Products Used For Smoking Cessation - TIG


This is an example CRF for collecting information about products used for smoking cessation.


This example CRF has 2 sections: Questions in the first section focus on whether any smoking cessation product has been used, and the questions in the second section collect each individual product used. In order to save space, some of the permissible values are only shown in the metadata specifications.


"Tobacco Implementation Guide-Products Used For Smoking Cessation [TIG_SMOKING_CESSATION]" Form Preview
Tobacco Implementation Guide-Products Used For Smoking Cessation
Any Products Used for Smoking Cessation
What is the category for the medication?
* Were any smoking cessation products taken? Yes  No  
Smoking Cessation Product
Smoking Cessation Product
Did the subject previously use the selected product for smoking cessation? No  Yes  Not Done  
What was the name of the other smoking cessation product used?
Was the smoking cessation product discontinued due to an adverse experience? No  Yes  
What was the last date the smoking cessation product was used?
 01 Jan 2000
* Mandatory field

Package(s)
TIG_eCRF_Package_Products_Used_For_Smoking_Cessation