|__|__|-|__|__|__|-|__|__|__|__| Sitting SITTING 12 Lead standard Standing STANDING |__|__|:|__|__| 12-LEAD STANDARD Supine SUPINE ECG TEST RESULTS ECG test name Results Units Not done Reason not done EGTEST EGORRES EGORRESU EGSTAT EGREASND MSEC RR-interval |__|__|__|__| RRMEAN_EGORRES MSEC PR-interval |__|__|__| PRMEAN_EGORRES MSEC QT-interval |__|__|__| QTMEAN_EGORRES MSEC QRS-duration |__|__|__| QRSDUR_EGORRES APPENDIX G MEAL RECORD Was detailed meal record information collected? Yes No NA MLPERF ML Amount of fat Reason not Start time End time (gms) FAORRES Date of meal Meal type Not done Amount consumed MLDOSTXT done MLSTTIM MLENTIM FATEST = MLDAT MLDTC MLTRT MLSTAT MLSTDTC MLENDTC Amount of Fat and MLREASND FAORRESU = g
|__|__|-|__|__|__|-|__|__|__|__| 12 Lead standard 12-LEAD STANDARD Sitting SITTING Standing STANDING Supine SUPINE |__|__|:|__|__| ECG TEST RESULTS ECG test name EGTEST Results EGORRES Units EGORRESU Not done EGSTAT Reason not done EGREASND RR-interval |__|__|__|__| RRMEAN_EGORRES MSEC PR-interval |__|__|__| PRMEAN_EGORRES MSEC QT-interval |__|__|__| QTMEAN_EGORRES MSEC QRS-duration |__|__|__| QRSDUR_EGORRES MSEC APPENDIX G MEAL RECORD ML Was detailed meal record information collected? MLPERF Yes No NA Date of meal MLDAT MLDTC Start time MLSTTIM MLSTDTC End time MLENTIM MLENDTC Meal type MLTRT Amount consumed MLDOSTXT Amount of fat (gms) FAORRES FATEST = Amount of Fat and FAORRESU = g Not done MLSTAT Reason not done MLREASND
wwarn-malaria-case-record-form-crf-v2_09apr2018.docx