Contents |
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Purpose
Chronic GVHD - Treatment History eCRF
Field Name |
Description / Instructions |
Format |
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Visit Date |
The Visit Date is required. |
DD-MMM-YYYY |
Date of GVHD Diagnosis | DD-MMM-YYYY | |
Biopsy Proven? |
|
Use pick list |
If Biopsy Proven, Date Obtained | DD-MMM-YYY | |
GVHD Type |
|
Use pick list |
Late Acute GVHD subtype |
|
Use pick list |
Intensity of current immunosuppression |
|
Use pick list |
Therapeutic intent at time of clinic visit |
|
Use pick list |
Clinician's impression of activity |
|
Use pick list |
cGVHD Biopsy Proven Organ Involvement |
|
Use pick list |
Biopsy Proven? |
|
Use pick list |
Prior Systemic Therapy |
|
Use pick list |
Prior Systemic Therapy - Agent Name | Use pick list | |
Current Systemic Therapy - Agent Name | Use pick list | |
Current Systemic Therapy - Comments | 200 characters | |
Type of Onset of cGVHD relative to aGVHD |
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Pre-defined |
Yes/No |
|
Use pick list |
Documented infections since cGVHD Diagnosis? |
|
Use pick list |
List infections since cGVHD Diagnosis |
|
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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