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Click ‘Get Form’ to open it in the editor.
Begin by filling out the required fields marked with an asterisk. Start with the 'Last Name' of the applicant, followed by their 'First Name', 'SSN', and 'Birth Date'. Ensure accuracy as this information is crucial for identification.
Next, indicate the 'Application Receipt Closure Basis' and 'Decision Office Date'. This helps in tracking the status of each case effectively.
For cases sent to DDSD but not listed, complete the corresponding sections by entering details for each case, ensuring all relevant codes are filled accurately.
In the section for other corrections/discrepancies, provide any additional information that may be necessary. Fill out both DDSD FILE and CWD FILE sections with correct and discrepant information respectively.
Finally, include your name, signature, phone number, and date at the bottom of the form before submitting it through our platform.
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How should you correct an error in a case report form?
When making a correction on a CRF, a single line should be drawn through the incorrect entry and the correct data should be entered above or next to the incorrect entry. The correction should be dated and initialed. White-out or eraser should never be used to correct an error.
What are the different types of case report forms?
Types of CRF in Clinical Research Paper-Based CRF. Historically, clinical trials relied on physical documents for data entry. Electronic Case Report Form (eCRF) With technological advancements, most trials have transitioned to electronic case report form design.
How to design a case report form?
Case report form design should be standardized to address the needs of all those who handle the data such as investigator, data manager, biostatistician, clinical research monitor/coordinator, database developer/programmer and data entry personnel etc. An effective CRF design would always be user friendly.
How to create a case report?
Case reports should encompass the following five sections: an abstract, an introduction with a literature review, a description of the case report, a discussion that includes a detailed explanation of the literature review, and a brief summary of the case and a conclusion.
What are the basics of a case report?
Case reports are generally written in a modified IMRaD (introduction, methods, results, and discussion) format of original research articles (7). This modified format consists of introduction, case presentation and discussion sections where case presentation section sits in for both methods and results.
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Important part of the CRF is an informative header and footer, which can be customized. [7] In general, the header includes protocol ID, site code, subject ID, and patient initials. Whereas, the footer includes investigators signature, date of signature, version number, and page number.
Related links
BSD/UCMC IRB News | Biological Sciences Division
The updated January 2025 template is available on the IRB website at: .
Jul 8, 2011 This program helps ensure the safety, security, and orderly operation of correctional facilities, and the protection of the public, by allowing
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