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  • Appendix Table1. Web-Based Clinical Reporting Form (CRF)

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    Subha Manivannan
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    A clinical reporting form collects patient information including name, date of birth, age, gender, marital status, family address, ID number, telephone number, occupation, education level, nationality, disease name, disease classification, dates of onset, date diagnosed, diagnosis methods, date of death, date form completed, reporting doctor, and department. The form is used to report on family members and collect key health details for classification and tracking of diseases.

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    bmjopen-2018-028248supp001

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    A clinical reporting form collects patient information including name, date of birth, age, gender, marital status, family address, ID number, telephone number, occupation, education level, nationality, disease name, disease classification, dates of onset, date diagnosed, diagnosis methods, date of death, date form completed, reporting doctor, and department. The form is used to report on family members and collect key health details for classification and tracking of diseases.

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    11 views1 page

    Appendix Table1. Web-Based Clinical Reporting Form (CRF)

    Uploaded by

    Subha Manivannan
    A clinical reporting form collects patient information including name, date of birth, age, gender, marital status, family address, ID number, telephone number, occupation, education level, nationality, disease name, disease classification, dates of onset, date diagnosed, diagnosis methods, date of death, date form completed, reporting doctor, and department. The form is used to report on family members and collect key health details for classification and tracking of diseases.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    of 1

    Appendix Table1.

    Web-based Clinical reporting form(CRF)


    Name: Family Date of Age: Gender: Marital Family
    member’s birth: status: address:
    Name:

    ID number: Telephone number: Occupation:


    Degree of education: Nationality: Report disease name:
    Classification of disease: i: Clinical diagnosis
    ii: Laboratory confirmationdiagnosis
    iii: Suspected cases
    iv: Pathogen carriers
    Dates of Date of being diagnosed: Methods of diagnose: Date of death:
    onset:

    Date of completing the CRF: Name of reporting doctor: Department:

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