ID

2959

Beschreibung

Hematology & Chemistries Lab Normal Ranges Form - RF39 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=CCE35EF9-9F5C-46AE-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=CCE35EF9-9F5C-46AE-E034-0003BA12F5E7

Stichworte

Versionen (2)
  1. 19.09.12 19.09.12 -
  2. 20.09.17 20.09.17 -
Hochgeladen am

19. September 2012

DOI

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Sarcoma, Kaposi xxx Lab - Hematology & Chemistries Lab Normal Ranges Form - RF39 - 2266501v3.0

Englisch

No Instruction available.

1 Formulare  
  1. StudyEvent: Hematology & Chemistries Lab Normal Ranges Form - RF39
    1. No Instruction available.
Ccrr Module For Hematology & Chemistries Lab Normal Ranges Form - Rf39
Beschreibung

Ccrr Module For Hematology & Chemistries Lab Normal Ranges Form - Rf39

Patient Initials
Beschreibung

PatientInitials

Datentyp

text

Study#
Beschreibung

Study#

Datentyp

text

Site#
Beschreibung

Site#

Datentyp

text

ID#
Beschreibung

ID#

Datentyp

text

Report Date
Beschreibung

ReportDate

Datentyp

text

Is more than one laboratory used by your site for the patient?
Beschreibung

Ismorethanonelaboratoryusedbyyoursiteforthepatient?

Datentyp

text

If "Yes", the name of the laboratory that is used.
Beschreibung

If"Yes",thenameofthelaboratorythatisused.

Datentyp

text

Is this an initial report by your site for the patient?
Beschreibung

Isthisaninitialreportbyyoursiteforthepatient?

Datentyp

text

If "No", date of change.
Beschreibung

If"No",dateofchange.

Datentyp

text

Hemoglobin from (g/dl)
Beschreibung

Hemoglobinfrom(g/dl)

Datentyp

text

Hemaoglobin to (g/dl)
Beschreibung

Hemaoglobinto(g/dl)

Datentyp

text

Hematocrit from (%)
Beschreibung

Hematocritfrom(%)

Datentyp

text

Hematocrit to (%)
Beschreibung

Hematocritto(%)

Datentyp

text

WBC from (1000/cu mm)
Beschreibung

WBCfrom(1000/cumm)

Datentyp

text

WBC to (1000/cu mm)
Beschreibung

WBCto(1000/cumm)

Datentyp

text

Neutrophils (includings Bands) from (%)
Beschreibung

Neutrophils(includingsBands)from(%)

Datentyp

text

Neutrophils (includings Bands) to (%)
Beschreibung

Neutrophils(includingsBands)to(%)

Datentyp

text

Absolute Neutrophil Count (1000/cu mm) WBC x (%Neutrophils including Bands)/100 from
Beschreibung

AbsoluteNeutrophilCount(1000/cumm)WBCx(%NeutrophilsincludingBands)/100from

Datentyp

text

Absolute Neutrophil Count (1000/cu mm) WBC x (%Neutrophils including Bands)/100 to
Beschreibung

AbsoluteNeutrophilCount(1000/cumm)WBCx(%NeutrophilsincludingBands)/100to

Datentyp

text

Lymphocytes from (%)
Beschreibung

Lymphocytesfrom(%)

Datentyp

text

Lymphocytes to (%)
Beschreibung

Lymphocytesto(%)

Datentyp

text

Monocytes from (%)
Beschreibung

Monocytesfrom(%)

Datentyp

text

Monocytes to (%)
Beschreibung

Monocytesto(%)

Datentyp

text

Eosinophils from (%)
Beschreibung

Eosinophilsfrom(%)

Datentyp

text

Eosinophils to (%)
Beschreibung

Eosinophilsto(%)

Datentyp

text

Basophils from (%)
Beschreibung

Basophilsfrom(%)

Datentyp

text

Basophils to (%)
Beschreibung

Basophilsto(%)

Datentyp

text

Other from (%)
Beschreibung

Otherfrom(%)

Datentyp

text

Other to (%)
Beschreibung

Otherto(%)

Datentyp

text

Other specify
Beschreibung

Otherspecify

Datentyp

text

Platelets from (1000/cu mm)
Beschreibung

Plateletsfrom(1000/cumm)

