1.1
Medication name *(brand/generic name)*
1.2
Indication
1.3
Dose per administration
1.4
Unit
1.5
Specify other unit:
Only shown if field 1.4 is equal to 33
1.6
Frequency
1.7
Specify other frequency:
Only shown if field 1.6 is equal to 16
1.8
Route
1.9
Specify other route:
Only shown if field 1.8 is equal to 26
1.10
Was the participant already receiving this concomitant medication prior to the study?
1.11
Start date
Only shown if field 1.10 is equal to 2
1.12
Ongoing at the end of study
1.13
End date
Only shown if field 1.12 is equal to 2
1.14
Is eind datum vóór start datum medicatie?
**NOTE: End date of medication is before the start date of medication. Please adjust!**
Only shown if field 1.14 is equal to 1
Med_unit
1: Becquerel (Bq)
2: Centimetre (cm)
3: Centilitre (cl)
4: Decilitre (dl)
5: Drop (dr)
6: Unit (U/unit)
7: Gigabecquerel (GBq)
8: Gram (g)
9: International unit (IU)
10: Joule (J)
11: Kilobecquerel (KBq)
12: Kilocalories (kcal)
13: Kilogram (kg)
14: Mercury (Hg)
15: Litre (l)
16: Megabecquerel (MBq)
17: Microgram (mcg)
18: Microlitre (mcl)
19: Micromol (mcmol)
20: Milligram (mg)
21: Millilitre (ml)
22: Millimetre (mm)
23: Millimol (mmol)
24: Milli-osmol (mosmol)
25: Millisecond (msec)
26: Minute (min)
27: Nanomol (nmol)
28: Percentage (%)
29: Second (sec)
30: Piece (st)
31: Hour (hour)
32: Square metre body surface area (m^2)
33: Other
Med_freq
15: Pro re nata (PRN = as needed)
1: Once daily
2: Twice daily
3: Three times a day
4: Four times a day
5: Every other day
6: Once weekly
7: Twice weekly
8: Once monthly
9: Twice monthly
10: Every two hours
11: Every four hours
12: Every six hours
13: Every eight hours
14: Continuous infusion
16: Other
Med_route
1: Intraotic OR into the ear
2: Cutaneaous
3: Epidural
4: Inhalation
5: Intra-articular
6: Intracervical
7: Intradermal
8: Intramuscular
9: Intraperitoneal
10: Intrathecal
11: Intravenous
12: Intravesical
13: Local
14: Nasal
15: Intraoculair OR into the eye
16: Oral/per os
17: Oromucosal
18: Parenteral
19: PEG (percutaneous endoscopic gastrostomy)
20: Rectal
21: Subcutaneous
22: Sublingual OR under the tongue
23: Transdermal
24: Urethral
25: Vaginal
26: Other
YesNo
1: Yes
2: No