English

CRB Electronic Signature Affidavit

1 forms  
CRB Electronic Signature Affidavit
Description

CRB Electronic Signature Affidavit

Alias
UMLS CUI-1
C2346576
By my dated signature below, I, (First Name) (Last Name) verify that this case report form accurately displays the results of the examinations, tests, evaluations and treatments performed on this patient.
Description

Investigator Name

Data type

text

Alias
UMLS CUI [1]
C2826892
Date
Description

Investigator Signature, Date in time

Data type

date

Alias
UMLS CUI [1,1]
C2346576
UMLS CUI [1,2]
C0011008
Investigator Signature
Description

Investigator Signature

Data type

text

Alias
UMLS CUI [1]
C2346576
Back to the top of the page

Similar models

CRB Electronic Signature Affidavit

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
CRB Electronic Signature Affidavit
C2346576 (UMLS CUI-1)
Investigator Name
Item
By my dated signature below, I, (First Name) (Last Name) verify that this case report form accurately displays the results of the examinations, tests, evaluations and treatments performed on this patient.
text
C2826892 (UMLS CUI [1])
Investigator Signature, Date in time
Item
Date
date
C2346576 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Investigator Signature
Item
Investigator Signature
text
C2346576 (UMLS CUI [1])
Back to the top of the page