Order | Question Text | Prompt | Case Report Form Completion Instructions | Type | Collection Variable | Tabulation Target | Mapping Instructions | Controlled Terminology CodeList Name | Permissible Values | Pre-Populated Value |
---|
1 | What was the medication name? | Medication |
| Text | CMTRT | CMTRT |
|
|
| DRUG USED IN NICOTINE DEPENDENCE |
2 |
| Pre-Specified Intervention |
| Text | CMPRESP | CMPRESP |
|
|
| Y |
3 | Did the subject previously use medications to reduce nicotine dependency? | Any Medications Taken For Nicotine Dependency | Indicate if the subject had used any medically acceptable products to attempt to reduce nicotine dependency | Text | CMOCCUR | CMOCCUR |
| (NY) | Yes; NoN;Y;NOT DONE |
|
4 | How many times did the subject attempt to use a medicaiton to reduce nicotine dependency | Times the Subject Attempted to Reduce Nicotine Dependency | Record the number of times a subject attempted to use a medicaiton to reduce nicotine dependency | Text | FAORRES | FAORRES | FAORRES where FAOBJ ="MEDICATION USED IN NICOTINE DEPENDENCE" and FATEST= Total Number " |
|
|
|
5What iwas the category? |
| Category |
| Text | FACAT | FACAT |
|
|
| ATTEMPTS TO REDUCE NICOTINE DEPENDENCE |