Inglés

Dosing Information - Circuit Prime and Bolus

1 formularios  
Administrative Data
Descripción

Administrative Data

Alias
UMLS CUI-1
C1320722
Site #
Descripción

Study centre number

Tipo de datos

integer

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

patient ID

Tipo de datos

integer

Alias
UMLS CUI [1]
C2348585
Visit Date
Descripción

visit date

Tipo de datos

date

Alias
UMLS CUI [1]
C1320303
Investigator Name
Descripción

Investigator Name

Tipo de datos

text

Alias
UMLS CUI [1]
C2826892
Check if (additional) supplemental instance of this form was used.
Descripción

Use one instance for every prime or for every nine boluses. Check this box on all instances except for the last one.

Tipo de datos

boolean

Alias
UMLS CUI [1]
C1706499
Instance Number
Descripción

Fill in the instance number, starting from 1. On all instances except for the last one, the preceding box has to be checked.

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C1516308
UMLS CUI [1,2]
C2348184
Dosing Information - Circuit Prime
Descripción

Dosing Information - Circuit Prime

Alias
UMLS CUI-1
C0678766
UMLS CUI-2
C1533716
UMLS CUI-3
C3805286
Equipment primed?
Descripción

*Protocol violation

Tipo de datos

text

Alias
UMLS CUI [1]
C3805286
**Primed dose: __ μg/__mL
Descripción

Part to be filled in: μg **Recommend 50μg/750mL

Tipo de datos

integer

Unidades de medida
  • μg
Alias
UMLS CUI [1,1]
C3174092
UMLS CUI [1,2]
C0304229
UMLS CUI [1,3]
C3805286
μg
**Primed dose: __ μg/__mL
Descripción

Part to be filled in: mL **Recommend 50μg/750mL

Tipo de datos

integer

Unidades de medida
  • mL
Alias
UMLS CUI [1,1]
C3174092
UMLS CUI [1,2]
C0304229
UMLS CUI [1,3]
C3805286
mL
Dosing Information - Bolus
Descripción

Dosing Information - Bolus

Alias
UMLS CUI-1
C0678766
UMLS CUI-2
C1533716
UMLS CUI-3
C1511237
Number of bolus administered
Descripción

Number of bolus administered

Tipo de datos

text

Alias
UMLS CUI [1,1]
C1511237
UMLS CUI [1,2]
C2348184
Was this bolus administered?
Descripción

Please fill in for all nine bolus numbers.

Tipo de datos

text

Alias
UMLS CUI [1,1]
C1511237
UMLS CUI [1,2]
C1521801
*If yes, bolus dose:
Descripción

Bolus dose

Tipo de datos

integer

Unidades de medida
  • mcg/kg
Alias
UMLS CUI [1]
C1511237
mcg/kg
Start Date:
Descripción

(dd-mmm-yyyy)

Tipo de datos

date

Alias
UMLS CUI [1,1]
C1511237
UMLS CUI [1,2]
C0808070
Start Time:
Descripción

(0000-2359)

Tipo de datos

time

Alias
UMLS CUI [1,1]
C1511237
UMLS CUI [1,2]
C1301880
Stop Time:
Descripción

(0000-2359)

Tipo de datos

time

Alias
UMLS CUI [1,1]
C1511237
UMLS CUI [1,2]
C1522314
Volver a la parte superior de la página

Similar models

Dosing Information - Circuit Prime and Bolus

1 formularios
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
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])
Additional form
Item
Check if (additional) supplemental instance of this form was used.
boolean
C1706499 (UMLS CUI [1])
CRF Sequential Number
Item
Instance Number
integer
C1516308 (UMLS CUI [1,1])
C2348184 (UMLS CUI [1,2])
Item Group
Dosing Information - Circuit Prime
C0678766 (UMLS CUI-1)
C1533716 (UMLS CUI-2)
C3805286 (UMLS CUI-3)
Item
Equipment primed?
text
C3805286 (UMLS CUI [1])
Circuit priming
Code List
Equipment primed?
CL Item
Yes (Yes)
CL Item
No* (No*)
Priming dose
Item
**Primed dose: __ μg/__mL
integer
C3174092 (UMLS CUI [1,1])
C0304229 (UMLS CUI [1,2])
C3805286 (UMLS CUI [1,3])
Priming dose
Item
**Primed dose: __ μg/__mL
integer
C3174092 (UMLS CUI [1,1])
C0304229 (UMLS CUI [1,2])
C3805286 (UMLS CUI [1,3])
Item Group
Dosing Information - Bolus
C0678766 (UMLS CUI-1)
C1533716 (UMLS CUI-2)
C1511237 (UMLS CUI-3)
Item
Number of bolus administered
text
C1511237 (UMLS CUI [1,1])
C2348184 (UMLS CUI [1,2])
Number of bolus administered
Code List
Number of bolus administered
CL Item
initial (initial)
CL Item
second (second)
CL Item
third (third)
CL Item
fourth (fourth)
CL Item
fifth (fifth)
CL Item
sixth (sixth)
CL Item
seventh (seventh)
CL Item
eighth (eighth)
CL Item
ninth (ninth)
Item
Was this bolus administered?
text
C1511237 (UMLS CUI [1,1])
C1521801 (UMLS CUI [1,2])
Bolus administered
Code List
Was this bolus administered?
CL Item
Yes* (Yes*)
CL Item
No (No)
Bolus dose
Item
*If yes, bolus dose:
integer
C1511237 (UMLS CUI [1])
Bolus start date
Item
Start Date:
date
C1511237 (UMLS CUI [1,1])
C0808070 (UMLS CUI [1,2])
Bolus start time
Item
Start Time:
time
C1511237 (UMLS CUI [1,1])
C1301880 (UMLS CUI [1,2])
Bolus stop time
Item
Stop Time:
time
C1511237 (UMLS CUI [1,1])
C1522314 (UMLS CUI [1,2])
Volver a la parte superior de la página