Create Patient page

Parents Name

Parent of the patient.

Whether this needs to be provided is specific to the study and patient. A parent may be an additional observer and/or required to provide information for young children.

First Name

First name of the patient.

Required.

Middle Name

Middle name of the patient.

Last Name

Last name of the patient.

Required.

Language

Language of the patient. After you make a change and submit, all forms that have been translated to the selected language appear in the selected language.

Required.

Zip (Postal Code)

ZIP code or postal code of residence.

Required.

Country

Country of residence.

Required.

Time Zone

Time zone in which the patient resides. After you make a change and submit, time values use the selected time zone.

Required.

Patient Group

Group attached to a study arm to which the patient is assigned.

Required.

Phone Number

Phone number to contact the patient.

Required.

Email Address

Email address for notifications. This is also the user name/sign in name for the patient.

Required.

Maximum length: 40 characters.

The ending must be standard for an email address, such as .com, .org, or .edu.

Site

Site to which the patient is assigned.

Required.