0 Ratings
ID

43736

Description

Protocol Identifier RRL 100013 A 12 Week, Double-Blind, Placebo Controlled, Twice Daily Dosing Study to Assess the Efficacy and Safety of Ropinirole in Patients Suffering from Restless Legs Syndrome (RLS) Requiring Extended Treatment Coverage

Keywords

Versions (2)
  1. 5/9/17 5/9/17 -
  2. 9/20/21 9/20/21 -
Uploaded on

September 20, 2021

DOI

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License

Creative Commons BY-NC 3.0
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    Case Report Form GSK

    German English

    Case report form RRL 100013

    1 forms  
    Patient demographics
    Description

    Patient demographics

    Subject Identifier
    Description

    Subject Identifier

    Data type

    integer

    Alias
    UMLS CUI [1]
    C2348585 (Clinical Trial Subject Unique Identifier)
    Date of birth
    Description

    Date of birth

    Data type

    date

    Alias
    UMLS CUI [1]
    C0421451 (Patient date of birth)
    SNOMED
    184099003
    LOINC
    LP57552-9
    Date of visit
    Description

    Date of visit

    Data type

    date

    Alias
    UMLS CUI [1]
    C1320303 (Date of visit)
    SNOMED
    406543005
    Gender
    Description

    Gender

    Data type

    integer

    Alias
    UMLS CUI [1]
    C0079399 (Gender)
    SNOMED
    263495000
    LOINC
    LP61312-2
    Ethnicity
    Description

    Please tick on box

    Data type

    integer

    Alias
    UMLS CUI [1]
    C0015031 (Ethnic group)
    SNOMED
    398089004
    LOINC
    LP36231-6
    Race
    Description

    check all that apply

    Data type

    integer

    Alias
    UMLS CUI [1]
    C0034510 (Racial group)
    SNOMED
    415229000
    LOINC
    LP7528-5
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    Similar models

    Case report form RRL 100013

    1 forms
    Name
    Type
    Description | Question | Decode (Coded Value)
    Data type
    Alias
    Item Group
    Patient demographics
    Subject Identifier
    Item
    Subject Identifier
    integer
    C2348585 (UMLS CUI [1])
    Date of birth
    Item
    Date of birth
    date
    C0421451 (UMLS CUI [1])
    Date of visit
    Item
    Date of visit
    date
    C1320303 (UMLS CUI [1])
    Item
    Gender
    integer
    C0079399 (UMLS CUI [1])
    Gender
    Code List
    Gender
    CL Item
    male (m)
    C0086582 (UMLS CUI-1)
    CL Item
    female (f)
    C0086287 (UMLS CUI-1)
    Item
    Ethnicity
    integer
    C0015031 (UMLS CUI [1])
    Ethnicity
    Code List
    Ethnicity
    CL Item
    Hispanic or Latino (1)
    C0019576 (UMLS CUI-1)
    CL Item
    Not Hispanic or Latino (2)
    C1518424 (UMLS CUI-1)
    Item
    Race
    integer
    C0034510 (UMLS CUI [1])
    Race
    Code List
    Race
    CL Item
    African American/African Heritage (1)
    C0085756 (UMLS CUI-1)
    CL Item
    American Indian or Alaskan Native (2)
    C0682125 (UMLS CUI-1)
    CL Item
    Asian - Central/South Asian Heritage (3)
    CL Item
    Asian - East Asian Heritage (4)
    CL Item
    Asian - Japanese Heritage (5)
    CL Item
    Asian - South East Asian Heritage (6)
    CL Item
    Native Hawaiian or Other Pacific Islander (7)
    CL Item
    White - Arabic/North African Heritage (8)
    CL Item
    White - White/Caucasian/European Heritage (9)
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