Datentyp

text

Platelets to (1000/cu mm)
Beschreibung

Plateletsto(1000/cumm)

Datentyp

text

RBC from (cmm)
Beschreibung

RBCfrom(cmm)

Datentyp

text

RBC to (ccm)
Beschreibung

RBCto(ccm)

Datentyp

text

Reticulocyte count from (%)
Beschreibung

Reticulocytecountfrom(%)

Datentyp

text

Reticulocyte count to (%)
Beschreibung

Reticulocytecountto(%)

Datentyp

text

PT (Prothrombin Time) from
Beschreibung

PT(ProthrombinTime)from

Datentyp

text

PT (Prothrombin Time) to
Beschreibung

PT(ProthrombinTime)to

Datentyp

text

PTT (Partial Thromboplastin Time) from
Beschreibung

PTT(PartialThromboplastinTime)from

Datentyp

text

PTT (Partial Thromboplastin Time) to
Beschreibung

PTT(PartialThromboplastinTime)to

Datentyp

text

Other hematology test from
Beschreibung

Otherhematologytestfrom

Datentyp

text

Other hematology test to
Beschreibung

Otherhematologytestto

Datentyp

text

Other hematology test, specify
Beschreibung

Otherhematologytest,specify

Datentyp

text

Other hematology test Units, specify
Beschreibung

OtherhematologytestUnits,specify

Datentyp

text

Sodium from (mEq/L)
Beschreibung

Sodiumfrom(mEq/L)

Datentyp

text

Sodium to (mEq/L)
Beschreibung

Sodiumto(mEq/L)

Datentyp

text

Potassium from (mEq/L)
Beschreibung

Potassiumfrom(mEq/L)

Datentyp

text

Potassium to (mEq/L)
Beschreibung

Potassiumto(mEq/L)

Datentyp

text

Chloride from (mEq/L)
Beschreibung

Chloridefrom(mEq/L)

Datentyp

text

Chloride to (mEq/L)
Beschreibung

Chlorideto(mEq/L)

Datentyp

text

Calcium from (mg/dl)
Beschreibung

Calciumfrom(mg/dl)

Datentyp

text

Calcium to (mg/dl)
Beschreibung

Calciumto(mg/dl)

Datentyp

text

Magnesium from (mg/dl)
Beschreibung

Magnesiumfrom(mg/dl)

Datentyp

text

Magnesium to (mg/dl)
Beschreibung

Magnesiumto(mg/dl)

Datentyp

text

Phosphorous from (mg/dl)
Beschreibung

Phosphorousfrom(mg/dl)

Datentyp

text

Phosphorous to (mg/dl)
Beschreibung

Phosphorousto(mg/dl)

Datentyp

text

CO2 (Bicarbonate) from (mEq/L)
Beschreibung

CO2(Bicarbonate)from(mEq/L)

Datentyp

text

CO2 (Bicarbonate) to (mEq/L)
Beschreibung

CO2(Bicarbonate)to(mEq/L)

Datentyp

text

Alkaline Phosphatase from (mU/ml)
Beschreibung

AlkalinePhosphatasefrom(mU/ml)

Datentyp

text

Alkaline Phosphatase to (mU/ml)
Beschreibung

AlkalinePhosphataseto(mU/ml)

Datentyp

text

SGOT (AST) from (mU/ml)
Beschreibung

SGOT(AST)from(mU/ml)

Datentyp

text

SGOT (AST) to (mU/ml)
Beschreibung

SGOT(AST)to(mU/ml)

Datentyp

text

SGPT (ALT) from (mU/ml)
Beschreibung

SGPT(ALT)from(mU/ml)

Datentyp

text

SGPT (ALT) to (mU/ml)
Beschreibung

SGPT(ALT)to(mU/ml)

Datentyp

text

LDH (Lactic Dehydrogenase) from (mU/ml)
Beschreibung

LDH(LacticDehydrogenase)from(mU/ml)

Datentyp

text

LDH (Lactic Dehydrogenase) to (mU/ml)
Beschreibung

LDH(LacticDehydrogenase)to(mU/ml)

Datentyp

text

Urea Nitrogen (BUN) from (mg/dl)
Beschreibung

UreaNitrogen(BUN)from(mg/dl)

