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This is an example CRF used to collect subject inclusion/exclusion criteria. 

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IECAT
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titleCDASH IE Metadata Specifications

Section 1 

Controlled Terminology Code List
Metadataspec
Order
CDASH Variable Name 
Question TextPrompt
CRF
Case Report Form Completion Instructions
SDTMIG Target
TypeCollection Variable
SDTM Target Mapping
Tabulation Target  Mapping Instructions  Controlled Terminology CodeList NamePermissible ValuesPre-Populated Value
1
IEYN
Were all eligibility criteria met?Met CriteriaRecord Yes if all eligibility criteria were met at the time the subject was enrolled. Record No if the subject did not meet all criteria at the time the subject was enrolled.TextIEYN
Were all eligibility criteria met?Met CriteriaRecord Yes if all eligibility criteria were met at the time the subject was enrolled. Record No if the subject did not meet all criteria at the time the subject was enrolled.2IECATWhat was the category of the criterion?Criterion TypeRecord whether the criterion exception was Inclusion or Exclusion.

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Section 2

OrderQuestion TextPromptCase Report Form Completion InstructionsTypeCollection VariableTabulation Target  Mapping Instructions  Controlled Terminology CodeList NamePermissible ValuesPre-Populated Value
2What was the category of the criterion?Criterion TypeRecord whether the criterion exception was Inclusion or Exclusion.
LAST ATTEMPTED USE WITH THIS MEDICATION
TextIECATIECAT



3
IETESTCDIf the subject was not eligible, record the identifying code for each criterion that was an exception.
What was the identifier of the inclusion criterion the subject did not meet or the exclusion criterion the subject met?Exception Criterion IdentifierIf the subject was not eligible, record the identifying code for each criterion that was an exception.TextIETESTCD
What was the identifier of the inclusion criterion the subject did not meet or the exclusion criterion the subject met?Exception Criterion Identifier
IETESTCD