Single Institutional Review Board (sIRB) Implementation Guide, published by HL7 International - BR&R Work Group. This is not an authorized publication; it is the continuous build for version 1.0.0). This version is based on the current content of https://github.com/HL7/fhir-sirb/ and changes regularly. See the Directory of published versions
Official URL: http://hl7.org/fhir/us/sirb/Questionnaire/sirb-continuing-review-questionnaire-populate | Version: 1.0.0 | |||
Draft as of 2023-04-24 | Computable Name: Continuing_review |
LinkId | Text | Cardinality | Type | Flags | Description & Constraints |
---|---|---|---|---|---|
Continuing_review | Questionnaire | http://hl7.org/fhir/us/sirb/Questionnaire/sirb-continuing-review-questionnaire-populate#1.0.0 | |||
cr1 | Research Study | 0..1 | group | ||
cr1.1 | Study Title | 0..1 | string | Expressions:
| |
cr1.1_help | Study Title from the Informed Consent | 0..1 | display | ||
cr1.2 | IRB Protocol Number | 0..1 | string | Expressions:
| |
cr1.2_help | Number assigned to the protocol by IRB | 0..1 | display | ||
cr1.3 | Enrollment Status | 0..1 | choice | Options: 4 options | |
cr1.4 | Intervention Status | 0..1 | choice | Options: 3 options | |
cr1.4_help | Current intervention status. This can be used by the IRB to determine that continuing review is no longer required. | 0..1 | display | ||
cr1.5 | Study Status | 0..1 | choice | Options: 9 options | |
cr1.5_help | Status of the study overall. Study Status can also be used by the IRB to determine that continuing review is no longer required. | 0..1 | display | ||
cr1.6 | Funding Source(check all that are applicable) | 0..* | choice | Options: 7 options | |
cr1.6_help | The funding source for the study. Note that a single study can have multiple funding sources and that the funding sources can change over time. | 0..1 | display | ||
cr1.7 | Other Funding Source-Please specify: | 0..1 | string | Enable When: cr1.6 = Other Funding Source (Temporary Codes#otherfund) | |
cr12 | sIRB (Reviewing Institution) | 0..1 | group | ||
cr12.1 | sIRB (Reviewing Institution) Name | 0..1 | string | Expressions:
| |
cr9 | Submission Type | 0..1 | group | ||
cr9.1 | Is this Continuing Review Form being submitted by the lead PI site on behalf of all of the relying sites? | 1..1 | choice | Options: 2 options | |
cr9.1_help | Select "Yes" if this Continuing Review Form is being completed by the lead principal investigator site, the study coordinating center or other administrative unit on behalf of all the relying sites in the overall study. | 0..1 | display | ||
ExternalDataFor_cr9.2 | External Data For linkId cr9.2 | 0..* | open-choice | Expressions:
| |
cr9.2 | If this Continuing Review Form is specific to a relying site, select the relying site in order to pre-populate the relying institution and relying site principal investigator details below. | 0..1 | choice | Enable When: cr9.1 = No (expandedYes-NoIndicator#N) | |
cr9.2_help | This question and its answer will not print on the Continuing Review Form but are necessary for the form logic. If you do not want pre-population to occur, leave this question blank and manually fill in the relying institution and relying site principal investigator details. | 0..1 | display | ||
