Withdrawal Form
Mathew Thorpe edited this page Jan 26, 2022
·
1 revision
| Variable / Field Name | Section Header | Field Type | Field Label | Choices or Calculations |
|---|---|---|---|---|
| withd_text | text | WITHDRAWAL form only to be completed for participants with data being collected on the shorter CRF first issued April 2020, so no fields will show here for participants where data was recorded in the older/longer CRF |
||
| withddat | WITHDRAWAL | text (date_dmy) | Date of withdrawal: | |
| withdtype | radio | Type of withdrawal: | 1, Withdrawal from samples only ; 10, Other Please specify | |
| withdreas | text | Other type of withdrawal: | ||
| reason_for_withdrawal | text | Reason for withdrawal: | ||
| withdrawal_form_complete | Form Status | dropdown | Withdrawal Form section complete? | 0, Incomplete ; 1, Unverified ; 2, Complete |
Contents
ISARIC
-
Additional Fields
-
Case Report Form Definitions
- Participant Identification Number (PIN)
- Tier
- Inclusion Criteria
- Demographics
- Onset and Admission
- Admission Signs and Symptoms
- Comorbidities
- Preadmission Treatment
- Preadmission Medication
- Reinfection Form
- Daily Form
- Infectious Respiratory Disease Pathogen Diagnosis
- Infectious Respiratory Disease Pathogen Testing
- Treatment
- Complications
- Study Participation
- Outcome
- Final Outcome
- Core Additional Information
- Withdrawal Form
- Consent Ctu Dms
- Confirmed Negative PCR
- Follow up Consent
- Follow up Self Assessment
PHOSP
-
Additional Fields
-
Case Report Form Definitions
- Forms
- Timepoints
- PHOSP ID
- eConsent Tier 1
- eConsent Tier 2
- Informed Consent Form
- Split Tier Consent
- Eligibility Checklist
- CRF1A Part 1
- CRF1A Part 2
- CRF1A Part 3
- CRF1B
- CRF2A
- CRF2B
- CRF3A
- CRF3B
- CRF3C
- CRF4A
- CRF4B
- CRF Emergency Visit
- Adverse Event Log
- Withdrawals
- CRF Early Termination
- CRF Tier 2 Withdrawal
- Medications Log
- Activity Monitor Log
- Mental Health Assessment
- Nutrition
- Social History
- EQ-5D-5L
- GAD-7
- PHQ-9
- MRC Dyspnoea
- SARC-F
- GPPAQ
- Dyspnoea-12
- FACIT Fatigue
- PCL-5
- BPI
- NEADL
- MoCA
- Rockwood Clinical Frailty
- PSQI
- MEQ
- LCQ
- PFTs
- Walk Tests
- Tier 2 Core Test Checklist
- Tier 2 Research Samples
- Tier 2 Notification - Blood
- Tier 2 Notification - Oral Wash
- Tier 2 Notification - Sputum
- Tier 2 Notification - Urine
- QRISK3
- BIA
- DXA
- Muscle Strength
- SPPB
- Pre-PSQ
- PSQ
- Lab Log - Routine Blood
- Lab Log - Urine
- Lab Log - Immuno
- Lab Log - Additional Tests
- PCR Swab Tests
GPES
-
Additional Fields
-
Table Definitions
APC
-
Additional Fields
-
Table Definitions
IAPT
-
Additional Fields
AE
-
Additional Fields
-
Table Definitions
NIMS
-
Additional Fields
-
Table Definitions
ECDS
-
Additional Fields
-
Table Definitions
MHS
-
Additional Fields
-
Table Definitions
- MHS Master Patient Index table
- MHS GP data table
- NHS Accommodation status table
- MHS Employment status table
- MHS Patient Ind table
- MHS MH Care Coord table
- MHS Disability type table
- MHS Care plan type table
- MHS Care plan arrangement table
- MHS Assistive technology to support disability type table
- MHS Social and Personal Circumstances table
- MHS Overseas Visitor Charging Category table
- MHS Service or Team Referral table
- MHS Service or Team Type Referred To table
- MHS Other Reason for Referral table
- MHS Referral to Treatment table
- MHS Onward Referral table
- MHS Discharge Plan Agreement table
- MHS Care Contact table
- MHS Care Activity table
- MHS Other in Attendance table
- MHS Indirect Activity table
- MHS Medical History (Previous Diagnosis) table
- MHS Provisional Diagnosis table
- MHS Primary Diagnosis table
- MHS Secondary Diagnosis table
- MHS Coded Scored Assessment (Referral) table
- MHS Coded Scored Assessment (Care Activity) table
- MHS Care Programme Approach (CPA) Care Episode table
- MHS Care Programme Approach (CPA) Review table
NDA
-
Additional Fields
SGSS
-
Additional Fields
-
Table Definitions
GDPPR
-
Additional Fields
-
Table Definitions
VACCINATION
-
Additional Fields
-
Table Definitions
COG_UK
-
Additional Fields
-
Table Definitions
COG_UK_VOC
-
Additional Fields
-
Table Definitions
CHESS
-
Additional Fields
-
Table Definitions
SGTF
-
Additional Fields
-
Table Definitions
CIVIL_REG_DEATHS
-
Additional Fields
-
Table Definitions