
float
Urinalysis Dipstick - pH Character Result
text
Urinalysis Dipstick - Specific Gravity
integer
Urinalysis Dipstick - Specific Gravitiy Numeric Result
float
Urinalysis Dipstick - Specific Gravitiy Character Result
text
Urinalysis Dipstick - Protein
integer
Urinalysis Dipstick - Protein Numeric Result
float
Urinalysis Dipstick - Protein Character Result
text
Urinalysis Dipstick - Glucose
integer
Urinalysis Dipstick - Glucose Numeric Result
float
Urinalysis Dipstick - Glucose Character Result
text
Urinalysis Dipstick - Ketones
integer
Urinalysis Dipstick - Ketones Numeric Result
float
Urinalysis Dipstick - Ketones Character Result
text
Urinalysis Dipstick - RBC
integer
Urinalysis Dipstick - RBC Numeric Result
float
Urinalysis Dipstick - RBC Character Result
text
Urinalysis Dipstick - WBC
integer
Urinalysis Dipstick - WBC Numeric Result
float
Urinalysis Dipstick - WBC Character Result
text
Result of dipstick
text
If yes, provide details on the MICROSCOPY form.
boolean
Urinalysis - Microscopy Details
Urinalysis Microscopy - Date and time sample taken
datetime
Urinalysis Microscopy - White blood cells
integer
Urinalysis Microscopy - White blood cells Numeric Result
float
Urinalysis Microscopy - White blood cells Character Result
text
Urinalysis Microscopy - Red blood cells
integer
Urinalysis Microscopy - Red blood cells Numeric Result
float
Urinalysis Microscopy - Red blood cells Character Result
text
Urinalysis Microscopy - Hyaline casts
integer
Urinalysis Microscopy - Hyaline casts Numeric Result
float
Urinalysis Microscopy - Hyaline casts Character Result
text
Urinalysis Microscopy - Granular casts
integer
Urinalysis Microscopy - Granular casts Numeric Result
float
Urinalysis Microscopy - Granular casts Character Result
text
Urinalysis Microscopy - Cellular casts
integer
Urinalysis Microscopy - Cellular casts Numeric Result
float
Urinalysis Microscopy - Cellular casts Character Result
text
PET - Scan Baseline
Date of PET Scan
date
PET Examination Number
integer
Radiochemical purity at release
integer
Radiochemical purity time at release
time
Mass of tracer administered
float
Volume to be administered (inc diluent)
float
Bolus activity injected
float
Bolus injection Start time
time
Duration of bolus injection
durationDatetime
Constant infusion activity concentration (at start of infusion)
float
Constant infusion start time
time
Constant infusion stop time
time
Volume of constant infusion administered
float
Functional MRI Scan
Has an fMRI scan been carried out?
boolean
If fMRI has been carried out, enter date of fMRI Scan
date
fMRI Examination Number
integer
fMRI Scan start time
time
fMRI Scan end time
time
Leave blank if scan was without incident (e.g., ‘subject moved’, subject was coughing‘)
text
MRI Scan
Has an MRI scan been carried out?
boolean
If MRI has been carried out, enter date of MRI Scan
date
MRI Examination Number
integer
MRI Scan start time
time
MRI Scan end time
time
Leave blank if scan was without incident (e.g., subject moved’, subject was coughing)
text
Randomisation Number
Was the subject able to be randomised?
boolean
If Sucject was randomised, provide Randomisation number
integer
Date of randomisation
date