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Screen Failure

1 forms  
  1. StudyEvent: ODM
    1. Screen Failure
Date of Visit/ Assessment
Description

Date of Visit/ Assessment

Alias
UMLS CUI-1
C1320303
UMLS CUI-2
C2985720
Date of Visit/ Assessment
Description

Date of Visit/ Assessment

Data type

date

Alias
UMLS CUI [1,1]
C1320303
UMLS CUI [1,2]
C2985720
Screen Failure
Description

Screen Failure

Alias
UMLS CUI-1
C1710476
Was this subject a screen failure?
Description

Was this subject a screen failure?

Data type

boolean

Alias
UMLS CUI [1]
C1710476
Screen failure date
Description

Screen failure date

Data type

date

Alias
UMLS CUI [1,1]
C1710476
UMLS CUI [1,2]
C0011008
Reason for Screen Failure
Description

Reason for Screen Failure

Data type

text

Alias
UMLS CUI [1,1]
C1710476
UMLS CUI [1,2]
C0566251
If reason for screen failure is investigator discretion, specify
Description

If reason for screen failure is investigator discretion, specify

Data type

text

Alias
UMLS CUI [1,1]
C1710476
UMLS CUI [1,2]
C0566251
UMLS CUI [2,1]
C0008961
UMLS CUI [2,2]
C0022423
UMLS CUI [3]
C2348235
If reason for screen failure is withdrew consent, specify
Description

If reason for screen failure is withdrew consent, specify

Data type

text

Alias
UMLS CUI [1,1]
C1710476
UMLS CUI [1,2]
C0566251
UMLS CUI [2]
C1707492
UMLS CUI [3]
C2348235
Investigator Signature
Description

Investigator Signature

Alias
UMLS CUI-1
C2346576
Is this casebook ready to sign?
Description

Is this casebook ready to sign?

Data type

text

Alias
UMLS CUI [1]
C2346576
Tick or untick this box to require the investigator to re-sign the case book
Description

For Data Managers or Monitors only

Data type

integer

Alias
UMLS CUI [1,1]
C2346576
UMLS CUI [1,2]
C0205341
UMLS CUI [1,3]
C1514873
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Similar models

Screen Failure

1 forms
  1. StudyEvent: ODM
    1. Screen Failure
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Date of Visit/ Assessment
C1320303 (UMLS CUI-1)
C2985720 (UMLS CUI-2)
Date of Visit/ Assessment
Item
Date of Visit/ Assessment
date
C1320303 (UMLS CUI [1,1])
C2985720 (UMLS CUI [1,2])
Item Group
Screen Failure
C1710476 (UMLS CUI-1)
Was this subject a screen failure?
Item
Was this subject a screen failure?
boolean
C1710476 (UMLS CUI [1])
Screen failure date
Item
Screen failure date
date
C1710476 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item
Reason for Screen Failure
text
C1710476 (UMLS CUI [1,1])
C0566251 (UMLS CUI [1,2])
Reason for Screen Failure
Code List
Reason for Screen Failure
CL Item
Did not meet inclusion/exclusion criteria (F01)
CL Item
Adverse Event (F02)
CL Item
Lost to follow up (F07)
CL Item
Investigator discretion, specify (F08)
CL Item
Withdrew consent, specify (F09)
If reason for screen failure is investigator discretion, specify
Item
If reason for screen failure is investigator discretion, specify
text
C1710476 (UMLS CUI [1,1])
C0566251 (UMLS CUI [1,2])
C0008961 (UMLS CUI [2,1])
C0022423 (UMLS CUI [2,2])
C2348235 (UMLS CUI [3])
If reason for screen failure is withdrew consent, specify
Item
If reason for screen failure is withdrew consent, specify
text
C1710476 (UMLS CUI [1,1])
C0566251 (UMLS CUI [1,2])
C1707492 (UMLS CUI [2])
C2348235 (UMLS CUI [3])
Item Group
Investigator Signature
C2346576 (UMLS CUI-1)
Item
Is this casebook ready to sign?
text
C2346576 (UMLS CUI [1])
Is this casebook ready to sign?
Code List
Is this casebook ready to sign?
CL Item
Yes (Y)
Item
Tick or untick this box to require the investigator to re-sign the case book
integer
C2346576 (UMLS CUI [1,1])
C0205341 (UMLS CUI [1,2])
C1514873 (UMLS CUI [1,3])
Tick or untick this box to require the investigator to re-sign the case book
Code List
Tick or untick this box to require the investigator to re-sign the case book
CL Item
Require the investigator to re-sign the case book (1)
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