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����� ELIGIBILITYE1E2YesE3000100020003000400050006000700080009001000110012001300140015001600170018001900200021002200230024002500260027002800290030003100320033003400350036003700380039004000410042004300440045004600470048004900500051005200530054005500560057005800590060006100620063006400650066006700680069007000710072007300740075007600770078007900800081008200830084008500860087008800890090009100920093009400950096009700980099010001010102010301040105010601070108010901100111011201130114011501160117011801190120012101220123012401250126012701280129013001310132013301340135013601370138013901400141014201430144014501460147014801490150015101520153015401550156015701580159016001610162016301640165016601670168016901700171017201730174017501760177017801790180018101820183018401850186018701880189019001910192019301940195019601970198019902000201020202030204020502060207020802090210021102120213021402150216021702180219022002210222022302240225022602270228022902300231023202330234023502360237023802390240024102420243024402450246024702480249025002510252025302540255025602570258025902600261026202630264026502660267026802690270027102720273027402750276027702780279028002810282028302840285028602870288028902900291029202930294029502960297029802990300030103020303030403050306030703080309031003110312031303140315031603170318031903200321032203230324032503260327032803290330033103320333033403350336033703380339034003410342034303440345034603470348034903500351035203530354035503560357035803590360036103620363036403650366036703680369037003710372037303740375037603770378037903800381038203830384038503860387038803890390039103920393039403950396039703980399040004010402040304040405040604070408040904100411041204130414041504160417041804190420042104220423042404250426042704280429043004310432043304340435043604370438043904400441044204430444044504460447044804490450045104520453045404550456045704580459046004610462,Screen Date
dd-mmm-yyyy
(last date screened)NoNo - patient refusedNo - patient diedNo - SDM refused
No - other;Yes, Immediate RRT - life-threatening acid-base disturbance5Yes, Immediate RRT - life-threatening volume overload=Yes, Immediate RRT - life-threatening electrolyte abnormality7Yes, Immediate RRT - severe non-renal organ dysfunctionYes, Immediate RRT - Other5Yes, Deferral of RRT - no evidence of volume overload3Yes, Deferral of RRT - vascular access not feasible@Yes, Deferral of RRT - patient will soon recover kidney function@Yes, Deferral of RRT - clinical improvement in non-renal domainsYes, Deferral of RRT - Other5No - insurmountable language barrier (patient or SDM) Excluded due to Co- enrolment?
<�Time
Fully Eligible
(24-hr clock HH:MM;
n/a if not eligible)5Date Fully Eligible
dd-mmm-yyyy
(n/a if not eligible)I1I2I3I4I5<�Document ALL Inclusion & Exclusion criteria for each patient*No - patient unable to decide within 18hrs&No - SDM unable to decide within 18hrsEligibleYes - deferred consentYes - SDM provided consent"Yes - participant provided consent'No - no known SDM (no deferred consent)=No - unable to contact SDM within 18hrs (no deferred consent)3If excluded due to co-enrolment, specify study nameSubject Screening ID%Informed Consent at Time of ScreeningfRedCap Participant ID
(for eligible, consented patients; assigned following randomization by database)Additional CommentsE40463046404650466046704680469047004710472047304740475047604770478047904800481048204830484048504860487048804890490049104920493049404950496049704980499050005010502050305040505050605070508050905100511051205130514051505160517051805190520052105220523052405250526052705280529053005310532053305340535053605370538053905400541054205430544054505460547054805490550055105520553055405550556055705580559056005610562056305640565056605670568056905700571057205730574057505760577057805790580058105820583058405850586058705880589059005910592059305940595059605970598059906000601060206030604060506060607060806090610061106120613061406150616061706180619062006210622062306240625062606270628062906300631063206330634063506360637version: 27Sep2024���$%AO%y�%��%��%!/&Yg&��&��&'9G'q'��'��''(Q_(��(��(�)1?)iw)��)��)*IW*��*��*��*)7+ao+��+��+ ,AO,y�,��,��,!/-Yg-��-��- .9 G.q .� �.� �.
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Month: _____-______
&C&"Lucida Bright,Demibold"&14Screening and Enrolment Log
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Site #: ________________________________
Site Name: ________________________________
Site PI Name: ________________________________~{&L&"Arial,Italic"&9**Please complete information for all randomized patients in the Subject Identification Log**&R&8Page &P��&�?'�?(�?)�?M AXX�"AXX333333�?333333�?�&�<3U
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