file:///c:/apache_tomcat/jakarta-tomcat-5.0.19/webapps/XML4PharmaServer/temp/xform200641322916.3591.html F_BASELINE system-generated M CAUCASIAN false LT1 0

eCRF XForms example
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Form: Baseline

Subject ID : Subject ID

Study Event ID:


Group: Common

Site number: Must be an integer.Value must be lower than 100

Visit Date: Must be a valid date. Correct format is: yyyy-mm-dd


Group: Demographics

Date of Birth: Must be a valid date. Correct format is: yyyy-mm-dd

Sex: Male M Female F

Race: Caucasian CAUCASIAN Black BLACK Asian ASIAN Other OTHER


Group: Smoking History

Is the subject a smoker?

Number of cigarettes per day: Less Than 10 cigarettes per day LT10 10 to 20 cigarettes per day 10TO20 Greater Than 20 cigarettes per day GT20


Group: Drinking history

Number of alcoholic drinks per day: Less Than 1 drink per day LT1 1 to 2 drinks per day 1TO2 Greater Than 2 drinks per day GT2


Group: Physical examination: Baseline

Height (cm): The height value should be below 220 cm

Weight (kg): The weight value should be below 150 kg

Systolic BP (mm Hg): The value should be below 180

Diastolic BP (mm Hg): The value should be below 120

Does the subject feel dizzy when standing up from a sitting position? No 0 Yes 1


Group: Complaints related to smoking

Breathing: No 0 Yes 1

Coughing: No 0 Yes 1

Heart: No 0 Yes 1

No. of illness days last year: Must be an integer.Value must be lower than 1000

Number of bronchitis cases during the last year: Must be an integer.Value must be lower than 100

Number of pneumonia cases last year: Must be an integer.Value must be lower than 100

Submit Data

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