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| Xformpusher |
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| Order | CDASH Variable | Question Text | Prompt | CRF Completion Instructions | Type | SDTMIG Target | SDTMIG Target Mapping | Controlled Terminology Code List Name | Permissible Values | Pre-Populated Value | Query Display | List Style | Hidden |
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| 21 | CMYN | Were any smoking cessation products taken? | Any Smoking Cessation Products | Indicate if the subject took any smoking cessation products If Yes, include the appropriate details where indicated on the CRF. | Text | N/A |
| (NY) | Yes; No | 4 | CMTRT(n) | What was the Smoking Cessation medication? | Smoking Cessation Product | Check all the Smoking Cessation Products previously used. Cessation product used. For each product previously complete the following i | Text | CMTRT | Nicotine Patches; Nicotine Gum; Nicotine Lozenge; Nicotine Inhaler; Chantix; Zyban ; Other | 5 | CMTRTOT | What was the name of the other smoking cessation product used? | Text | CMTRT |
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For each product previously taken record the appropriate details below.
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