HIVEC HEAT — Eligibility Screener

⚠ Existing Screening Record Found

Patient ID already has a screening record. Review the comparison below before deciding whether to proceed.

Field	Previous Value	New Value

Reason for overriding this patient ID

I wish to overwrite the previous entry for this patient ID. I understand the previous record will be preserved in the Overwrite Log.

Clinician Details

Site

Clinician name

Role

Patient Details

Screening date

Screening ID

—

Sequential screening number for your site — 3 digits, e.g. 020 for the 20th participant

Age (optional)

Ethnicity (optional)

Sex (optional)

✓ Record saved · Google Sheet updated · Trial team notified