postpart_rptestcd_out |
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radio |
PREGNANCY OUTCOME: If delivered during admission, please confirm:POST PARTUM (within six weeks of delivery) |
1, Yes ; 0, No ; 3, N/K |
post partum notes |
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pregout_rptestcd_out |
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radio |
Pregnancy Outcome |
1, Live birth ; 2, Still birth |
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dlvrdtc_rptestcd_out |
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text (date_dmy) |
Delivery Date |
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aplb_lbperf_out |
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radio |
Has infant(s) been tested for Mother's infection? |
1, Yes ; 2, No ; 3, N/K |
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aplb_lborres_out |
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radio |
If YES (to Has infant been tested for Mother's infection): |
1, Positive ; 2, Negative |
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outcome_text1 |
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text |
OUTCOME: (complete at discharge, transfer, death or DAY 28, whichever occurs first) |
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dsterm |
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dropdown |
Outcome: |
1, Discharged alive ; 2, Hospitalisation (Remains in Hospital ≥ Day 28 after symptom onset) ; 3, Transfer to other facility ; 4, Death ; 5, Palliative discharge ; 6, Unknown |
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dshosp |
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dropdown |
If hospitalised: |
1, Ongoing health care needs relating to this admission for COVID-19 ; 3, Ongoing health care needs NOT related to COVID episode ; 2, Medically fit for discharge (COVID-19 resolved) but remains in hospital for other reason (e.g. awaiting suitable care in community, resident in long term health care or mental health facility) |
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dsstdtcyn |
|
radio |
Is the Outcome date known |
1, Yes ; 2, No ; 3, N/A |
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dsstdtc |
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text (date_dmy) |
Outcome date |
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suppds_qval |
IF Discharged alive |
dropdown |
If Discharged alive: Ability to self-care at discharge versus before illness |
1, Same as before illness ; 2, Worse ; 3, Better ; N/A |
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oxygen_proccur |
Post-discharge treatment: |
radio |
Oxygen therapy |
1, Yes ; 2, No ; 3, N/A |
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renal_proccur |
|
radio |
Dialysis / renal treatment? |
1, Yes ; 2, No ; 3, N/A |
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other_cmoccur |
|
radio |
Other intervention or procedure? |
1, Yes ; 2, No ; 3, N/A |
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other_cmtrt |
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text |
If YES: Specify (multiple permitted) |
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siteid |
IF Transferred: |
text |
If Transferred: Facility name |
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siteidnk |
|
radio |
IF Transferred: Facility name N/K |
1, N/K |
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siteyn |
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dropdown |
If Transferred: Is the transfer facility a study site? |
1, Yes ; 2, No ; 3, N/A |
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subjidcat |
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dropdown |
If a Study Site: Participant number at new facility |
1, Same as the above ; 2, Different ; 3, N/K |
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transfer_subjid |
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text |
If Different, Participant number at the new facility(CPMS Site code (hypen) four or five digit number patientnumber e.g Y0401-0001). |
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outcome_complete |
Form Status |
dropdown |
Outcome section complete? |
0, Incomplete ; 1, Unverified ; 2, Complete |
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