Subject Characteristics - TIG


This is an example Subject Characteristics CRF.


This example CRF has 2 sections: The questions in the first section focus on whether subject characteristics were collected and the questions in the second section are each subject characteristic collected. For an eCRF, if "No" is selected as the answer to the question in the first section, the second section would not be displayed.


"Tobacco Implementation Guide-Subject Characteristics [TIG_SUB_CHAR]" Form Preview
Tobacco Implementation Guide-Subject Characteristics
Any Subject Characteristics
* Were subject characteristics collected? No  Yes  
Subject Chacteristics
What is the subject's education level?
What is the subject’s employment status? Full-time  Part-time  Not Employed  
What is the subject's income? <100% poverty guideline  100-200% poverty guidelines  >200% poverty guidelines;  
What is the subject's marital status?
What is the subject's national origin status?
What is the subject’s military status ? No Military Service  Active Service  Veteran  
Was the subject exposed to second hand smoke ?
What was the age of the subject when they started smoking?
Did the subject have any tobacco cessation counseling? No  Yes  
What is the longest duration of previous abstinence from tobacco use?
* Mandatory field

Package(s)
TIG_eCRF_Package_Subject_Characteristics