Prior Crohn's Disease Medication: Corticosteroids

This CRF collects information about individual corticosteroid medications previously used to treat Crohn's disease.

This is a repeating CRF that is completed once for each corticosteroid medication previously used to treat Crohn's disease.

"Prior Crohn's Disease Medication Class- Corticosteroids [CD_CMCS]" Form Preview

Prior Crohn's Disease Medication Class- Corticosteroids

Prior Crohn's Disease Medication Class- Corticosteroids 1

* What is the category for the medication?

* For what indication was the medication taken?

* What is the subcategory for the medication?

* What was the medication identifier?

* What was the name of the corticosteroid drug taken for Crohn's disease?

What was the start date of this corticosteroid?

01 Jan 2000

What was the end date of this corticosteroid?

01 Jan 2000

How many months did the subject take this corticosteroid?

* What was the maximum dose amount of this corticosteroid?

* What was the unit of the maximum dose amount of this corticosteroid?

* What was the frequency of the maximum dose amount of this corticosteroid?

* What was the final dose amount of this corticosteroid?

* What was the final dose amount unit of this corticosteroid?

* What was the frequency of the final dose amount of this corticosteroid?

* What was the route of administration of this corticosteroid?

* What was the primary reason for discontinuation of this corticosteroid?

Prior Crohn's Disease Medication Class- Corticosteroids 2

* What was the category of the medical history?

* When did the medical history event start relative to the study reference period?

* What was the relationship to the non-study medication?

* If treatment was discontinued due to intolerance, which condition(s) indicated intolerance?

If "Other", what was the other condition indicating intolerance to previous corticosteroid treatment?

* Mandatory field

Package(s)
CD CMCS Package