Forms in DM (2)
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Example Case Report Forms for DM domain
Sources: DB1 | Forms loaded: 2
Form: Demographics
Show domain info
Primary Domain
DM
All Domains
DM, RP
# Question Response
1
Sex
demog.SEX
2
Age
demog.AGE_RAW
3
Age units
demog.AGE_U
4
Ethnicity
demog.ETHNIC
5
Race
demog.RACE
6
Specify if Race is “Other”
demog.RACESP
7
Date of birth
demog.BIRTHDT_RAW
8
Is subject of child bearing status
demog.CHILDPOT
Example Case Report Forms for DM domain
Sources: DB1 | Forms loaded: 2
Form: Enrollment
Show domain info
Primary Domain
DM
All Domains
DM, DS
# Question Response
1
Date Consent Form Signed
enrlment.ICDT_RAW
2
Consent Version Number
enrlment.ICVERS
3
Protocol Version
enrlment.PRTVERS
4
Date of Enrollment
enrlment.ENRLDT_RAW
5
Date of Randomization
enrlment.RANDDT_RAW
6
Randomization number
enrlment.RANDNO