Medical History - TIG


This is an example Medical History CRF.


This CRF collects verbatim descriptions of any medical conditions or events experienced by the subject. This CRF was designed to allow the applicant to use either MHENRF or MHENRTPT to represent an event was ongoing.


"Tobacco Implementation Guide-Medical History [TIG_Medical History]" Form Preview
Tobacco Implementation Guide-Medical History
Any Medical History Events
* Were any medical conditions or events reported? No  Yes  
What is the category?
Medical History Events       [No information given about how to repeat this Field Group] 
What is the medical condition or event identifier? What is the medical condition or event term? What was the medical event or condition start date? Is the medical condition or event ongoing? What was the medical condition or event end date?
 01 Jan 2000
No  Yes  
 01 Jan 2000
* Mandatory field

Package(s)
TIG_eCRF_Package_Medical_History