eCRF XForms example
Courtesy of
XML4Pharma
Form: Baseline
Study Event ID
Group: Common
Site number
Must be an integer.
Subject ID
Visit Date
Must be a valid date. Correct format is: yyyy-mm-dd
Visit Start Time
Must be a valid time. Correct format is: hh:mm:ss
Group: Demographics
Date of Birth
Must be a valid date. Correct format is: yyyy-mm-dd
Sex
Male
M
Female
F
Race
Caucasian
CAUCASIAN
Black
BLACK
Asian
ASIAN
Other
OTHER
Group: Smoking History
Check when the subject is a smoker
Give "false" or "true"
Number of cigarettes per day
Less Than 10 cigarettes per day
LT10
10 to 20 cigarettes per day
10TO20
Greater Than 20 cigarettes per day
GT20
Group: Drinking history
Number of alcoholic drinks per day
< 1
< 1
1-2
1-2
> 2
> 2
Group: Physical examination: Base
Height
The height value should be below 220 cm
Weight
The weight value should be below 150 kg
Systolic BP
The value should be below 180
Diastolic BP
The value should be below 120
Does the subject feel dizzy when standing up from a sitting position
No
0
Yes
1
Group: X-Ray
Server or File location of X-Ray photograph
Must be a valid URI or URL
Group: Complaints related to smoking
Breathing
No
0
Yes
1
Coughing
No
0
Yes
1
Heart
No
0
Yes
1
No. of illness days last year
Must be an integer.Value must be lower than 1000
Number of bronchitis cases during the last year
Must be an integer.Value must be lower than 100
Number of pneumonia cases last year
Must be an integer.Value must be lower than 100
Submit Data
Reset
Copyright XML4Pharma 2004-2007