Form HO - Healthcare Encounters
HO - Healthcare Encounters
Were there any healthcare encounters?
No
Yes
What was the healthcare encounter?
Choose
EMERGENCY ROOM VISIT
HOSPITAL STAY
INTENSIVE CARE UNIT STAY
PRIMARY CARE PHYSICIAN'S OFFICE VISIT
SKILLED NURSING FACILITY STAY
OTHER
If Other, specify
What was the [healthcare encounter/HOTERM] [start/admission] date?
01 Jan 2000
What was the [healthcare encounter/HOTERM] [end/discharge] date?
01 Jan 2000
Was the [healthcare encounter/HOTERM] ongoing (as of the [study-specific timepoint or period])?
No
Yes
What was the reason for the [healthcare encounter/HOTERM]?
What was the identifier for the adverse event(s), which precipitated the [healthcare encounter/HOTERM]?
*
Mandatory field