First assessment case report form

The grey box “For office use only”, will auto-populate with the patient’s ID, and the practice ODS code. The Pharmacist ID may be left blank but may be used for the main clinical trial.

Please complete the requested information about the appointment, the type of consultation and whether the patient agreed to the consultation to be recorded.  The remaining parts of the document allow for you to record the consultation, and an example is given below for your reference.

On the same day as your consultation, please email the completed CRF to the study manager ([email protected]).