Prior Crohn's Disease Medication: Aminosalicylates

This CRF collects information about individual 5-aminosalicylate medications previously used to treat Crohn's disease.

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

"Prior Crohn's Disease Medication Class- Aminosalicylates [CD_CM5ASA]" Form Preview

Prior Crohn's Disease Medication Class- Aminosalicylates

Prior Crohn's Disease Medication Class- Aminosalicylates 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 aminosalicylate medication taken for Crohn's disease?

What was the start date of this aminosalicylate?

01 Jan 2000

What was the end date of this aminosalicylate?

01 Jan 2000

How many months did the subject take this aminosalicylate?

* What was the maximum dose amount of this aminosalicylate?

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

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

* What was the final dose amount of this aminosalicylate?

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

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

* What was the route of administration of this aminosalicylate?

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

* Mandatory field

Package(s)
CD CM5ASA Package