Contents |
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Purpose
Chronic GVHD - Activity Assessment Clinician eCRF
Field Name |
Description / Instructions |
Format |
---|---|---|
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 |
Skin- erythematous rash of any sort (%BSA) | Number (99.999) | |
Skin- Moveable sclerosis (%BSA) | Number (99.999) | |
Skin- Non-moveable sclerosis or subcutaneous | Number (99.999) | |
Skin- Ulcers (largest ulceration lesion) Location | 100 characters | |
Skin- Ulcers (largest ulceration lesion) Dimension (cm) | Number (99.99) | |
Eye- Right |
|
Use pick list |
Eye- Left |
|
Use pick list |
Mouth- Mucosal Change Erythema |
|
Use pick list |
Mouth- Mucosal Change Lichenoid |
|
Use pick list |
Mouth - Mucosal Change Ulcers |
|
Use pick list |
Mouth- Mucosal Change Mucoceles |
|
Use pick list |
Mouth - Total Score | Number (99) | |
Upper GI |
|
Use pick list |
Esophageal |
|
Use pick list |
Lower GI- Diarrhea |
|
Use pick list |
Health Care Provider Global Rating- Severity of cGVHD |
|
Use pick list |
Health Care Provider Global Rating- Severity Scale | Enter a number between 0 and 10. | Number (99) |
Health Care Provider Global Rating- Past Month Status |
|
Use pick list |
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 |
---|---|---|
There are no derivations. |
Overview
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