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Contents

Purpose

This CRF will be used to record that a neurological exam was completed.

Neurological Assessment 

Field Name

Description / Instructions

Format

Visit Date

The Visit Date is optional on this case report form. Hit the "Tab" key to leave it empty and move to the Date of Vitals field.

DD-MMM-YYYY

Data Collected

To indicate whether the data was collected for this assessment and time-point
YES - Yes
NO - No

Use pick list.

Reason if No

If necessary, enter text reason that data is not collected for an identified assessment at this assessment and time point .200 characters

Evaluation Date (m)

Enter the date the neurological exam was performed by the treating investigator.

DD-MMM-YYYY

Neurological Assessment

Enter the time point per protocol study calendar. For example, "Cycle 2",  "End of Treatment". 

Use pick list.

Preference HandSelect relating to the subject's identification of the preference or dominant hand.  Preference hand can be defined as right, left, or both (bilateral).

Use pick list.

 

Legend: (m) RDC mandatory

Validations

Code

Description

Resolutions

TBD

 

 

 

 

 

 

 

 

 

  
Last updated by Blackburn, Katie (NIH/NCI) [C] on Apr 18, 2017