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Eligibility checklist
Ewen Harrison edited this page Aug 27, 2021
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1 revision
Variable / Field Name | Section Header | Field Type | Field Label | Choices or Calculations |
---|---|---|---|---|
inc_1 | 1. Inclusion Criteria | yesno | 1.1 Participant admitted to an admissions unit or ward at a UK hospital and discharged with suspected COVID-19 |
1, Yes |
inc_2 | yesno | 1.2 Participant is willing and able to give informed consent for participation in the study | 1, Yes | |
inc_3 | yesno | 1.3 Aged 18 years or above. | 1, Yes | |
exc_1 | 2. Exclusion Criteria | yesno | 2.1 Confirmed diagnosis of a pathogen unrelated to the objectives of this study and no indication or likelihood of co-infection with a relevant pathogen. | 1, Yes |
exc_2 | yesno | 2.2 Attendance at an A&E or emergency department only | 1, Yes | |
exc_3 | yesno | 2.3 Refusal by participant, parent or appropriate representative. | 1, Yes | |
exc_4 | yesno | 2.4 Other life limiting illness with life expectancy < 6 months such as disseminated malignancy. | 1, Yes |
Contents
Case Report Form Definitions
- Forms
- Timepoints
- PHOSP ID
- eConsent Tier 1
- eConsent Tier 2
- Informed Consent Form
- Split Tier Consent
- Eligibility Checklist
- CRF1A Part 1
- CRF1A Part 2
- CRF1A Part 3
- CRF1B
- CRF2A
- CRF2B
- CRF3A
- CRF3B
- CRF3C
- CRF4A
- CRF4B
- CRF Emergency Visit
- Adverse Event Log
- Withdrawals
- CRF Early Termination
- CRF Tier 2 Withdrawal
- Medications Log
- Activity Monitor Log
- Mental Health Assessment
- Nutrition
- Social History
- EQ-5D-5L
- GAD-7
- PHQ-9
- MRC Dyspnoea
- SARC-F
- GPPAQ
- Dyspnoea-12
- FACIT Fatigue
- PCL-5
- BPI
- NEADL
- MoCA
- Rockwood Clinical Frailty
- PSQI
- MEQ
- LCQ
- PFTs
- Walk Tests
- Tier 2 Core Test Checklist
- Tier 2 Research Samples
- Tier 2 Notification - Blood
- Tier 2 Notification - Oral Wash
- Tier 2 Notification - Sputum
- Tier 2 Notification - Urine
- QRISK3
- BIA
- DXA
- Muscle Strength
- SPPB
- Pre-PSQ
- PSQ
- Lab Log - Routine Blood
- Lab Log - Urine
- Lab Log - Immuno
- Lab Log - Additional Tests
- PCR Swab Tests