Datentyp

text

Urea Nitrogen (BUN) to (mg/dl)
Beschreibung

UreaNitrogen(BUN)to(mg/dl)

Datentyp

text

Creatinine from (mg/dl)
Beschreibung

Creatininefrom(mg/dl)

Datentyp

text

Creatinine to (mg/dl)
Beschreibung

Creatinineto(mg/dl)

Datentyp

text

Uric Acid from (mg/dl)
Beschreibung

UricAcidfrom(mg/dl)

Datentyp

text

Uric Acid to (mg/dl)
Beschreibung

UricAcidto(mg/dl)

Datentyp

text

Glucose from (mg/dl)
Beschreibung

Glucosefrom(mg/dl)

Datentyp

text

Glucose to (mg/dl)
Beschreibung

Glucoseto(mg/dl)

Datentyp

text

Total Bilirubin from (mg/dl)
Beschreibung

TotalBilirubinfrom(mg/dl)

Datentyp

text

Total Bilirubin to (mg/dl)
Beschreibung

TotalBilirubinto(mg/dl)

Datentyp

text

Total Protein from (mg/dl)
Beschreibung

TotalProteinfrom(mg/dl)

Datentyp

text

Total Protein to (mg/dl)
Beschreibung

TotalProteinto(mg/dl)

Datentyp

text

Albumin from (g/dl)
Beschreibung

Albuminfrom(g/dl)

Datentyp

text

Albumin to (g/dl)
Beschreibung

Albuminto(g/dl)

Datentyp

text

Globulin from (g/dl)
Beschreibung

Globulinfrom(g/dl)

Datentyp

text

Globulin to (g/dl)
Beschreibung

Globulinto(g/dl)

Datentyp

text

Lipase from (U/L)
Beschreibung

Lipasefrom(U/L)

Datentyp

text

Lipase to (U/L)
Beschreibung

Lipaseto(U/L)

Datentyp

text

Amylase from (U/L)
Beschreibung

Amylasefrom(U/L)

Datentyp

text

Amylase to (U/L)
Beschreibung

Amylaseto(U/L)

Datentyp

text

CPK (Creatinine Phosphokinase) from (U/L)
Beschreibung

CPK(CreatininePhosphokinase)from(U/L)

Datentyp

text

CPK (Creatinine Phosphokinase) to (U/L)
Beschreibung

CPK(CreatininePhosphokinase)to(U/L)

Datentyp

text

Total Triglycerides from (mg/dl)
Beschreibung

TotalTriglyceridesfrom(mg/dl)

Datentyp

text

Total Triglycerides to (mg/dl)
Beschreibung

TotalTriglyceridesto(mg/dl)

Datentyp

text

LDL from (mg/dl)
Beschreibung

LDLfrom(mg/dl)

Datentyp

text

LDL to (mg/dl)
Beschreibung

LDLto(mg/dl)

Datentyp

text

HDL from (mg/dl)
Beschreibung

HDLfrom(mg/dl)

Datentyp

text

HDL to (mg/dl)
Beschreibung

HDLto(mg/dl)

Datentyp

text

Total Cholesterol from (mg/dl)
Beschreibung

TotalCholesterolfrom(mg/dl)

Datentyp

text

Total Cholesterol to (mg/dl)
Beschreibung

TotalCholesterolto(mg/dl)

