You are viewing an old version of this page. View the current version.

Compare with Current View Page History

« Previous Version 4 Next »

OrderCDASH Variable Name Question TextPromptCRF Completion InstructionsSDTMIG Target VariableSDTM Target MappingControlled Terminology Code List NamePermissible ValuesPre-Populated Value
1What is the category of the  medication the subject used to attempt to reduce nicotine dependencyMedication CategoryRecord the type of medicaiton the subject used to reduce nicotine dependency.Indicate if the subject experienced any medical conditions or events. If Yes, include the appropriate details where indicated on the CRF.CMCAT

NICOTINE REPLACEMENT THERAPY; DRUG USED IN REDUCING NICOTINE DEPENDENCE OTHER THAN NRTS;  



2What is the subcategory for the medication?Medication SubcategoryRecord the medication subcategory, if not pre-printed on the CRF.
CMSCAT


LAST ATTEMPTED USE WITH THIS MEDICATION
3What was the name of the medication the subject used to reduce nicotine dependency

 MedicationRecord only one medication per line. Provide the full trade or proprietary name of the medication; otherwise, record the generic name.Applicant-Defined CRF Completion InstructionsCMTRT



4What was the duration of the medication used to reduce nicotine dependency for the last attempt?  Collected DurationProvide the duration of the medication used. Record all relevant medical conditions or events, as defined in the protocol. Record only one medical condition or event per line. Ensure that the medical conditions or events listed on the Medical History page do not meet any of the exclusion criteria.CMDUR



5What was the duration unit of the medication used to reduce nicotine dependency for the last attempt Collected Duration UnitSelect the appropriate duration unit of the medication used. Record the start date of the medical event or condition using this format (DD-MON-YYYY).CMDUR

DAYS; MONTHS; YEARS

  • No labels