dm CRFs

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Example Case Report Forms for DM domain

Ex 1: demog
Ex 2: enrlment

Form: Demographics

Question	Response
Sex	Male Female SEX
Age	AGE
Age units	Years Months Days AGEU
Ethnicity	Hispanic or Latino Not Hispanic or Latino Not Applicable ETHNIC
Race	American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Other Unknown Not Reported RACE
Specify if Race is �Other�	RACESP in SUPPDM
Date of birth	BRTHDTC
Is subject of child bearing status	Able to bear children Premenarche Post-Menopausal Sterile - of child bearing age RPORRES when RPTESTCD=CHILDPOT

Form: Enrollment

Question	Response
Date Consent Form Signed	"DM.RFICDTC\|DS.DSSTDTC when DS.DSDECOD=""INFORMED CONSENT OBTAINED"""
Consent Version Number	"SUPPDS.QNAM.ICVERS when DS.DSDECOD=""INFORMED CONSENT OBTAINED"""
Protocol Version	"SUPPDS.QNAM.PRTVERS when DS.DSDECOD=""INFORMED CONSENT OBTAINED"""
Date of Enrollment	"DS.DSSTDTC when DS.DSDECOD=""ENROLLED"""
Date of Randomization	"DS.DSSTDTC when DS.DSDECOD=""RANDOMIZED"""
Randomization number	"DS.DSREFID when DS.DSDECOD=""RANDOMIZED"""