Indicate the date of discontinuation _______
Enter the date the subject was discontinued from the study in the DD/MMM/YYYY format.
Indicate the reason for discontinuation
Provide the reason from the list below for why the subject was discontinued from the study.
- Completion of study
- Death
- Kidney graft loss or failure
- Physician decision
- Study terminated by sponsor
- Site terminated by sponsor
- Patient withdrew consent
- Lost to follow up
- Other
If Death, specify cause of death _______
If Physician decision, specify reason _______
If Lost to follow up, specify last contact date _______
If Lost to follow-up specify reason _______
If other reason, specify _______
CCG v.1 | CRF v.1
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