cr11 | Site Principal Investigator Institution | 0..1 | group | ||
cr11.1 | Site Principal Investigator Institution Name | 1..1 | string | Expressions:
| |
cr11.2 | Institution Department Name or Division | 0..1 | string | Expressions:
| |
cr2 | Site Principal Investigator | 0..1 | group | ||
cr2.1 | First Name | 0..1 | string | Expressions:
| |
cr2.1_help | First or given name of the site principal investigator | 0..1 | display | ||
cr2.4 | Last Name | 0..1 | string | Expressions:
| |
cr2.4_help | Surname or family name | 0..1 | display | ||
cr2.5 | Suffix | 0..1 | string | Expressions:
| |
cr2.5_help | Suffix such as Junior (Jr.), Senior (Sr.), I, II, III, IV, etc. | 0..1 | display | ||
cr2.6 | Degree(s) | 0..1 | string | Expressions:
| |
cr2.6_help | Professional and Academic degrees of the site principal investigator | 0..1 | display | ||
cr2.10 | Site Principal Investigator Department Name or Division | 0..1 | string | Expressions:
| |
cr2.2 | Phone | 0..1 | string | Expressions:
| |
cr2.2_help | 10-digit phone number, including area code | 0..1 | display | ||
cr2.3 | 0..1 | string | Expressions:
| ||
cr2.3_help | Email address for site PI | 0..1 | display | ||
cr7 | Report Type | 0..1 | group | ||
cr7.1 | Is this an initial report? | 0..1 | choice | Options: 2 options | |
cr7.1_help | An initial report is the first time that the study is reviewed. | 0..1 | display | ||
cr3 | Accrual of Participants | 0..1 | group | ||
cr3_help | The number of participants who are enrolled, approved to enroll, consented, withdrawn, lost to contact, screen failures, active or in follow-up, or completed study. | 0..1 | display | ||
cr3.1 | Provide counts for the following | 0..1 | group | ||
cr3.1.15 | If this is an initial review, provide counts since study inception. The count for the Previous Accrual should be entered as 0 when completing the questionnaire for the initial report. | 0..1 | display | Enable When: cr7.1 = Yes (expandedYes-NoIndicator#Y) | |
cr3.1.1 | Participants enrolled since activation | 0..1 | group | ||
cr3.1.1.1 | Previous Accrual | 0..1 | integer | ||
cr3.1.1.2 | Additional enrollees this approval period | 0..1 | integer | ||
cr3.1.1.3 | Total | 0..1 | integer | Expressions:
| |
cr3.1.31 | null | 0..1 | display | ||
cr3.1.2 | Participants enrolled since last approval | 0..1 | group | ||
cr3.1.2.1 | Previous Accrual | 0..1 | integer | ||
cr3.1.2.2 | Additional enrollees this approval period | 0..1 | integer | ||
cr3.1.2.3 | Total | 0..1 | integer | Expressions:
| |
cr3.1.32 | null | 0..1 | display | ||
cr3.1.3 | Participants approved to enroll | 0..1 | group | ||
cr3.1.3.1 | Previous Accrual | 0..1 | integer | ||
cr3.1.3.2 | Additional enrollees this approval period | 0..1 | integer | ||
cr3.1.3.3 | Total | 0..1 | integer | Expressions:
| |
cr3.1.33 | null | 0..1 | display | ||
cr3.1.4 | Participants consented | 0..1 | group | ||
cr3.1.4.1 | Previous Accrual | 0..1 | integer | ||
cr3.1.4.2 | Additional enrollees this approval period | 0..1 | integer | ||
cr3.1.4.3 | Total | 0..1 | integer | Expressions:
| |
cr3.1.34 | null | 0..1 | display | ||
cr3.1.5 | Participants withdrawn | 0..1 | group | ||
cr3.1.5.1 | Previous Accrual | 0..1 | integer | ||
cr3.1.5.2 | Additional enrollees this approval period | 0..1 | integer | ||
