Routine Laboratory Testing - TIG


This is an example CRF used to collect routine safety laboratory tests from local laboratories in tobacco studies.


The lab names may be collected only when multiple labs are used by a site. The lab test name are often preprinted on the CRF. The names are not included as they are study specific. In order to save space, some of the permissible values are only shown in the metadata specifications.


"Tobacco Implementation Guide -Routine Laboratory- Local Processing [TIG_ ROUTINE_LB]" Form Preview
Tobacco Implementation Guide -Routine Laboratory- Local Processing
Laboratory
What was the name of the laboratory used?
Was the lab performed? No  Yes  
What was the date of the lab specimen collection?
 01 Jan 2000
What was the (start) time of the lab specimen collection?
 12:00
* Was the subject fasting? No  Yes  
Laboratory Tests
Lab Test Name
What was the result?
What was the lab test unitt?
What was the upper limit of the reference range for this lab test?
What was the lower limit of the reference range for this lab test?
Was this result clinically significant? No  Yes  
* Mandatory field