Contents |
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Purpose
Record the patient's ECG.
ECG eCRF
Field Name | Description / Instructions | Format |
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Visit Date | The Visit Date is optional on this case report form. Hit the "Tab" key to leave it empty and move to the Date field. | DD-MMM-YYYY |
Course #(d) | Indicates the course number the ECGs are related to based on their date and time. | 5 digits |
Day in Course(d) | Indicates the day since the beginning of course the cardiac ejection fraction results are related to based on their date and time. | 5 digits |
Date of Exam(m) | Enter the date the ECG was performed. | DD-MMM-YYYY |
Time | Enter the time the ECG was performed. | HH(24):MM |
QRSD Interval | Enter the QRS duration (QRSD) interval in milliseconds. | 8 digits. |
QT Interval | Enter the QT interval in milliseconds. | 3 digits. |
QTC Interval | Enter the QTC interval in milliseconds. | 3 digits. |
PR Interval | Enter the PR interval in milliseconds. | 3 digits. |
ECG Impression(m) | Select one of the following summary finding: | Use pick list. |
Rate(m) | Enter the patient’s pulse rate. | 3 digits. |
Rhythm(m) | Select one of the following rhythm finding: | Use pick list. |
Arrhythmia Type | Select the patient’s arrhythmia type. | Use pick list. |
P Wave | Select one of the following P Wave finding: | Use pick list. |
QRS Complex | Select one of the following QRS Complex finding: | Use pick list. |
ST Segment | Select one of the following ST Segment finding: | Use pick list. |
Comments | Enter comments applicable to the ECG. | 200 characters |
Legend: (d) derived field, (m) RDC mandatory, (c) for CTEP reporting only.
Validations
Code | Description | Resolutions |
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ECG01 | Date of Exam is in the future. | Enter a date that is equal to or prior to the current date. |
Derivations
Code | Field Name | Description |
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ECG1001 | Course # | Course number is derived based on the course initiation start dates and the Evaluation Date. |
ECG1002 | Day in Course | Number of days since the beginning of the course is derived from the course initiation start date and the Evaluation Date. |