<h3>Special Instructions</h3>    None.    <h3>Description</h3>  <p>This test asks Form Fillers to create pre-population data for two subjects/patients and then        verifies that this data is sent back correctly by the Form Manager in the form returned to the        Form Filler.</p>      <p>Data to be used in this test follows. This table contains all of the "R" and "R2" elements.        Refer to the CRD Trial Implementation Supplement Sec 5.8.4 for a definition of each Clinical        Database Variable Name. </p>      <table width="668" border="3" cellspacing="0" cellpadding="0">        <tr>          <td width="146" bgcolor="#CCCCCC">            <strong>CDASH Domain </strong>          </td>          <td width="96" bgcolor="#CCCCCC">            <strong>Clinical DB variable name </strong>          </td>          <td width="110" bgcolor="#99FFCC">            <div align="center">              <strong>Subject 1 </strong>            </div>          </td>          <td width="49" bgcolor="#99FFCC">            <div align="center">              <p>                <strong>Eval:<br/>                </strong>                <strong>Y/N</strong>              </p>            </div>          </td>          <td width="105" bgcolor="#FFFFCC">            <div align="center">              <strong>Subject 2 </strong>            </div>          </td>          <td width="49" bgcolor="#FFFFCC">            <div align="center">              <strong>Eval:<br/> Y/N</strong>            </div>          </td>          <td width="93" bgcolor="#CCCCCC">            <div align="center">              <strong>Evaluator's Comments </strong>            </div>          </td>        </tr>        <tr>          <td>            <strong>Common Identifiers </strong>          </td>          <td>STUDYID</td>          <td>111</td>          <td>'</td>          <td>112</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>SITEID</td>          <td>Chicago09</td>          <td>'</td>          <td>Vienna09</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>SUBJID</td>          <td>SUBJ-1</td>          <td>'</td>          <td>SUBJ-2</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>            <strong>Demography</strong>          </td>          <td>BRTHRY</td>          <td>1944</td>          <td>'</td>          <td>1966</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>BRTHMO</td>          <td>04</td>          <td>'</td>          <td>06</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>BRTHDY</td>          <td>04</td>          <td>'</td>          <td>06</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>SEX</td>          <td>M</td>          <td>'</td>          <td>F</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>DMDTC</td>          <td>today's date </td>          <td>'</td>          <td>today's date </td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>RACE</td>          <td>2106-3 (White) </td>          <td>'</td>          <td>2029-7 (Asian Indian) </td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>            <strong>Subject Characteristics </strong>          </td>          <td>SCDTC</td>          <td>today's date </td>          <td>'</td>          <td>today's date </td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>            <strong>Medical History </strong>          </td>          <td>MHTERM</td>          <td>Patient is recovering from a salomnella infection from eating raw eggs. </td>          <td>'</td>          <td>            <p>Patient suffers from asthma </p>            <p>Patient experiences arthritis in her left foot that was broken in the past.</p>          </td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>MHONG</td>          <td>'</td>          <td>'</td>          <td>Arthritis is ongoing </td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>            <strong>Concomitant Medication </strong>          </td>          <td>CMTRT</td>          <td rowspan="8">            <p>Augmentin 125 Mg Chew</p>            <p>Freq: twice/day. Start: 11-Feb-09. Status: active </p>          </td>          <td>'</td>          <td rowspan="8">            <p>Albuterol Sulfate 108 MCG/ACT AERS</p>            <p>Freq: 2 puffs q6hrs pm. Start: 21-Feb-09. Status: active </p>            <p>=================</p>            <p>Naproxen Sodium 550 MG TABS</p>            <p>Take one tablet by mouth every six hours as needed.</p>          </td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>CMINDC</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>CMDOSTOT</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>CMROUTE</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>CMSTDTC</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>CMSTTM</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>CMENDTC</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>CMENTM</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>            <strong>Substance Use </strong>          </td>          <td>SUTRT</td>          <td>None</td>          <td>'</td>          <td rowspan="2">Patient was a pack-a-day tobacco smoker for 10 years. She quit smoking in            1990.</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>SUNCF</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>            <strong>Vital Signs </strong>          </td>          <td>VSDTC</td>          <td>today's date </td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>VSTEST</td>          <td rowspan="6">            <p>code/code=8380-6</p>            <p>code/displayName=<br/> INTRAVASCULAR SYSTOLIC</p>            <p>code/codeSystem=<br/> 2.16.840.1.113883.6.1</p>            <p>value/value=68</p>            <p>value/unit=mm[Hg]</p>            <p>==========</p>            <p>code/code=8462-4</p>            <p>code/displayName=<br/> INTRAVASCULAR DIASTOLIC</p>            <p>code/codeSystem=<br/> 2.16.840.1.113883.6.1</p>            <p>value/value=108</p>            <p>value/unit=mm[Hg]</p>            <p>=========</p>            <p>Pulse: 82 / minute</p>            <p>Respiration: 29 / minute </p>          </td>          <td>'</td>          <td rowspan="6">            <p>code/code=8380-6</p>            <p>code/displayName=<br/> INTRAVASCULAR SYSTOLIC</p>            <p>code/codeSystem=<br/> 2.16.840.1.113883.6.1</p>            <p>value/value=102</p>            <p>value/unit=mm[Hg]</p>            <p>========</p>            <p>code/code=8462-4</p>            <p>code/displayName=<br/> INTRAVASCULAR DIASTOLIC</p>            <p>code/codeSystem=<br/> 2.16.840.1.113883.6.1</p>            <p>value/value=140</p>            <p>value/unit=mm[Hg]</p>            <p>======</p>            <p>Pulse: 86 / minute</p>            <p>Respiration: 30 / minute </p>          </td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>VSSTAT</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>VSORRES</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>VSORRESU</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>VSLOC</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>VSPOS</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>            <strong>Physical Exam - Traditional Approach </strong>          </td>          <td>PEDTC</td>          <td>April 1, 2008</td>          <td>'</td>          <td>December 1, 2008 </td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>            <strong>Adverse Events </strong>          </td>          <td>AETERM</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>AESER</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>AEENDTC</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>AESTTM</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>AEENDTC</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>AEENTM</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td height="22">'</td>          <td>AESEV and/or AETOXGR </td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>AEREL</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>AERELTP</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>AEACN</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>AEOUT</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>            <strong>Lab Test Results - Scenario 1: Local processing </strong>          </td>          <td>LBDTC</td>          <td>'</td>          <td>'</td>          <td rowspan="7">            <p>              <strong>Test: CBC w/ Differential ; Platelet</strong>            </p>            <p>White Blood Cell (WBC) Count:</p>            <p>Result=4.50<br/> Units=MILL/MCL<br/> Ref Range=3.8-10.8 </p>            <p>------------------</p>            <p>Hemoglobin:</p>            <p>Result=13.7<br/> Units=G/DL<br/> Ref Range=11.7-15.5 </p>          </td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>LBTM</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>LBSTAT</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>LBCAT LBSCAT </td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>LBTPT</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>LBFAST</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>LBREFID</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>            <strong>Lab Test Results - Scenario 1: Local processing</strong>          </td>          <td>LBDTC</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>LBTM</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>LBSTAT</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>LBCAT LBSCAT </td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>LBTPT</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>LBFAST</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>LBPCCND</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>LBTESTCD and/or LBTEST </td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>LBORRES</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>LBORRESU</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>LBORNRLO LBORNRHI LBSTNRC </td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>LBNRIND</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>LBCLSG</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>LBNAM</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>LBREFID</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>            <strong>Lab Test Results - Scenario 3: Central processing but CRF... </strong>          </td>          <td>LBDTC</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>LBTM</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>LBSTAT</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>LBCAT LBSCAT </td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>LBTPT</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>LBFAST</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>LBTEST</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>LBORRES</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>LBCLSG</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>LBNAM</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>LBREFID</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>            <strong>ECG Test Results - Scenario 1: Central reading... </strong>          </td>          <td>LBDTC</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>SBSTAT</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>LBCAT LBSCAT </td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>LBTPT</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>            <strong>ECG Test Results - Scenario 2: Local reading: ECGs... </strong>          </td>          <td>EGSTAT</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>EGDTC</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>EGTM</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>EGTPT</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>EGTESTCD and/or EGTEST </td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>EGORRES</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>EGORRESU</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>            <strong>ECG Test Results - Scenario 3: Central reading (as in Scen 1): But...</strong>          </td>          <td>EGSTAT</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>EGDTC</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>EGTM</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>EGTPT</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>EGTEST</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>EGORRESU</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>EGCLSG</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>EGORRESU</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>EGCLSG</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>EGORRES</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>EGNAM</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td colspan="7" bgcolor="#CCCCCC">            <em>              <strong>List below optional attributes that are supported, but which were not included                above. Include the CDASH domain in Column 1 and Variable Name in Column 2 </strong>            </em>          </td>        </tr>        <tr>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>        <tr>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>          <td>'</td>        </tr>      </table>  <h3>Evaluation</h3>      <p>The Connectathon Monitor will check for correct exchange of the pre-population data contained        in the test description. </p>      <p>The table in the test description contains all "R" and "R2" elements in the CDASH option. The        connectathon monitor will use this table to record (Y/N) which elements were successfully        exchanged.</p>      <p>The Connectathon Monitor may ask the Form Filler to request the forms for the test        subjects/patients again in his/her presence, or to send data for an additional subject/patient        and observe the transfer real-time.</p>      <p>On the <strong>Form Filler</strong>, the Connectathon monitor will observe that a form is        returned with the data in the Test Description pre-populated on the form. The Form Filler        should be able to add additional data, or change existing fields, and then submit the        completed form back to the Form Manager.</p>  