da CRFs

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Example Case Report Forms for DA domain

Ex 1: da_drug_acct

Form: Drug Accountability

Question	Response
Date Tablets Dispensed	DA.DADTC
Dispensed Treatment label ID	"DA.DAREFID when DA.DATESTCD=""DISPAMT"""
Number of Tablets Dispensed	"DA.DAORRES when DA.DATESTCD=""DISPAMT"""
Date Tablets Returned	DA.DADTC
Returned Treatment label ID	"DA.DAREFID when DA.DATESTCD=""RETAMT"""
Number of Tablets Returned	"DA.DAORRES when DA.DATESTCD=""RETAMT"""
Returned Amount Compliance	As expected More returned than expected Less returned than expected SUPPDA.QNAM.RETCOMP
Reason Returned Amount Higher than Expected	Accidental lack of use Intentional lack of use for any reason other than occurrence of an AE Intentional lack of use because of an AE Unknown/Unexplained SUPPDA.QNAM.RETHIRS
Reason Returned Amount Lower than Expected	Loss of study treatment Some study treatment given to another person Accidental overdose by subject Intentional overuse by subject Unknown/Unexplained SUPPDA.QNAM.RETLORS