This e-CRF 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.
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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 between 1 and 31.
Start Month - Enter Two Digits 01-12, or leave blank if unknown
Must be an integer between 1 and 12.
Start Year - Enter Four Digit Year, or leave blank if unknown
Must be an integer. Maximum length is 4 characters.
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 between 1 and 31.
Stop Month - Enter Two Digits 01-12, or leave blank if unknown
Must be an integer between 1 and 12.
Stop Year - Enter Four Digit Year, or leave blank if unknown
Must be an integer. Maximum length is 4 characters.
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