Datentyp

text

Other chemistry test from
Beschreibung

Otherchemistrytestfrom

Datentyp

text

Other chemistry test to
Beschreibung

Otherchemistrytestto

Datentyp

text

Other chemistry test specify
Beschreibung

Otherchemistrytestspecify

Datentyp

text

Other chemistry test Units, specify
Beschreibung

OtherchemistrytestUnits,specify

Datentyp

text

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1 Formulare
  1. StudyEvent: Hematology & Chemistries Lab Normal Ranges Form - RF39
    1. No Instruction available.
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Ccrr Module For Hematology & Chemistries Lab Normal Ranges Form - Rf39
PatientInitials
Item
Patient Initials
text
Study#
Item
Study#
text
Site#
Item
Site#
text
ID#
Item
ID#
text
ReportDate
Item
Report Date
text
Item
Is more than one laboratory used by your site for the patient?
text
CL.1
Code List
Is more than one laboratory used by your site for the patient?
CL Item
Yes (Yes)
CL Item
No (No)
If"Yes",thenameofthelaboratorythatisused.
Item
If "Yes", the name of the laboratory that is used.
text
Item
Is this an initial report by your site for the patient?
text
CL.2
Code List
Is this an initial report by your site for the patient?
CL Item
Yes (Yes)
CL Item
No (No)
If"No",dateofchange.
Item
If "No", date of change.
text
Hemoglobinfrom(g/dl)
Item
Hemoglobin from (g/dl)
text
Hemaoglobinto(g/dl)
Item
Hemaoglobin to (g/dl)
text
Hematocritfrom(%)
Item
Hematocrit from (%)
text
Hematocritto(%)
Item
Hematocrit to (%)
text
WBCfrom(1000/cumm)
Item
WBC from (1000/cu mm)
text
WBCto(1000/cumm)
Item
WBC to (1000/cu mm)
text
Neutrophils(includingsBands)from(%)
Item
Neutrophils (includings Bands) from (%)
text
Neutrophils(includingsBands)to(%)
Item
Neutrophils (includings Bands) to (%)
text
AbsoluteNeutrophilCount(1000/cumm)WBCx(%NeutrophilsincludingBands)/100from
Item
Absolute Neutrophil Count (1000/cu mm) WBC x (%Neutrophils including Bands)/100 from
text
AbsoluteNeutrophilCount(1000/cumm)WBCx(%NeutrophilsincludingBands)/100to
Item
Absolute Neutrophil Count (1000/cu mm) WBC x (%Neutrophils including Bands)/100 to
text
Lymphocytesfrom(%)
Item
Lymphocytes from (%)
text
Lymphocytesto(%)
Item
Lymphocytes to (%)
text
Monocytesfrom(%)
Item
Monocytes from (%)
text
Monocytesto(%)
Item
Monocytes to (%)
text
Eosinophilsfrom(%)
Item
Eosinophils from (%)
text
Eosinophilsto(%)
Item
Eosinophils to (%)
text
Basophilsfrom(%)
Item
Basophils from (%)
text
Basophilsto(%)
Item
Basophils to (%)
text
Otherfrom(%)
Item
Other from (%)
text
Otherto(%)
Item
Other to (%)
text
Otherspecify
Item
Other specify
text
Plateletsfrom(1000/cumm)
Item
Platelets from (1000/cu mm)
text
Plateletsto(1000/cumm)
Item
Platelets to (1000/cu mm)
text
RBCfrom(cmm)
Item
RBC from (cmm)
text
RBCto(ccm)
Item
RBC to (ccm)
text
Reticulocytecountfrom(%)
Item
Reticulocyte count from (%)
text
Reticulocytecountto(%)
Item
Reticulocyte count to (%)
text
PT(ProthrombinTime)from
Item
PT (Prothrombin Time) from
text
PT(ProthrombinTime)to
Item
PT (Prothrombin Time) to
text
PTT(PartialThromboplastinTime)from
Item
PTT (Partial Thromboplastin Time) from
text
PTT(PartialThromboplastinTime)to
Item
PTT (Partial Thromboplastin Time) to
text
Otherhematologytestfrom
Item
Other hematology test from
text
Otherhematologytestto
Item
Other hematology test to
text
Otherhematologytest,specify
Item