cr3.1.5.3 | Total | 0..1 | integer | Expressions:
| |
cr3.1.35 | null | 0..1 | display | ||
cr3.1.6 | Participants lost to contact | 0..1 | group | ||
cr3.1.6.1 | Previous Accrual | 0..1 | integer | ||
cr3.1.6.2 | Additional enrollees this approval period | 0..1 | integer | ||
cr3.1.6.3 | Total | 0..1 | integer | Expressions:
| |
cr3.1.36 | null | 0..1 | display | ||
cr3.1.7 | Participants with screen failures | 0..1 | group | ||
cr3.1.7.1 | Previous Accrual | 0..1 | integer | ||
cr3.1.7.2 | Additional enrollees this approval period | 0..1 | integer | ||
cr3.1.7.3 | Total | 0..1 | integer | Expressions:
| |
cr3.1.37 | null | 0..1 | display | ||
cr3.1.8 | Participants still active or follow-up | 0..1 | group | ||
cr3.1.8.1 | Previous Accrual | 0..1 | integer | ||
cr3.1.8.2 | Additional enrollees this approval period | 0..1 | integer | ||
cr3.1.8.3 | Total | 0..1 | integer | Expressions:
| |
cr3.1.38 | null | 0..1 | display | ||
cr3.1.9 | Participants completed study | 0..1 | group | ||
cr3.1.9.1 | Previous Accrual | 0..1 | integer | ||
cr3.1.9.2 | Additional enrollees this approval period | 0..1 | integer | ||
cr3.1.9.3 | Total | 0..1 | integer | Expressions:
| |
cr3.1.39 | null | 0..1 | display | ||
cr3.1.10 | By Sex | 0..1 | group | ||
cr3.1.10.1 | Men | 0..1 | group | ||
cr3.1.10.1.1 | Previous Accrual | 0..1 | integer | ||
cr3.1.10.1.2 | Additional enrollees this approval period | 0..1 | integer | ||
cr3.1.10.1.3 | Total | 0..1 | integer | Expressions:
| |
cr3.1.10.31 | null | 0..1 | display | ||
cr3.1.10.2 | Women | 0..1 | group | ||
cr3.1.10.2.1 | Previous Accrual | 0..1 | integer | ||
cr3.1.10.2.2 | Additional enrollees this approval period | 0..1 | integer | ||
cr3.1.10.2.3 | Total | 0..1 | integer | Expressions:
| |
cr3.1.40 | null | 0..1 | display | ||
cr3.1.11 | By Race | 0..1 | group | ||
cr3.1.11.1 | White | 0..1 | group | ||
cr3.1.11.1.1 | Previous Accrual | 0..1 | integer | ||
cr3.1.11.1.2 | Additional enrollees this approval period | 0..1 | integer | ||
cr3.1.11.1.3 | Total | 0..1 | integer | Expressions:
| |
cr3.1.11.31 | null | 0..1 | display | ||
cr3.1.11.2 | Black or African American | 0..1 | group | ||
cr3.1.11.2.1 | Previous Accrual | 0..1 | integer | ||
cr3.1.11.2.2 | Additional enrollees this approval period | 0..1 | integer | ||
cr3.1.11.2.3 | Total | 0..1 | integer | Expressions:
| |
cr3.1.11.32 | null | 0..1 | display | ||
cr3.1.11.3 | Asian | 0..1 | group | ||
cr3.1.11.3.1 | Previous Accrual | 0..1 | integer | ||
cr3.1.11.3.2 | Additional enrollees this approval period | 0..1 | integer | ||
cr3.1.11.3.3 | Total | 0..1 | integer | Expressions:
| |
cr3.1.11.33 | null | 0..1 | display | ||
cr3.1.11.4 | American Indian or Alaska Native | 0..1 | group | ||
cr3.1.11.4.1 | Previous Accrual | 0..1 | integer | ||
cr3.1.11.4.2 | Additional enrollees this approval period | 0..1 | integer | ||
cr3.1.11.4.3 | Total | 0..1 | integer | Expressions:
| |
cr3.1.11.34 | null | 0..1 | display | ||
cr3.1.11.5 | Native Hawaiian or other Pacific Islander | 0..1 | group | ||
cr3.1.11.5.1 | Previous Accrual | 0..1 | integer | ||
cr3.1.11.5.2 | Additional enrollees this approval period | 0..1 | integer | ||
cr3.1.11.5.3 | Total | 0..1 | integer | Expressions:
| |
cr3.1.11.35 | null | 0..1 | display | ||
