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Questions in this form will only display if you have selected Yes for Are you completing details for CRF v9.7 or later?, in the Inclusion Criteria form |
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FINAL OUTCOME - this form no longer needs completing |
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Outcome |
1, Same as before illness ; 5, Palliative discharge ; 4, Death ; 3, Transfer to other facility ; 6, N/K |
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Outcome date |
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Outcome date N/K |
1, N/K |
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If discharged alive |
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Ability to self-care at discharge versus before illness: |
1, Same as before illness ; 2, Worse ; 3, Better ; N/A |
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Post-discharge treatment: Oxygen therapy |
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If transferred |
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If Transferred: Facility name |
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If Transferred: Facility name N/K |
1, N/K |
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If transferred, is the transfer facility a study site? |
1, Yes ; 2, No ; 3, N/K |
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If a Study Site: Participant number at new facility |
1, Same as the above ; 2, Different ; 3, N/K |
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If a Study Site: Participant # at new facility |
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Form Status |
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Final Outcome section complete? |
0, Incomplete ; 1, Unverified ; 2, Complete |