Contents

Purpose

 

Chronic GVHD - Patient Symptom Scale eCRF

Field Name

Description / Instructions

Format

Visit Date

The Visit Date is required.

DD-MMM-YYYY

Data Collected Enter the date the information was collected.

DD-MMM-YYYY

Reason if Not Collected Enter the reason the information was not collected. 200 characters
Sequence Symptom's sequence. Pre-defined.  
Symptom Description of Symptom. Pre-defined.  
Score

Symptom's score. Use the pick list.

0 - NOT AT ALL
1 - Slightly
2 - MODERATELY
3 - QUITE A BIT
4 - EXTREMELY

 Use pick list.
Total Score (d) Total score derived by adding all the symptoms scores. Number (3.0) 

Legend: (d) derived field, (m) RDC mandatory, (c) for CTEP reporting only.

Validations

Code

Description

Resolutions

 There are no validations.    

Derivations

Code

Field Name

Description

 N/A  Total Score Total Score derived from adding all individual symptom scores on this CRF.
Last updated by Fontinha, Marcelo (NIH/OD) [E] on Jul 30, 2013