| CDE ID | CDE Description | | * 421 | EDRN Participant ID (Go To: 423) |
| * 423 | EDRN Protocol ID (Go To: 422) |
| * 422 | EDRN Site ID (Go To: 929) |
| * 929 | EDRN Staff ID of the person who collected the data: (Go To: 1391) |
| * 1391 | Date of participant´s study termination (MM/DD/YYYY): (Go To: 1392) |
| * 1392 | Reason(s) for study termination: (Check all that apply.) (Go To: 4568) |
| | | Permissible Values (value): | Participant completed study as expected (1) |
|
| | | | Participant refused all future contact (3) |
|
| | | | Participant deceased (5) (Go To: 3408) |
|
| | |
| | | | Participant relocated (7) |
|
| | | | Participant did not sign a consent form (11) |
|
| | | | Other, specify: (97) (Go To: 1695) |
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| * 1695 | Other termination reason, specify: (Go To: 4568) |
| * 3408 | Date of death (MM/YYYY): (Go To: 1332) |
| * 1332 | Cause of death: (Go To: 4568) |
| * 4568 | Has the participant's research chart been internally flagged to effectively prevent any future research related data and/or specimens from being collected? (Go To: 1097) |
| | | Permissible Values (value): | Yes (1) |
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| 1097 | Comments (do not include any participant identifiers) (Go To: End of Form) |