cr3.1.11.6 | More than One Race | 0..1 | group | ||
cr3.1.11.6.1 | Previous Accrual | 0..1 | integer | ||
cr3.1.11.6.2 | Additional enrollees this approval period | 0..1 | integer | ||
cr3.1.11.6.3 | Total | 0..1 | integer | Expressions:
| |
cr3.1.11.36 | null | 0..1 | display | ||
cr3.1.11.7 | Unknown/Not Reported | 0..1 | group | ||
cr3.1.11.7.1 | Previous Accrual | 0..1 | integer | ||
cr3.1.11.7.2 | Additional enrollees this approval period | 0..1 | integer | ||
cr3.1.11.7.3 | Total | 0..1 | integer | Expressions:
| |
cr3.1.41 | null | 0..1 | display | ||
cr3.1.12 | By Ethnicity | 0..1 | group | ||
cr3.1.12.1 | Hispanic or Latino | 0..1 | group | ||
cr3.1.12.1.1 | Previous Accrual | 0..1 | integer | ||
cr3.1.12.1.2 | Additional enrollees this approval period | 0..1 | integer | ||
cr3.1.12.1.3 | Total | 0..1 | integer | Expressions:
| |
cr3.1.12.31 | null | 0..1 | display | ||
cr3.1.12.2 | Not Hispanic or Latino | 0..1 | group | ||
cr3.1.12.2.1 | Previous Accrual | 0..1 | integer | ||
cr3.1.12.2.2 | Additional enrollees this approval period | 0..1 | integer | ||
cr3.1.12.2.3 | Total | 0..1 | integer | Expressions:
| |
cr3.1.12.32 | null | 0..1 | display | ||
cr3.1.12.3 | Unknown/Not Reported | 0..1 | group | ||
cr3.1.12.3.1 | Previous Accrual | 0..1 | integer | ||
cr3.1.12.3.2 | Additional enrollees this approval period | 0..1 | integer | ||
cr3.1.12.3.3 | Total | 0..1 | integer | Expressions:
| |
cr3.1.42 | null | 0..1 | display | ||
cr3.1_help | Number of participants by category | 0..1 | display | ||
cr3.2 | Vulnerable Populations | 0..1 | group | ||
cr3.2.1 | Number of potentially vulnerable participants enrolled | 0..1 | group | ||
cr3.2.1.1 | Previous Accrual | 0..1 | integer | ||
cr3.2.1.2 | Additional enrollees this approval period | 0..1 | integer | ||
cr3.2.1.3 | Total | 0..1 | integer | Expressions:
| |
cr3.2.30 | null | 0..1 | display | ||
cr3.2.2 | Check the applicable checkboxes if these groups are represented in the columns above | 0..1 | group | ||
cr3.2.2.15 | For an initial report, skip the checkboxes for Previous Accrual | 0..1 | display | Enable When: cr7.1 = Yes (expandedYes-NoIndicator#Y) | |
cr3.2.2.1 | Children | 0..* | choice | Options: 2 options | |
cr3.2.2.2 | Cognitively Impaired | 0..* | choice | Options: 2 options | |
cr3.2.2.3 | Employees | 0..* | choice | Options: 2 options | |
cr3.2.2.4 | Fetuses | 0..* | choice | Options: 2 options | |
cr3.2.2.5 | Neonates (non-viable / uncertain viability) | 0..* | choice | Options: 2 options | |
cr3.2.2.6 | Pregnant Women | 0..* | choice | Options: 2 options | |
cr3.2.2.7 | Prisoners | 0..* | choice | Options: 2 options | |
cr3.2.2.8 | Students | 0..* | choice | Options: 2 options | |
cr3.2.2.9 | Other | 0..* | choice | Options: 2 options | |
cr3.2.2.10 | Please describe other vulnerable participants enrolled, if any: | 0..1 | text | Enable When: | |
cr3.2_help | Vulnerable persons are those who are relatively (or absolutely) incapable of protecting their own interests. More formally, they may have insufficient power, intelligence, education, resources, strength, or other needed attributes to protect their own interests. (CIOMS) | 0..1 | display | ||
cr4 | Study Report | 0..1 | group | ||
cr4.5 | Since your last report: | 0..1 | group | ||
