cm CRFs

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Example Case Report Forms for CM domain

Form: Anti-hyperglycemic agents

Question	Response
Collection Date	CM.CMDTC
Did the subject take any anti-hyperglycemic agent in the last 10 years?	Yes No "CMTRT=""ANTI-HYPERGLYCEMIC"" CM.CMOCCUR CM.CMPRESP=""Y"" CM.CMEVLINT=""-P10Y"""
If yes, List the Treatments received
Treatment Name	CM.CMTRT
Start Date	CM.CMSTDTC
Ongoing?	Yes No CM.CMENRTPT
End Date	CM.CMENDTC
Dose	CM.CMDOSE
Dose Unit	mg ug mL g IU CM.CMDOSU
Frequency	BID TID QID QOD QM PRN UNKNOWN CM.CMDOSFRQ
Route	ORAL TOPICAL SUBCUTANEOUS TRANSDERMAL INTRAOCULAR INTRAMUSCULAR RESPIRATORY (INHALATION) INTRAPERITONIAL NASAL RECTAL CM.CMROUTE

Form: General Concomitant Medications

Question	Response
Treatment Name	CM.CMTRT
Taken prior to the study?	Yes No SUPPCM.CMPRIOR
Indication	CM.CMINDC
Start Date	CM.CMSTDTC
Ongoing?	Yes No CM.CMENRTPT
End Date	CM.CMENDTC
Dose	CM.CMDOSE
Dose Unit	mg ug mL g IU CM.CMDOSU
Frequency	BID TID QID QOD QM PRN UNKNOWN CM.CMDOSFRQ
Route	ORAL TOPICAL SUBCUTANEOUS TRANSDERMAL INTRAOCULAR INTRAMUSCULAR RESPIRATORY (INHALATION) INTRAPERITONIAL NASAL RECTAL CM.CMROUTE

Form: Concomitant Medications

Question	Response
Medication category	CM.CMCAT
Medication	CM.CMTRT
Taken prior to study?	No Yes
Date First Taken	CM.CMSTDTC
Date Last Taken	CM.CMENDTC
Indication	CM.CMINDC
Dose	CM.CMDOSE
Unit	CM.CMDOSU
Frequency	CM.CMDOSFRQ
Route	CM.CMROUTE