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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 Evaluation Date.

DD-MMM-YYYY

Evaluation Date

DD-MMM-YYYY

Consult Evaluation Type

Use pick list.

Notes

Note: If the consult is not applicable or wasn’t done, ‘NA’ if not applicable or ‘Not Done’ with a reason should be entered in the "Notes" section.

200 characters

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

Code	Description	Resolutions
CON ?	?	?