cr4.5.50 | (since the study inception for an initial report) | 0..1 | display | Enable When: cr7.1 = Yes (expandedYes-NoIndicator#Y) | |
cr4.5.1 | Summarize the study progress | 0..1 | text | ||
cr4.5.1_help | Summary of activities in the study (since the last report if this is not an initial review) | 0..1 | display | ||
cr4.5.2 | Have participants experienced any benefits? | 0..1 | choice | Options: 2 options | |
cr4.5.2_help | Indicator of benefits to participants | 0..1 | display | ||
cr4.5.3 | If yes, please summarize the benefits: | 0..1 | text | Enable When: cr4.5.2 = Yes (expandedYes-NoIndicator#Y) | |
cr4.5.4 | Have participants been withdrawn from this study? | 0..1 | choice | Options: 2 options | |
cr4.5.5 | If yes, please summarize the withdrawals: | 0..1 | text | Enable When: cr4.5.4 = Yes (expandedYes-NoIndicator#Y) | |
cr4.5.6 | Have any participants or others complained about the research? | 0..1 | choice | Options: 2 options | |
cr4.5.7 | If yes, please summarize the complaints: | 0..1 | text | Enable When: cr4.5.6 = Yes (expandedYes-NoIndicator#Y) | |
cr4.5.8 | Has any new and relevant literature been published related to the risks or benefits associated with this research? | 0..1 | choice | Options: 2 options | |
cr4.5.8_help | literature published related to the risks or benefits associated with this research | 0..1 | display | ||
cr4.5.9 | If yes, please summarize relevance to study: | 0..1 | text | Enable When: cr4.5.8 = Yes (expandedYes-NoIndicator#Y) | |
cr4.5.10 | Have there been any interim findings? | 0..1 | choice | Options: 2 options | |
cr4.5.11 | If yes, please summarize findings: | 0..1 | text | Enable When: cr4.5.10 = Yes (expandedYes-NoIndicator#Y) | |
cr4.5.12 | Have there been any multi-center trial reports? | 0..1 | choice | Options: 2 options | |
cr4.5.13 | If yes, please summarize findings and recommendations | 0..1 | text | Enable When: cr4.5.12 = Yes (expandedYes-NoIndicator#Y) | |
cr4.5.14 | Have there been any data safety monitoring board reports? | 0..1 | choice | Options: 2 options | |
cr4.5.15 | If yes, please summarize findings and recommendations: | 0..1 | text | Enable When: cr4.5.14 = Yes (expandedYes-NoIndicator#Y) | |
cr4.5.16 | In the opinion of the Principal Investigator, have the risks or potential benefits changed? | 0..1 | choice | Options: 2 options | |
cr4.5.17 | If yes, please summarize the changes: | 0..1 | text | Enable When: cr4.5.16 = Yes (expandedYes-NoIndicator#Y) | |
cr4.5.18 | Has an audit of the research been conducted by a federal agency or sponsor? | 0..1 | choice | Options: 2 options | |
cr4.5.19 | Have there been any presentations or publications (including abstracts) from this research? | 0..1 | choice | Options: 2 options | |
cr4.5.20 | Have there been any substantial changes to the study (protocol, consent forms, or other study documents) or to the risk-benefit assessment? | 0..1 | choice | Options: 2 options | |
cr4.5.21 | If yes, please summarize the changes: | 0..1 | text | Enable When: cr4.5.20 = Yes (expandedYes-NoIndicator#Y) | |
cr4.5.22 | Was informed consent obtained from all enrolled participants? | 0..1 | choice | Options: 2 options | |
cr4.5.23 | Has there been any other relevant information regarding this protocol? | 0..1 | choice | Options: 2 options | |
