file:///usr/local/tomcat/apache-tomcat-5.5.17/webapps/XML4PharmaServer/temp/xform2007218153938.0994.xhtml F_AE Test Subject system-generated 0 0 enter text P0DT0H 0 1 0 1 1 -->

eCRF XForms example
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XML4Pharma

Form: Adverse Events

Study Event ID:

Group: Common

Site number: Must be an integer. Subject ID: Visit Date: Must be a valid date. Correct format is: yyyy-mm-dd Visit Start Time: Must be a valid time. Correct format is: hh:mm:ss

Group: Adverse events

Has the subject experienced any adverse events? No 0 Yes 1

Group: Adverse events

Insert after selected Group Remove selected Group Event No.: Must be an integer.Value must be lower than 1000
Adverse event:
Start Date: Must be a valid date. Correct format is: yyyy-mm-dd
Is the adverse event still continuing? No 0 Yes 1
Stop Date: Must be a valid date. Correct format is: yyyy-mm-dd
Duration of the adverse event: Must be a valid duration. Correct format is: PnYnMnDTnHnMnS
Was event serious? No 0 Yes 1
Severity: Mild 1 Moderate 2 Severe 3
Is there a reasonable possibility that the AE may have been caused by the study drug? No 0 Yes 1
Action taken with study drug: None 1 Study drug regimen changed 2 Temporarily stopped study drug 3 Study drug discontinued 4
Subject outcome: Subject remains in study 1 Withdrawn from study 2 Lost to follow-up 3 Death 4
Submit Data Reset

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