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Logs and repeats: Investigational product

1 forms  
Administrative Data
Description

Administrative Data

Alias
UMLS CUI-1
C1320722
Subject number
Description

Subject number

Data type

integer

Alias
UMLS CUI [1]
C2348585
Investigational product
Description

Investigational product

Alias
UMLS CUI-1
C0304229
Sequence Number
Description

Sequence Number

Data type

integer

Alias
UMLS CUI [1]
C2348184
Date Dispensed
Description

day month year

Data type

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0947323
Total number of sachets/tablets dispensed
Description

Total number of sachets/tablets dispensed

Data type

integer

Alias
UMLS CUI [1,1]
C0805077
UMLS CUI [1,2]
C0039225
Container number
Description

Container number

Data type

text

Alias
UMLS CUI [1,1]
C0304229
UMLS CUI [1,2]
C0180098
UMLS CUI [1,3]
C0600091
Did the subject return the investigational product?
Description

If you tick yes, please note the date of return and the total number of sachets/tablets returned in the appropriate items. If you tick no, please specify in the appropriate item.

Data type

text

Alias
UMLS CUI [1,1]
C0332156
UMLS CUI [1,2]
C0304229
Date of subject return the investigational product
Description

day month year

Data type

date

Alias
UMLS CUI [1,1]
C0332156
UMLS CUI [1,2]
C0304229
UMLS CUI [1,3]
C0011008
Total number of sachets/tablets returned
Description

Total number of sachets/tablets returned

Data type

integer

Alias
UMLS CUI [1,1]
C2699071
UMLS CUI [1,2]
C0304229
UMLS CUI [2,1]
C2699071
UMLS CUI [2,2]
C0039225
No return of investigational product, specification
Description

No return of investigational product, specification

Data type

text

Alias
UMLS CUI [1,1]
C1298908
UMLS CUI [1,2]
C0332156
UMLS CUI [1,3]
C0304229
UMLS CUI [1,4]
C2348235
Investigational Product. Tick if Open-label tablets
Description

In the original form this item is hidden

Data type

boolean

Alias
UMLS CUI [1,1]
C0304229
UMLS CUI [1,2]
C3640652
Tablets dose received
Description

If subject did not receive tablet but suspension, fill in the item "Suspension dose received". If you tick alternating dose, please specify in the appropriate item.

Data type

integer

Alias
UMLS CUI [1,1]
C0039225
UMLS CUI [1,2]
C0304229
UMLS CUI [1,3]
C1514756
If alternating tablets dose, please specify
Description

Alternating dose

Data type

text

Alias
UMLS CUI [1,1]
C0332270
UMLS CUI [1,2]
C0039225
Suspension dose received
Description

If subject did not receive suspension but tablets, fill in the item "Tablets dose received".

Data type

integer

Measurement units
  • mg
Alias
UMLS CUI [1,1]
C0038960
UMLS CUI [1,2]
C0304229
UMLS CUI [1,3]
C0178602
UMLS CUI [1,4]
C1514756
mg
Frequency of investigational product
Description

Frequency

Data type

text

Alias
UMLS CUI [1,1]
C0439603
UMLS CUI [1,2]
C0304229
Units of dosage
Description

In the original form this item is hidden.

Data type

text

Alias
UMLS CUI [1,1]
C1519795
UMLS CUI [1,2]
C0304229
Route of investigational product
Description

In the original form this item is hidden.

Data type

text

Alias
UMLS CUI [1,1]
C0013153
UMLS CUI [1,2]
C0304229
Formulation of investigational product
Description

In the original form this item is hidden.

Data type

text

Alias
UMLS CUI [1,1]
C1705957
UMLS CUI [1,2]
C0304229
Did the subject receive the correct treatment/dose (e.g., treatment which the subject was assigned to) during this dosing interval?
Description

Note: For Day 1 dosing, please enter Yes If you tick no, please record reason(s) in the following item.

Data type

text

Alias
UMLS CUI [1,1]
C0087111
UMLS CUI [1,2]
C2349182
UMLS CUI [1,3]
C0347984
UMLS CUI [1,4]
C0178602
UMLS CUI [1,5]
C1272706
UMLS CUI [2,1]
C2349182
UMLS CUI [2,2]
C0178602
UMLS CUI [2,3]
C0347984
UMLS CUI [2,4]
C0178602
UMLS CUI [2,5]
C1272706
If there was no correct treatment/dose during dosage interval, please record reason(s)
Description

No correct treatment/dose, reason

Data type

text

Alias
UMLS CUI [1,1]
C0392360
UMLS CUI [1,2]
C1298908
UMLS CUI [1,3]
C2349182
UMLS CUI [1,4]
C0087111
UMLS CUI [2,1]
C0392360
UMLS CUI [2,2]
C1298908
UMLS CUI [2,3]
C2349182
UMLS CUI [2,4]
C0178602
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Similar models

