Form:DCP Ineligibility v1.0


CDE IDCDE Description
* 421EDRN Participant ID (Go To: 422)
* 422EDRN Site ID (Go To: 423)
* 423EDRN Protocol ID (Go To: 929)
* 929EDRN Staff ID of the person who collected the data: (Go To: 1066)
* 1066Date participant was determined to be ineligible (MM/DD/YYYY): (Go To: 1056)
* 1056Proposed study group (Go To: 1080)
 
Permissible Values (value):Cases group 1 (1)
 
 Control Group 2 (2)
* 1080General reason(s) for ineligibility: (Check all that apply.) (Go To: 1097)
 
Permissible Values (value):Not enough imaging tests or test not done within required time frame (1)
 
 Other cancer diagnosed within the past 5 years (2)
 
 Participant decided not to participate (10)
 
 Participant did not meet MELD/Child Class criteria (11)
 
 Received treatment for HCC (12)
 
 Unable to draw blood (13)
 
 Undiagnosed Hepatic Mass (14)
 
 Other, specify: (97) (Go To: 1081)
   1081Reason(s) why participant is ineligible (other, specify): (Go To: 1097)
   1097Comments (do not include any participant identifiers) (Go To: End of Form)