Concomitant Medications - TIG

This is an example CRF used to collect general concomitant medications/products in a study.

This CRF was designed to allow the applicant to use either CMENRF or CMENRTPT to represent an intervention was ongoing. In order to save space, some of the example permissible values are only shown in the metadata specifications.

"Tobacco Implementation Guide-Concomitant Medications [TIG_CONC_MED_GENERAL]" Form Preview

Tobacco Implementation Guide-Concomitant Medications

Any Concomitant Medications

Were any concomitant medications/products taken?

No Yes

Medications

What is the category for the concomitant medication/product?

What is the line number?

What was the medication/product?

For what indication was the medication/product taken?

What was the individual dose of the medication/product?

What is the unit?

What was the dose form of the medication/product?

What was the route of administration of the medication/product?

What was the frequency of the medication/product?

What was the medication/product dose start date?

01 Jan 2000

Is the medication/product ongoing?

No Yes

What was the end date?

01 Jan 2000

* Mandatory field

Package(s)
TIG_eCRF_Package_Concomitant_Medications.zip