This is an example CRF used to collect information on prior use of smoking cessation products. The specific type of non-pharmaceutical smoking cessation product was not of interest. The reason why a product was discontinued and any use in the last 14 days was of interest. .
Indicate if the subject took any smoking cessation products If Yes, include the appropriate details where indicated on the CRF. | Were any smoking cessation products taken? CMYN Not Submitted | <NY codelist> | |
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Check all the Smoking Cessation Products previously used. Cessation product used. For each product previously complete the following i | What was the Smoking Cessation medication? CMTRT(n) CMTRT | ||
CMTRTOT CMTRT | _________________ |
Indicate if the smoking cessation product was discontinued due to a Adverse Event | Was the smoking cessation products discontinued due to a adverse event ? CMCRSDIS If Yes then CMRSDISC = "ADVERSE EVENT" | <NY codelist> | |
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Was the product used in the last 14 days : CM CMENDTC |
Represent that end sometime between the date of collection , and 14 days prior IF DTC = 2020-02-15 then ENDTC= (e.g 2020-02-02/2003-02-15 )
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