Logs and repeats: Investigational product

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Administrative Data
C1320722 (UMLS CUI-1)
Subject number
Item
Subject number
integer
C2348585 (UMLS CUI [1])
Item Group
Investigational product
C0304229 (UMLS CUI-1)
Sequence Number
Item
Sequence Number
integer
C2348184 (UMLS CUI [1])
Date Dispensed
Item
Date Dispensed
date
C0011008 (UMLS CUI [1,1])
C0947323 (UMLS CUI [1,2])
Total number of sachets/tablets dispensed
Item
Total number of sachets/tablets dispensed
integer
C0805077 (UMLS CUI [1,1])
C0039225 (UMLS CUI [1,2])
Container number
Item
Container number
text
C0304229 (UMLS CUI [1,1])
C0180098 (UMLS CUI [1,2])
C0600091 (UMLS CUI [1,3])
Item
Did the subject return the investigational product?
text
C0332156 (UMLS CUI [1,1])
C0304229 (UMLS CUI [1,2])
Investigational product return
Code List
Did the subject return the investigational product?
CL Item
Yes (Y)
CL Item
No (N)
Date of subject return the investigational product
Item
Date of subject return the investigational product
date
C0332156 (UMLS CUI [1,1])
C0304229 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
Total number of sachets/tablets returned
Item
Total number of sachets/tablets returned
integer
C2699071 (UMLS CUI [1,1])
C0304229 (UMLS CUI [1,2])
C2699071 (UMLS CUI [2,1])
C0039225 (UMLS CUI [2,2])
No return of investigational product, specification
Item
No return of investigational product, specification
text
C1298908 (UMLS CUI [1,1])
C0332156 (UMLS CUI [1,2])
C0304229 (UMLS CUI [1,3])
C2348235 (UMLS CUI [1,4])
Investigational Product open-label
Item
Investigational Product. Tick if Open-label tablets
boolean
C0304229 (UMLS CUI [1,1])
C3640652 (UMLS CUI [1,2])
Item
Tablets dose received
integer
C0039225 (UMLS CUI [1,1])
C0304229 (UMLS CUI [1,2])
C1514756 (UMLS CUI [1,3])
Tablets dose received
Code List
Tablets dose received
CL Item
0 mg (Dose interruption period) (0)
CL Item
12.5 mg (1)
CL Item
25 mg (2)
CL Item
37.5 mg (3)
CL Item
50 mg (4)
CL Item
62.5 mg (5)
CL Item
75 mg (6)
CL Item
Alternating Dose (7)
Alternating dose
Item
If alternating tablets dose, please specify
text
C0332270 (UMLS CUI [1,1])
C0039225 (UMLS CUI [1,2])
Suspension dose received
Item
Suspension dose received
integer
C0038960 (UMLS CUI [1,1])
C0304229 (UMLS CUI [1,2])
C0178602 (UMLS CUI [1,3])
C1514756 (UMLS CUI [1,4])
Item
Frequency of investigational product
text
C0439603 (UMLS CUI [1,1])
C0304229 (UMLS CUI [1,2])
Frequency
Code List
Frequency of investigational product
CL Item
Every day (QD)
CL Item
Every other day (QOD)
CL Item
Every 3 days (Q3D)
CL Item
Every 4 days (Q4D)
CL Item
Every 5 days (Q5D)
CL Item
Every 6 days (Q6D)
CL Item
Every week (QWK)
CL Item
Twice weekly (2XW)
CL Item
3 times a week (3XW)
CL Item
4 times a week (4XW)
CL Item
5 times a week (5XW)
CL Item
6 times a week (6XW)
Item
Units of dosage
text
C1519795 (UMLS CUI [1,1])
C0304229 (UMLS CUI [1,2])
Units
Code List
Units of dosage
CL Item
Milligram (MG)
Item
Route of investigational product
text
C0013153 (UMLS CUI [1,1])
C0304229 (UMLS CUI [1,2])
Units
Code List
Route of investigational product
CL Item
Oral (PO)
Item
Formulation of investigational product
text
C1705957 (UMLS CUI [1,1])
C0304229 (UMLS CUI [1,2])
Units
Code List
Formulation of investigational product
CL Item
Tablet (TAB)
CL Item
Suspension (SUSP)
Item
Did the subject receive the correct treatment/dose (e.g., treatment which the subject was assigned to) during this dosing interval?
text
C0087111 (UMLS CUI [1,1])
C2349182 (UMLS CUI [1,2])
C0347984 (UMLS CUI [1,3])
C0178602 (UMLS CUI [1,4])
C1272706 (UMLS CUI [1,5])
C2349182 (UMLS CUI [2,1])
C0178602 (UMLS CUI [2,2])
C0347984 (UMLS CUI [2,3])
C0178602 (UMLS CUI [2,4])
C1272706 (UMLS CUI [2,5])
Investigational product return
Code List
Did the subject receive the correct treatment/dose (e.g., treatment which the subject was assigned to) during this dosing interval?
CL Item
Yes (Y)
CL Item
No (N)
No correct treatment/dose, reason
Item
If there was no correct treatment/dose during dosage interval, please record reason(s)
text
C0392360 (UMLS CUI [1,1])
C1298908 (UMLS CUI [1,2])
C2349182 (UMLS CUI [1,3])
C0087111 (UMLS CUI [1,4])
C0392360 (UMLS CUI [2,1])
C1298908 (UMLS CUI [2,2])
C2349182 (UMLS CUI [2,3])
C0178602 (UMLS CUI [2,4])
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