Englisch

Diary Card 3: Concomitant Medications

1 Formulare  
Administrative data
Beschreibung

Administrative data

Subject Number
Beschreibung

Subject Number

Datentyp

integer

Dose
Beschreibung

Dose

Datentyp

text

Medication
Beschreibung

Medication

Trade Name/Generic Name
Beschreibung

Trade Name/Generic Name

Datentyp

text

Reason
Beschreibung

Reason

Datentyp

text

Total Daily Dose?
Beschreibung

Total Daily Dose?

Datentyp

text

Start Date
Beschreibung

Start Date

Datentyp

date

End Date
Beschreibung

End Date

Datentyp

date

Ongoing?
Beschreibung

Ongoing?

Datentyp

boolean

Reminder
Beschreibung

Reminder

Please do not forget to bring back the diary card on
Beschreibung

fill the date below

Datentyp

date

In case of hospitalisation, please inform
Beschreibung

fill the name below

Datentyp

text

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Ähnliche Modelle

Diary Card 3: Concomitant Medications

1 Formulare
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Administrative data
Subject Number
Item
Subject Number
integer
Item
Dose
text
Dose
Code List
Dose
CL Item
Dose 3 (1)
Item Group
Medication
Trade Name/Generic Name
Item
Trade Name/Generic Name
text
Item
Reason
text
Intensity
Code List
Reason
Total Daily Dose?
Item
Total Daily Dose?
text
Start Date
Item
Start Date
date
End Date
Item
End Date
date
Ongoing?
Item
Ongoing?
boolean
Item Group
Reminder
Please do not forget to bring back the diary card on
Item
Please do not forget to bring back the diary card on
date
In case of hospitalisation, please inform
Item
In case of hospitalisation, please inform
text
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