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Patient Enrollment / Screen Failure

1 forms  
Administrative Data
Description

Administrative Data

Alias
UMLS CUI-1
C1320722
Site #
Description

Study centre number

Data type

integer

Alias
UMLS CUI [1,1]
C0600091
UMLS CUI [1,2]
C0019994
Patient #
Description

patient ID

Data type

integer

Alias
UMLS CUI [1]
C2348585
Visit Date
Description

visit date

Data type

date

Alias
UMLS CUI [1]
C1320303
Investigator Name
Description

Investigator Name

Data type

text

Alias
UMLS CUI [1]
C2826892
Patient Enrollment / Screen Failure
Description

Patient Enrollment / Screen Failure

Alias
UMLS CUI-1
C4041024
UMLS CUI-2
C1710476
Has the patient been enrolled into the study for Argatroban administration?
Description

*If No, check reason for patient not being enrolled into study:

Data type

text

Alias
UMLS CUI [1,1]
C2348568
UMLS CUI [1,2]
C1516879
UMLS CUI [1,3]
C0048470
Patient did not meet one or more of the inclusion/exclusion criteria
Description

Eligibility Criteria not met

Data type

boolean

Alias
UMLS CUI [1,1]
C1516637
UMLS CUI [1,2]
C0231175
Patient’s age stratification group is full
Description

Age stratification group full

Data type

boolean

Alias
UMLS CUI [1,1]
C0441833
UMLS CUI [1,2]
C1514983
UMLS CUI [1,3]
C0001779
UMLS CUI [1,4]
C0443225
Patient and/or guardian withdrew consent
Description

Consent withdrawal

Data type

boolean

Alias
UMLS CUI [1]
C1707492
Other
Description

Other reason of screen failure

Data type

boolean

Alias
UMLS CUI [1,1]
C1710476
UMLS CUI [1,2]
C0566251
UMLS CUI [1,3]
C0205394
Other, specify:
Description

Other reason of screen failure - specification

Data type

text

Alias
UMLS CUI [1,1]
C1710476
UMLS CUI [1,2]
C0566251
UMLS CUI [1,3]
C0205394
UMLS CUI [1,4]
C1521902
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Similar models

Patient Enrollment / Screen Failure

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Administrative Data
C1320722 (UMLS CUI-1)
Study centre number
Item
Site #
integer
C0600091 (UMLS CUI [1,1])
C0019994 (UMLS CUI [1,2])
patient ID
Item
Patient #
integer
C2348585 (UMLS CUI [1])
visit date
Item
Visit Date
date
C1320303 (UMLS CUI [1])
Investigator Name
Item
Investigator Name
text
C2826892 (UMLS CUI [1])
Item Group
Patient Enrollment / Screen Failure
C4041024 (UMLS CUI-1)
C1710476 (UMLS CUI-2)
Item
Has the patient been enrolled into the study for Argatroban administration?
text
C2348568 (UMLS CUI [1,1])
C1516879 (UMLS CUI [1,2])
C0048470 (UMLS CUI [1,3])
Patient enrolled into study for Argatroban administration
Code List
Has the patient been enrolled into the study for Argatroban administration?
CL Item
Yes (Yes)
CL Item
No* (No*)
Eligibility Criteria not met
Item
Patient did not meet one or more of the inclusion/exclusion criteria
boolean
C1516637 (UMLS CUI [1,1])
C0231175 (UMLS CUI [1,2])
Age stratification group full
Item
Patient’s age stratification group is full
boolean
C0441833 (UMLS CUI [1,1])
C1514983 (UMLS CUI [1,2])
C0001779 (UMLS CUI [1,3])
C0443225 (UMLS CUI [1,4])
Consent withdrawal
Item
Patient and/or guardian withdrew consent
boolean
C1707492 (UMLS CUI [1])
Other reason of screen failure
Item
Other
boolean
C1710476 (UMLS CUI [1,1])
C0566251 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
Other reason of screen failure - specification
Item
Other, specify:
text
C1710476 (UMLS CUI [1,1])
C0566251 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
C1521902 (UMLS CUI [1,4])
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