ID

6198

Descrizione

AIDS and Cancer Specimen Resource (ACSR) Procurement Form (F37) Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=

collegamento

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=

Keywords

  1. 18/12/14 18/12/14 - Martin Dugas
Caricato su

18 dicembre 2014

DOI

Per favore, per richiedere un accesso.

Licenza

Creative Commons BY-NC 3.0 Legacy

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AIDS and Cancer Specimen Resource (ACSR) Procurement Form (F37) 3369057v1.0

No Instruction available.

  1. StudyEvent: SE.0000
    1. No Instruction available.
Header Module
Descrizione

Header Module

Alias
UMLS CUI-1
C1320722
Visit number
Descrizione

HospitalAdmissionOrdinalNumber

Tipo di dati

double

Specimen Procurement
Descrizione

Specimen Procurement

Date Specimen Obtained (for previously donated specimens mm/dd/yyyy)
Descrizione

SpecimenCollectedDate

Tipo di dati

date

Specimen(s) obtained for donation to ACSR
Descrizione

AIDSMalignancyConsortiumSpecimenProcurementInd-2

Tipo di dati

boolean

Specimen Type (check all that apply)
Descrizione

SpecimenSubmittedType

Tipo di dati

text

Other specify
Descrizione

SpecimenCellSourceSpecify

Tipo di dati

text

ACSR site the specimen(s) shipped to
Descrizione

AIDSMalignancyConsortiumSpecimenProcurementType

Tipo di dati

text

Other, specify
Descrizione

AIDSMalignancyConsortiumSpecimenProcurementSpecify

Tipo di dati

text

If specimens were not obtained for ACSR, please indicate reason
Descrizione

AIDSMalignancyConsortiumSpecimenNotSubmittedReason

Tipo di dati

text

Other, specify
Descrizione

AIDSMalignancyConsortiumSpecimenNotSubmittedSpecify

Tipo di dati

text

Date Specimen Obtained (for previously donated specimens mm/dd/yyyy)
Descrizione

SpecimenCollectedDate

Tipo di dati

date

Study Coordinator
Descrizione

Study Coordinator

Study Coordinator's name
Descrizione

AIDSMalignancyConsortiumPersonStudyCoordinatorName

Tipo di dati

text

E-mail
Descrizione

ResponsiblePersonE-mailAddressText

Tipo di dati

text

Phone Number (xxx-xxx-xxxx)
Descrizione

OrganizationPhoneNumber

Tipo di dati

text

Comments
Descrizione

Comments

Comments
Descrizione

ResearchCommentsText

Tipo di dati

text

Similar models

No Instruction available.

  1. StudyEvent: SE.0000
    1. No Instruction available.
Name
genere
Description | Question | Decode (Coded Value)
Tipo di dati
Alias
Item Group
Header Module
C1320722 (UMLS CUI-1)
HospitalAdmissionOrdinalNumber
Item
Visit number
double
Item Group
Specimen Procurement
SpecimenCollectedDate
Item
Date Specimen Obtained (for previously donated specimens mm/dd/yyyy)
date
AIDSMalignancyConsortiumSpecimenProcurementInd-2
Item
Specimen(s) obtained for donation to ACSR
boolean
Item
Specimen Type (check all that apply)
text
Code List
Specimen Type (check all that apply)
CL Item
Serum (Serum)
CL Item
Plasma (Plasma)
CL Item
Pbmc (peripheral Blood Mononuclear Cells) (PBMC)
CL Item
Peripheral Blood (Blood)
CL Item
Tissue (Tissue)
CL Item
Other (Other)
SpecimenCellSourceSpecify
Item
Other specify
text
Item
ACSR site the specimen(s) shipped to
text
Code List
ACSR site the specimen(s) shipped to
CL Item
Gwu (GWU)
CL Item
Ucsf (UCSF)
CL Item
Jhu (JHU)
CL Item
Other (Other)
AIDSMalignancyConsortiumSpecimenProcurementSpecify
Item
Other, specify
text
Item
If specimens were not obtained for ACSR, please indicate reason
text
Code List
If specimens were not obtained for ACSR, please indicate reason
CL Item
Patient Had Previously Donated Specimen To Acsr (Patient had previously donated specimen to ACSR)
CL Item
Patient Refused To Give Informed Consent For Acsr Specimen Donation (Patient refused to give informed consent for ACSR specimen donation)
CL Item
Patient Was Not Asked To Consider Acsr Specimen Donation (Patient was not asked to consider ACSR specimen donation)
CL Item
Other (Other)
AIDSMalignancyConsortiumSpecimenNotSubmittedSpecify
Item
Other, specify
text
SpecimenCollectedDate
Item
Date Specimen Obtained (for previously donated specimens mm/dd/yyyy)
date
Item Group
Study Coordinator
AIDSMalignancyConsortiumPersonStudyCoordinatorName
Item
Study Coordinator's name
text
ResponsiblePersonE-mailAddressText
Item
E-mail
text
OrganizationPhoneNumber
Item
Phone Number (xxx-xxx-xxxx)
text
Item Group
Comments
ResearchCommentsText
Item
Comments
text

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