This form is required if, on the AE Summary form, it is reported that relevant laboratory tests were performed to assess the adverse event.
Indicate any relevant laboratory tests (Log lines)
Indicate any relevant laboratory tests performed to assess the adverse event. Report the following information:
- Tests (i.e. serum creatinine (up to 100 characters))
- Collection date (in DD/MMM/YYYY format)
- Results (include units (up to 100 characters))
- Site normal range (include units (up to 100 characters))
- Laboratory value previous to this AE (include units (up to 100 characters))
- Collection date of previous lab (in DD/MMM/YYYY format)
If more than one laboratory assessment was performed, add a new log line in the Rave application to capture each laboratory assessment.
| Test | Collection Date | Result (include units) |
Site Normal Range (include units) |
Lab Value Previous To This AE (include units) |
Collection Date Of Previous Lab |
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CCG v.4.0 | CRF v.3.0
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