Other hematology test, specify
text
OtherhematologytestUnits,specify
Item
Other hematology test Units, specify
text
Sodiumfrom(mEq/L)
Item
Sodium from (mEq/L)
text
Sodiumto(mEq/L)
Item
Sodium to (mEq/L)
text
Potassiumfrom(mEq/L)
Item
Potassium from (mEq/L)
text
Potassiumto(mEq/L)
Item
Potassium to (mEq/L)
text
Chloridefrom(mEq/L)
Item
Chloride from (mEq/L)
text
Chlorideto(mEq/L)
Item
Chloride to (mEq/L)
text
Calciumfrom(mg/dl)
Item
Calcium from (mg/dl)
text
Calciumto(mg/dl)
Item
Calcium to (mg/dl)
text
Magnesiumfrom(mg/dl)
Item
Magnesium from (mg/dl)
text
Magnesiumto(mg/dl)
Item
Magnesium to (mg/dl)
text
Phosphorousfrom(mg/dl)
Item
Phosphorous from (mg/dl)
text
Phosphorousto(mg/dl)
Item
Phosphorous to (mg/dl)
text
CO2(Bicarbonate)from(mEq/L)
Item
CO2 (Bicarbonate) from (mEq/L)
text
CO2(Bicarbonate)to(mEq/L)
Item
CO2 (Bicarbonate) to (mEq/L)
text
AlkalinePhosphatasefrom(mU/ml)
Item
Alkaline Phosphatase from (mU/ml)
text
AlkalinePhosphataseto(mU/ml)
Item
Alkaline Phosphatase to (mU/ml)
text
SGOT(AST)from(mU/ml)
Item
SGOT (AST) from (mU/ml)
text
SGOT(AST)to(mU/ml)
Item
SGOT (AST) to (mU/ml)
text
SGPT(ALT)from(mU/ml)
Item
SGPT (ALT) from (mU/ml)
text
SGPT(ALT)to(mU/ml)
Item
SGPT (ALT) to (mU/ml)
text
LDH(LacticDehydrogenase)from(mU/ml)
Item
LDH (Lactic Dehydrogenase) from (mU/ml)
text
LDH(LacticDehydrogenase)to(mU/ml)
Item
LDH (Lactic Dehydrogenase) to (mU/ml)
text
UreaNitrogen(BUN)from(mg/dl)
Item
Urea Nitrogen (BUN) from (mg/dl)
text
UreaNitrogen(BUN)to(mg/dl)
Item
Urea Nitrogen (BUN) to (mg/dl)
text
Creatininefrom(mg/dl)
Item
Creatinine from (mg/dl)
text
Creatinineto(mg/dl)
Item
Creatinine to (mg/dl)
text
UricAcidfrom(mg/dl)
Item
Uric Acid from (mg/dl)
text
UricAcidto(mg/dl)
Item
Uric Acid to (mg/dl)
text
Glucosefrom(mg/dl)
Item
Glucose from (mg/dl)
text
Glucoseto(mg/dl)
Item
Glucose to (mg/dl)
text
TotalBilirubinfrom(mg/dl)
Item
Total Bilirubin from (mg/dl)
text
TotalBilirubinto(mg/dl)
Item
Total Bilirubin to (mg/dl)
text
TotalProteinfrom(mg/dl)
Item
Total Protein from (mg/dl)
text
TotalProteinto(mg/dl)
Item
Total Protein to (mg/dl)
text
Albuminfrom(g/dl)
Item
Albumin from (g/dl)
text
Albuminto(g/dl)
Item
Albumin to (g/dl)
text
Globulinfrom(g/dl)
Item
Globulin from (g/dl)
text
Globulinto(g/dl)
Item
Globulin to (g/dl)
text
Lipasefrom(U/L)
Item
Lipase from (U/L)
text
Lipaseto(U/L)
Item
Lipase to (U/L)
text
Amylasefrom(U/L)
Item
Amylase from (U/L)
text
Amylaseto(U/L)
Item
Amylase to (U/L)
text
CPK(CreatininePhosphokinase)from(U/L)
Item
CPK (Creatinine Phosphokinase) from (U/L)
text
CPK(CreatininePhosphokinase)to(U/L)
Item
CPK (Creatinine Phosphokinase) to (U/L)
text
TotalTriglyceridesfrom(mg/dl)
Item
Total Triglycerides from (mg/dl)
text
TotalTriglyceridesto(mg/dl)
Item
Total Triglycerides to (mg/dl)
text
LDLfrom(mg/dl)
Item
LDL from (mg/dl)
text
LDLto(mg/dl)
Item
LDL to (mg/dl)
text
HDLfrom(mg/dl)
Item
HDL from (mg/dl)
text
HDLto(mg/dl)
Item
HDL to (mg/dl)
text
TotalCholesterolfrom(mg/dl)
Item
Total Cholesterol from (mg/dl)
text
TotalCholesterolto(mg/dl)
Item
Total Cholesterol to (mg/dl)
text
Otherchemistrytestfrom
Item
Other chemistry test from
text
Otherchemistrytestto
Item
Other chemistry test to
text
Otherchemistrytestspecify
Item
Other chemistry test specify
text
OtherchemistrytestUnits,specify
Item
Other chemistry test Units, specify
text
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