Form: (EXPIRED) Canary: PASS Missed Visits v2.0


CDE IDCDE Description
* 421EDRN Participant ID (Go To: 1390)
* 1390Follow-up visit missed: (Go To: 423)
 
Permissible Values (value):Y1V06 (20)
 
 Y1V12 (21)
 
 Y2V06 (22)
 
 Y2V12 (23)
 
 Y3V06 (24)
 
 Y3V12 (25)
 
 Y4V06 (26)
 
 Y4V12 (27)
 
 Y5V06 (28)
 
 Y5V12 (29)
* 423EDRN Protocol ID (Go To: 422)
* 422EDRN Site ID (Go To: 929)
* 929EDRN Staff ID of the person who collected the data: (Go To: 1389)
* 1389Reason for missed visit: (Go To: 1097)
 
Permissible Values (value):Participant too ill (1)
 
 Participant temporarily away from area (2)
 
 Scheduling problem (3)
 
 Unable to contact participant (4)
 
 Other, specify: (97) (Go To: 2185)
* 2185Reason for missed visit (Other, specify): (Go To: 1097)
   1097Comments (do not include any participant identifiers) (Go To: End of Form)