eCRF template · ScreeningUpdated September 28, 2026

Eligibility screening eCRF template that catches ineligible enrolments

One question per inclusion and exclusion criterion, an investigator confirmation, and edit checks that flag an ineligible answer before the participant is enrolled or randomised.

  • One criterion, one answer
  • Investigator e-signature
  • Screen-failure reasons structured

Free sandbox · No credit card · 21 CFR Part 11 aligned

Eligibility · Screening
Subject S-0014 · Protocol v2.0Query open

Inclusion criteria

I1. Aged 18 to 75 at consent

INCL01
MetNot met

I2. BMI 27 to 40 kg/m²

INCL02
MetNot met

Exclusion criteria

E3. eGFR below 45 mL/min/1.73m²

EXCL03
Not presentPresent

Exclusion present: subject is not eligible

Flagged before randomisation, not after

Key points

  • Each inclusion and exclusion criterion from the protocol becomes its own question with a fixed answer, so eligibility can be checked and audited criterion by criterion.
  • An edit check raises a query the moment any inclusion is not met or any exclusion is present, before the participant is enrolled.
  • The investigator confirms eligibility with a re-authenticated electronic signature, stored with its meaning.
  • Screen failures get a structured reason, and rescreened participants get a new screening number through the screening wizard.
  • When the protocol is amended and criteria change, the form version changes with it, and every site gets the same new version.

Why it matters

Ineligible enrolments are expensive

Enrolling a participant who does not meet the criteria is one of the most frequently reported protocol deviations, and one of the costliest. The participant may have to be withdrawn, their data may be excluded from the per-protocol analysis, and an inspector will ask how the site confirmed eligibility. A paper checklist signed in a hurry at the end of a long screening visit rarely holds up.

An eligibility eCRF turns the protocol criteria into a structured record. Every criterion has an answer, every answer has an audit trail entry, and the investigator confirms the whole set with an electronic signature. If something is wrong, an edit check says so while there is still time to stop.

Write criteria as answerable questions

Protocol criteria are often compound ("adults aged 18 to 75 with type 2 diabetes for at least six months on a stable dose of metformin"). On the form, split compound criteria so that each question has one clear met or not-met answer, and number them exactly as the protocol does (I1, I2, E1, E2) so monitors can trace every answer back.

Where a criterion depends on a measured value such as age, BMI or eGFR, record the value itself rather than only a tick, so the investigator confirms against data rather than memory. Capture calculates BMI, age from date of birth and eGFR (CKD-EPI 2021) as built-in derived fields, shown read-only during entry.

Eligibility and the SDTM IE domain

In SDTM, the IE domain records only the criteria that were not met. On the eCRF you still ask every criterion, because the positive record is what proves eligibility was assessed. The template carries the IE domain label, and your programmers derive the IE dataset from the exported answers.

Add subject · Step 1 of 3

Start screening

Screen new subject

Not screened before

Rescreen subject

Needs a new screening number

ICF date

14-Sep-2026

Year of birth

1971

Sex

Female

Next screening numberS-0014

Investigator confirmation

Eligibility signed, not just ticked

The final question on the form is the investigator confirmation that the participant meets all criteria. Signing asks for the password again, verified on the server, and stores the signer, the time and the meaning of the signature. Signing under delegation is recorded as such.

  • Re-authenticated electronic signature with a meaning statement.
  • Only roles with delegated authority can sign.
  • Any later change to a criterion answer is visible in the field-level audit trail.
Electronic signatures for clinical trials
Electronic signature

Meaning of signature

I have reviewed this adverse event and confirm the assessment of seriousness, severity and causality.

Signer

Dr. A. Ozola, PI

Password

••••••••••

Verified on the serverAutofill blockedSingle-use token
Sign

Template structure

Sections of the eligibility eCRF template

SectionQuestion typeEdit checkWhy
Protocol versionDropdownRequiredCriteria change between amendments.
Inclusion criteria (one per row)Single choice: met / not metQuery if any answer is not metEvery criterion assessed and auditable.
Exclusion criteria (one per row)Single choice: not present / presentQuery if any answer is presentSame, for exclusions.
Supporting valuesNumber or calculated fieldRange check on the valueAge, BMI or eGFR recorded, not just ticked.
Eligible?Single choiceQuery if answered Not eligibleA single field for the enrolment decision.
Screen-failure reasonDropdown plus textRequired when not eligibleStructured reasons feed screening reports.
Investigator confirmationElectronic signatureRequired before enrolmentAccountability for the eligibility decision.

Screen failures and rescreening

Screen failures recorded, rescreens kept separate

A participant who fails screening keeps their screening number and a structured reason. If the protocol allows rescreening, the screening wizard issues a new screening number, so the first attempt and the rescreen remain two traceable records instead of one overwritten one.

  • Screen new subject or rescreen subject, chosen at the start of screening.
  • Screening numbers issued automatically, such as S-0014.
  • Screen-failure reasons exportable for enrolment and feasibility reporting.
Patient eligibility screening software
Participant funnel
Identified40
Consented31
Enrolled26
Randomized22

Site risk

Site 03 needs attention

Action items

2 overdue

Paste your criteria and test the edit checks

Use the AI form builder to turn protocol criteria into questions, then review every one before approving.

Use this eligibility template free

Protocol amendments

When the criteria change mid-study

Eligibility criteria are among the most frequently amended parts of a protocol, usually to widen enrolment. When that happens the form has to change without confusing which participants were screened under which version. In Capture, the amended form goes back through draft and approval; approved forms are locked for live use and shared identically across every site, so there is no period where one site screens against old criteria and another against new ones.

Record the protocol version on the form (the template has a field for it) so every eligibility decision can be tied to the criteria that applied at the time. For the wider picture see protocol amendments without change orders.

FAQ

Questions about this template

Something not covered here? Ask us directly.

What is an eligibility eCRF?

The electronic case report form where sites record whether a participant meets each inclusion criterion and none of the exclusion criteria, and where the investigator confirms eligibility.

Should every criterion be a separate question?

Yes. One criterion per question, numbered as in the protocol, makes eligibility auditable and lets edit checks flag the exact criterion that failed.

Can the form stop an ineligible participant being enrolled?

Edit checks raise a query as soon as an inclusion is not met or an exclusion is present, and the investigator confirmation is required before enrolment. Your procedures define who resolves the query.

How are screen failures recorded?

With a structured screen-failure reason on the form. The participant keeps their screening number, and rescreening issues a new one.

Can AI draft the criteria questions?

Yes. The AI form builder can draft questions from a description or an uploaded file. Nothing is saved until a person reviews and applies it, and it only works on draft forms.

What happens after a protocol amendment?

The updated form goes through draft and approval again. Approved forms are locked and identical at every site, and the protocol version field ties each answer to the criteria in force.

Is the template free?

Yes, in the free sandbox with the rest of the template library.

Make eligibility auditable from day one

Copy the eligibility template, add your criteria and test it free. No credit card.

Use this eligibility template free