ID
44769
Description
ODM Form derived from: https://ictr.wisc.edu/CaseReptTempt. Template Name: Device Accountability Log. Case Report Form (CRF)/Source Document templates were created for University of Wisconsin-Madison researchers. These templates are consistent with the FDA's CDASH (Clinical Data Acquisition Standards Harmonization) standards. The CDASH standards identify those elements that should be captured on a Case Report Form (CRF). The forms serve only as templates, and must be edited to meet the study data collection needs as described in the protocol.
Link
https://ictr.wisc.edu/CaseReptTempt
Keywords
Versions (4)
- 7/26/16 7/26/16 -
- 11/18/16 11/18/16 -
- 4/13/21 4/13/21 - Dr. rer. medic Philipp Neuhaus
- 11/17/21 11/17/21 -
Copyright Holder
University of Wisconsin-Madison
Uploaded on
November 17, 2021
DOI
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License
Creative Commons BY-NC 4.0
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Device Accountability Log: CRF Wisconsin Madison
Device Accountability Log: CRF Wisconsin Madison
- StudyEvent: ODM
Description
Device Accountability Log: Device Receipt
Description
Date Received
Data type
date
Alias
- UMLS CUI [1,1]
- C0011008
- UMLS CUI [1,2]
- C1514756
Description
Batch # or Device Type
Data type
text
Alias
- UMLS CUI [1]
- C3641829
- UMLS CUI [2]
- C0449497
Description
Lot #, Serial #, or Model Number(s)
Data type
integer
Alias
- UMLS CUI [1]
- C1115660
- UMLS CUI [2]
- C2348188
- UMLS CUI [3]
- C3274659
Description
Received by (staff initials)
Data type
text
Alias
- UMLS CUI [1,1]
- C1709850
- UMLS CUI [1,2]
- C2986440
Description
Device Accountability Log: Device Use
Description
Device Accountability Log: Device Return/Repair/Destruction
Description
RET = Returned DES = Destroyed REP = Repaired
Data type
text
Alias
- UMLS CUI [1,1]
- C0025080
- UMLS CUI [1,2]
- C0733755
Description
Date of final Device Disposition
Data type
date
Alias
- UMLS CUI [1,1]
- C0011008
- UMLS CUI [1,2]
- C0743223
- UMLS CUI [1,3]
- C0025080
Description
Reason
Data type
text
Alias
- UMLS CUI [1]
- C0392360
Description
Confirmed by (staff initials)
Data type
text
Alias
- UMLS CUI [1,1]
- C0521093
- UMLS CUI [1,2]
- C2986440
Description
Comments
Data type
text
Alias
- UMLS CUI [1]
- C0947611
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Device Accountability Log: CRF Wisconsin Madison
- StudyEvent: ODM
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C0449788 (UMLS CUI [1,2])
C0449788 (UMLS CUI [1,2])
C1514756 (UMLS CUI [1,2])
C0449497 (UMLS CUI [2])
C2348188 (UMLS CUI [2])
C3274659 (UMLS CUI [3])
C2986440 (UMLS CUI [1,2])
C0733755 (UMLS CUI [1,2])
C0743223 (UMLS CUI [1,2])
C0025080 (UMLS CUI [1,3])
C2986440 (UMLS CUI [1,2])