Information: This is an outdated version of the data model. You can find a Versions overview via Versions on the left. You can find the newest Version by clicking here.
Information:
Error:
ID
2959
Description
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
Keywords
Versions (2)
- 9/19/12 9/19/12 -
- 9/20/17 9/20/17 -
Uploaded on
September 19, 2012
DOI
To request one please log in.
License
Creative Commons BY-NC 3.0 Legacy
Model comments :
You can comment on the data model here. Via the speech bubbles at the itemgroups and items you can add comments to those specificially.
Itemgroup comments for :
Item comments for :
In order to download data models you must be logged in. Please log in or register for free.
Sarcoma, Kaposi xxx Lab - Hematology & Chemistries Lab Normal Ranges Form - RF39 - 2266501v3.0
No Instruction available.
- StudyEvent: Hematology & Chemistries Lab Normal Ranges Form - RF39
Similar models
No Instruction available.
- StudyEvent: Hematology & Chemistries Lab Normal Ranges Form - RF39
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
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 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 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