| 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: 1097) |
| | | Permissible Values (value): | Participant refused all future contact (3) |
|
| | | | Participant completed study on active surveillance (21) |
|
| | | | Participant changed care facility (22) |
|
| | | | Participant received treatment (23) |
|
| | | | Participant lost to follow-up (24) |
|
| | | | Participant indicated treatment; no documentation (26) |
|
| | | | Participant non-compliant (27) |
|
| | | | Other, specify: (97) (Go To: 1695) |
|
| * 1695 | Other termination reason, specify: (Go To: 1097) |
| 1097 | Comments (do not include any participant identifiers) (Go To: End of Form) |
| 2572 | Principal Investigator signature: (Go To: End of Form) |