APPENDIX F Was the ECG recorded? ECG RECORDING Yes No NA111 EGPERF NOT SUBMITTED Date of ECG Method Position Not done Reason not done EGDTC Time of ECG EGTIM EGDTC EGMETHOD EGPOS EGSTAT EGREASND |__|__|-|__|__|__|-|__|__|__|__| 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 EGSTAT EGREASND EGTEST EGRRES EGORRESU MSEC RR-interval RRMEAN_EGORRES MSEC PR-interval |__|__|__| PRMEAN_EGORRES MSEC QT-interval |__|__|__| QTMEAN_EGORRES MSEC QRS-duration |__|__|__| QRSDUR_EGORRES APPENDIX G Was detailed meal record information collected? MEAL RECORD Yes No NA MLPERF NOT SUBMITTED
APPENDIX F ECG RECORDING Was the ECG recorded? EGPERF NOT SUBMITTED Yes No NA111 Date of ECG EGDTC Time of ECG EGTIM EGDTC Method EGMETHOD Position EGPOS Not done EGSTAT Reason not done EGREASND |__|__|-|__|__|__|-|__|__|__|__| 12 Lead standard 12-LEAD STANDARD Sitting SITTING Standing STANDING Supine SUPINE |__|__|:|__|__| ECG TEST RESULTS ECG test name EGTEST Results EGRRES 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 Was detailed meal record information collected? MLPERF NOT SUBMITTED Yes No NA
wwarn-malaria-case-record-form-crf-v1-january-2017.docx