FORM.CONMED system-generated ONC USA S true N true 1 1 0

Dynamic eCRF XForms example

courtesy of
XML4Pharma

This eCRF in XForms format demonstrates how XForms can be made dynamic.
In this form, for entering the start and stop date of the concomitant medication, there are two possibilities: First of all, if the exact start or stop date is known, the date can simply be entered using a Calendar. Secondly, if the start or stop date is not exactly known, three fields pop up, which allow to enter the approximate date: day, month and year. As such, after the data has been returned to the server, from the stored data, it will always be clear whether the entered date was an exact or approximate one.

Also remark that when you tick that the Adverse Event is 'ongoing', all questions about the stop date disappear.

Form: Concom Meds

Subject ID ID of the Subject

Study Event ID : system-generated

Group: Concom Meds

Compound Maximum length is 8 characters.

Therapeutic Area Oncology ONC

Protocol Code Maximum length is 15 characters.

Country Code United States USA France FR Germany DE

Record status Source verified, not queried S Source verified, queried V

Line Number Must be an integer. Maximum length is 2 characters.

Medication For Conmed Maximum length is 200 characters.

Exact start date is known true unknown false

Start Date Correct format is yyyy-mm-dd e.g. 2004-01-27 Maximum length is 10 characters.

Start Day - Enter Two Digits 01-31, or leave blank if unknown Must be an integer. Maximum value is 31.

Start Month - Enter Two Digits 01-12, or leave blank if unknown Must be an integer. Maximum value is 12

Start Year - Enter Four Digit Year, or leave blank if unknown Must be an integer. Maximum value is 2010.

Ongoing Yes Y No N

Exact stop date is known true unknown false

Stop Date Correct format is yyyy-mm-dd e.g. 2004-01-27 Maximum length is 10 characters.

Stop Day - Enter Two Digits 01-31, or leave blank if unknown Must be an integer. Maximum value is 31.

Stop Month - Enter Two Digits 01-12, or leave blank if unknown Must be an integer. Maximum value is 12.

Stop Year - Enter Four Digit Year, or leave blank if unknown Must be an integer. Maximum value is 2010.

Dose and Unit Maximum length is 20 characters.

Conmed Route IV 1 IM 2 PO 3 SC 4 PV 5 PR 6 Sublingual 7 Inhaled 8 Topical 9 If not in list 10

Conmed Regimen q.d. 1 b.i.d. 2 t.i.d. 3 q.i.d. 4 q.o.d. 5 q.h.s. 6 cont. IV 7 prn 8 If not in list, record as Other 9

Conmed Indication Maximum length is 100 characters.

Taken for AE None 0 Unlikely 1 Possible 2 Probable 3

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