Overview eCRF Preview Download This is an example CRF for collecting information about medications used for nicotine dependency. "Tobacco Implementation Guide-Medications Used for Nicotine Dependency [TIG_NIC_DEP]" Form Preview Tobacco Implementation Guide-Medications Used for Nicotine Dependency Medications What was the medically recognized product name? Pre-Specified Intervention Did the subject previously use the selected product for smoking cessation? No Yes Not Done How many times did the subject attempt to use medically recognized products to attempt to reduce nicotine dependency? Category LAST ATTEMPT FOR EACH MEDICATION TYPE What is the category of the medication/product the subject used to attempt to reduce nicotine dependency? Nicotine Replacement Therapy (NRT) Not a NRT What is the medication/product subcategory, if not pre-printed on the CRF. What was the name of the medication/product the subject used to reduce nicotine dependency? What was the duration of the medication/product used to reduce nicotine dependency for the last attempt? What was the duration unit of the medication/product used to reduce nicotine dependency for the last attempt? Days Month Years * Mandatory field Package(s) TIG_eCRF_Package_Medications_Used_for_Nicotine_Dependency