Contents |
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Purpose
Chronic GVHD - Activity Assessment Patient Self Reported eCRF
Field Name |
Description / Instructions |
Format |
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Visit Date |
The Visit Date is required. |
DD-MMM-YYYY |
Data Collected? | Indicate if data was collected or not. | Use pick list. |
Assessment Date | Enter the Assessment Date. |
DD-MMM-YYYY |
Reason if Data Not Collected | Enter the reason data was not collected. | 200 characters |
Severity of Symptom - Skin itching | 10 characters | |
Severity of Symptom - Mouth dryness | 10 characters | |
Severity of Symptom - Mouth Pain | 10 characters | |
Severity of Symptom - Mouth Sensitivity | 10 characters | |
Severity of Symptom - What is your main complaint with regard to your eyes? | 200 characters | |
Severity of Symptom - Eye Symptoms | 10 characters | |
Vulvovaginal Symptoms - Do you have any burning, pain or discomfort? |
|
Use pick list |
Vulvovaginal Symptoms - Comments | 200 characters | |
Patient Global Rating- Severity of cGVHD |
|
Use pick list |
Patient Global Rating - Severity Scale | Enter a number between 0 and 10. | Number (99) |
Patient Global Rating- Past Month Status |
|
Use pick list |
Legend: (d) derived field, (m) RDC mandatory, (c) for CTEP reporting only.
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Validations
Code |
Description |
Resolutions |
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There are no validations. |
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Derivations
Code |
Field Name |
Description |
---|---|---|
There are no derivations. |
Overview
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