Get the free CASE REPORT FORM - ESGE

ANNEX SHORT BARRETT ESOPHAGUS (TONGUE) VOLATILITY CASE REPORT FORM PATIENT IDENTIFICATION LAST NAME (3 first letters) Given name (3 first letters) Center N Inclusion number Inclusion date 1 Patient

How to fill out case report form

How to fill out a case report form?

1. Review the instructions: Before starting to fill out a case report form, it is essential to carefully read and understand the instructions provided. These instructions will guide you on how to properly complete each section of the form.
2. Gather all relevant information: Collect all the necessary information required to complete the case report form accurately. This may include details about the patient, their medical history, specific symptoms or conditions, treatment received, and any relevant test results or medications.
3. Start with the patient's information: Begin by entering the patient's personal details such as their name, date of birth, gender, contact information, and any identifying numbers or codes assigned to the patient.
4. Provide medical history: Record the patient's medical history, including any past illnesses, surgeries, allergies, or chronic conditions. This section helps provide context for the current case and may offer insights into potential factors influencing the current condition.
5. Document the current case: Describe the reasons for the patient's visit or consultation, as well as any symptoms they are experiencing. Include information about when the symptoms started, their severity, and any factors that may aggravate or alleviate the symptoms.
6. Capture treatment information: Document any treatments or interventions provided to the patient, including medications administered, dosage, frequency, and duration. Additionally, note any surgical procedures performed or therapies recommended.
7. Include supporting information: Attach any necessary supporting documents, such as laboratory results, imaging reports, or referrals. These documents provide additional evidence and context for the case.
8. Review and verify the entered information: Double-check all the information entered in the form for accuracy and completeness. Ensure that all fields have been appropriately filled out and that there are no missing or contradictory details.

Who needs a case report form?

1. Healthcare professionals: Case report forms are primarily used by healthcare professionals, including doctors, nurses, and medical researchers. They are an essential tool for documenting and studying individual cases, identifying patterns, and analyzing treatment outcomes.
2. Clinical research organizations (CROs) and pharmaceutical companies: CROs and pharmaceutical companies often utilize case report forms to collect data on patients participating in clinical trials. These forms help track and evaluate the effectiveness and safety of new medications or treatments.
3. Government agencies and regulatory bodies: Case report forms play a crucial role in regulatory processes, as they provide detailed information about individual cases that can be used for monitoring public health, investigating outbreaks, and making informed policy decisions.
4. Medical journals and publications: Medical journals and publications often require case report forms to be submitted along with research papers or case studies. These forms help ensure that the reported cases are accurately documented and supported by relevant data.

In summary, filling out a case report form requires careful attention to detail, gathering all necessary information, and following the provided instructions. Healthcare professionals, clinical research organizations, government agencies, and medical journals are among the entities that commonly use case report forms.

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What is case report form?

A case report form is a document used in clinical research to collect data about individual participants in a study.

Who is required to file case report form?

The researchers or healthcare professionals conducting the study are required to file the case report form.

How to fill out case report form?

The case report form should be filled out by providing accurate and detailed information about the participant's medical history, treatment, and outcomes.

What is the purpose of case report form?

The purpose of the case report form is to collect uniform data that can be used to analyze the results of the study and draw conclusions.

What information must be reported on case report form?

Information such as patient demographics, medical history, treatment received, adverse events, and study outcomes must be reported on the case report form.