pe CRFs

Example Case Report Forms for PE domain

Form: Physical Examination

Question	Response
Date of Collection	PE.PEDTC
Was Physical Examination Performed?	Yes No PE.PESTAT
Appearance/Skin	Normal Abnormal Not Done PE.PETEST PE.PEORRES,PE.PETEST PE.PEORRES,PE.PESTAT
Appearance/Skin, Abnormal Specify	SUPPPE.ABNSP
Head/Neck (including Thyroid)	Normal Abnormal Not Done PE.PETEST PE.PEORRES,PE.PETEST PE.PEORRES,PE.PESTAT
Head/Neck (including Thyroid), Abnormal Specify	SUPPPE.ABNSP
Eyes-Ears-Nose_Throat	Normal Abnormal Not Done PE.PETEST PE.PEORRES,PE.PETEST PE.PEORRES,PE.PESTAT
Eyes-Ears-Nose_Throat, Abnormal Specify	SUPPPE.ABNSP
Cardiovascular	Normal Abnormal Not Done PE.PETEST PE.PEORRES,PE.PETEST PE.PEORRES,PE.PESTAT
Cardiovascular, Abnormal Specify	SUPPPE.ABNSP
Pulmonary	Normal Abnormal Not Done PE.PETEST PE.PEORRES,PE.PETEST PE.PEORRES,PE.PESTAT
Pulmonary, Abnormal Specify	SUPPPE.ABNSP
Abdomen	Normal Abnormal Not Done PE.PETEST PE.PEORRES,PE.PETEST PE.PEORRES,PE.PESTAT
Abdomen, Abnormal Specify	SUPPPE.ABNSP
Neurological	Normal Abnormal Not Done PE.PETEST PE.PEORRES,PE.PETEST PE.PEORRES,PE.PESTAT
Neurological, Abnormal Specify	SUPPPE.ABNSP
Musculoskeletal	Normal Abnormal Not Done PE.PETEST PE.PEORRES,PE.PETEST PE.PEORRES,PE.PESTAT
Musculoskeletal, Abnormal Specify	SUPPPE.ABNSP
Other	Normal Abnormal Not Done PE.PETEST PE.PEORRES,PE.PETEST PE.PEORRES,PE.PESTAT
Other, Abnormal Specify	SUPPPE.ABNSP