Date |
|
2021-06-16
|
Study ID |
|
PT-101
|
Date subject signed consent |
|
2010-09-01
|
Upload the patient's consent form |
|
Consent.docx
|
First Name |
|
Malcolm
|
Last Name |
|
Reynolds
|
Street, City, State, ZIP |
|
101 Serenity Ship, Out-of-sight, NoWhere, 18533
|
Phone number |
|
(435) 271-8000
|
E-mail |
|
SpaceCowboy@gmail.com
|
Date of birth |
|
2015-08-08
|
Age (years) |
|
2
|
Sex |
|
1
|
Has the patient given birth before? |
|
|
Gym |
|
Friday,Tuesday,Monday,Thursday,Wednesday
|
Aerobics |
|
Thursday,Tuesday
|
Smoke |
|
|
Drink (Alcoholic Beverages) |
|
Thursday,Friday,Monday,Tuesday,Wednesday
|
Specify the patient's mood |
|
53
|
Is patient taking any of the following medications? (check all that apply) |
|
|
Height (cm) |
|
187.0
|
Weight (kilograms) |
|
78
|
BMI |
|
22.3
|
Comments |
|
|
participant_id |
|
|
Test Field 1 |
|
|
Test Field 2 |
|
|
DSRowId |
|
1741
|
Di Import Hash |
|
qEDU/pnvIM/Tk1D5FUyw3g==
|
Day |
|
44361
|
Dataset Id |
|
1
|
|
Date |
|
2021-06-16
|
Emergency Contact Phone Number |
|
(246) 810-1214
|
Next of Kin Contact Name |
|
|
Next of Kin Contact Address |
|
|
Next of Kin Contact Phone Number |
|
|
DSRowId |
|
1741
|
Di Import Hash |
|
fw49xysumadMaCUiQ2DP2w==
|
Day |
|
44361
|
Dataset Id |
|
2
|
|
Date |
|
2021-06-16
|
Serum Prealbumin (mg/dL) |
|
65.0
|
Creatinine (mg/dL) |
|
85.0
|
Normalized Protein Catabolic Rate (g/kg/d) |
|
112.0
|
Cholesterol (mg/dL) |
|
65.0
|
Transferrin (mg/dL) |
|
33.0
|
DSRowId |
|
1741
|
Di Import Hash |
|
OIu+xE/FH7s2ERA5C0qvBg==
|
Day |
|
44361
|
Dataset Id |
|
3
|
|