cr4.5.24 | If yes, please summarize: | 0..1 | text | Enable When: cr4.5.23 = Yes (expandedYes-NoIndicator#Y) | |
cr5 | Adverse Events | 0..1 | group | ||
cr5_help | Any adverse events (medical and/or non-medical) during the previous continuing review period (or since the study inception for an initial report) | 0..1 | display | ||
cr5.1 | Have there been any internal or local adverse events in the research? | 0..1 | choice | Options: 2 options | |
cr5.2 | Did these adverse events occur at the frequency and level of severity expected? | 0..1 | choice | Enable When: cr5.1 = Yes (expandedYes-NoIndicator#Y) Options: 2 options | |
cr5.12 | If no, please explain: | 0..1 | text | Enable When: cr5.2 = No (expandedYes-NoIndicator#N) | |
cr5.3 | Have any protocol deviations or violations occurred in this study? | 0..1 | choice | Options: 2 options | |
cr5.13 | If yes, please describe the protocol deviations or violations | 0..1 | text | Enable When: cr5.3 = Yes (expandedYes-NoIndicator#Y) | |
cr6 | Conflict of Interest | 0..1 | group | ||
cr6.1 | Has there been a change in the financial disclosure status of the Principal Investigator or other members of the Research Staff that has not been reported to the IRB? | 0..1 | choice | Options: 2 options | |
cr6.2 | If yes, please explain: | 0..1 | text | Enable When: cr6.1 = Yes (expandedYes-NoIndicator#Y) | |
cr17 | Attachments | 0..* | group | ||
cr17.1 | Describe the file that is being attached (optional) | 0..1 | string | ||
cr17.2 | Attachment | 0..1 | attachment | ||
cr17_help | Attachments related to the Continuing Review can be included here. Examples are a DSMB report or an Adverse Event Report (Medical or Non-Medical). | 0..1 | display | ||
ADMIN00 | Administrative Use Only | 0..1 | group | ||
ADMIN01 | Link ID prefix | 0..1 | string | Initial Value: string = cr | |
ADMIN02 | Questionnaire Response ID for the parent Questionnaire Response (such as the Initiate a Study Questionnaire Response), if any | 0..1 | string | Initial Value: string = temporarily unavailable Expressions:
| |
ADMIN03 | ID of the Research Study FHIR Resource associated with the study Questionnaire Responses, if any | 0..1 | string | Initial Value: string = temporarily unavailable Expressions:
| |
ADMIN04 | Questionnaire Response ID of the local considerations Questionnaire Response, if any | 0..1 | string | ||
Documentation for this format |
Option Sets
Answer options for cr1.3
Answer options for cr1.4
Answer options for cr1.5
Answer options for cr1.6
Answer options for cr9.1
Answer options for cr7.1
Answer options for cr3.2.2.1
Answer options for cr3.2.2.2
Answer options for cr3.2.2.3
Answer options for cr3.2.2.4
Answer options for cr3.2.2.5
Answer options for cr3.2.2.6
Answer options for cr3.2.2.7
Answer options for cr3.2.2.8
Answer options for cr3.2.2.9
Answer options for cr4.5.2
Answer options for cr4.5.4
Answer options for cr4.5.6
Answer options for cr4.5.8
Answer options for cr4.5.10
Answer options for cr4.5.12
Answer options for cr4.5.14
Answer options for cr4.5.16
Answer options for cr4.5.18
Answer options for cr4.5.19
Answer options for cr4.5.20
Answer options for cr4.5.22
Answer options for cr4.5.23
Answer options for cr5.1
Answer options for cr5.2
Answer options for cr5.3
Answer options for cr6.1