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ID

11113

Description

The Pharmacogenomic Submission and Quality Assurance Form, a CDE-compliant CALGB CRF to be used on most CALGB protocols. Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=01347EC9-2FD9-7195-E044-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=01347EC9-2FD9-7195-E044-0003BA3F9857

Keywords

Versions (3)
  1. 9/19/12 9/19/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
  3. 6/18/15 6/18/15 -
Uploaded on

June 18, 2015

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Creative Commons BY-NC 3.0 Legacy
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    CALGB: Pharmacogenomic Submission and Quality Assurance Form

    English

    INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted.

    1 forms  
    Header
    Description

    Header

    CALGB Form
    Description

    Form ID CALGB

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C3262252
    NCI Thesaurus ObjectClass
    C19464
    UMLS CUI-2
    C1516238
    NCI Thesaurus Property
    C25364
    NCI Thesaurus ObjectClass-2
    C25442
    CALGB Study No.
    Description

    Protocol ID CALGB

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C3274381
    NCI Thesaurus ObjectClass
    C25320
    UMLS CUI-2
    C1516238
    NCI Thesaurus Property
    C25364
    NCI Thesaurus Property-2
    C25442
    CALGB Patient ID
    Description

    Trial subject ID CALGB

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2348585
    NCI Thesaurus ObjectClass
    C16960
    UMLS CUI-2
    C1516238
    NCI Thesaurus Property
    C25364
    NCI Thesaurus Property-2
    C25442
    Form Submission Date (MM/DD/YYYY)
    Description

    FormSubmissionDate

    Data type

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ObjectClass
    C40988
    UMLS 2011AA ObjectClass
    C1516308
    NCI Thesaurus Property
    C25694
    UMLS 2011AA Property
    C1515022
    Are data amended
    Description

    Data amended

    Data type

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS CUI-1
    C0680532
    NCI Thesaurus ObjectClass
    C25474
    NCI Thesaurus Property
    C25416
    Patient demographics
    Description

    Patient demographics

    Patient Initials (Last, First Middle)
    Description

    Patient Initials

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2986440
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25536
    Patient Hospital No
    Description

    Patient Hospital No

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C0421459
    NCI Thesaurus Property
    C16960
    NCI Thesaurus Property-2
    C25364
    NCI Thesaurus ObjectClass
    C16696
    Institution/Affiliate
    Description

    Institution Name

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C25454
    UMLS CUI-1
    C1301943
    NCI Thesaurus ObjectClass-2
    C21541
    NCI Thesaurus Property
    C25364
    NCI Thesaurus ValueDomain
    C25191
    NCI Thesaurus ValueDomain-2
    C21541
    Participating Group
    Description

    Participating Group

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2347449
    NCI Thesaurus ObjectClass
    C25608
    NCI Thesaurus ObjectClass-2
    C17005
    NCI Thesaurus Property
    C25364
    Participating Group Study No.
    Description

    Study Number Participating Group

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C3274381
    NCI Thesaurus ObjectClass
    C25320
    UMLS CUI-2
    C2347449
    NCI Thesaurus Property
    C25608
    NCI Thesaurus Property-2
    C25364
    Participating Group Patient ID
    Description

    Trial subject ID Participating Group

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2348585
    NCI Thesaurus ObjectClass
    C16960
    UMLS CUI-2
    C2347449
    NCI Thesaurus Property
    C25608
    NCI Thesaurus Property-2
    C25364
    Biopsy specimen
    Description

    Biopsy specimen

    Does specimen accompany this form
    Description

    SpecimenFormSubmittedInd-2

    Data type

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    NCI Thesaurus Property
    C19464
    UMLS 2011AA Property
    C0376315
    NCI Thesaurus ObjectClass
    C19157
    UMLS 2011AA ObjectClass
    C0370003
    NCI Thesaurus Property-2
    C25695
    UMLS 2011AA Property-2
    C1515023
    Specify reason (If no,)
    Description

    SpecimenNotSubmittedReason

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25638
    UMLS 2011AA ValueDomain
    C0392360
    NCI Thesaurus Property
    C25594
    UMLS 2011AA Property
    C1518422
    NCI Thesaurus ObjectClass
    C19157
    UMLS 2011AA ObjectClass
    C0370003
    NCI Thesaurus Property-2
    C25695
    UMLS 2011AA Property-2
    C1515023
    Biopsy and Cytology Specimens collection
    Description

    Biopsy and Cytology Specimens collection

    Date Specimen Collected (MM DD YYYY)
    Description

    SpecimenCollectedDate

    Data type

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ObjectClass
    C19157
    UMLS 2011AA ObjectClass
    C0370003
    NCI Thesaurus Property
    C25452
    NCI Thesaurus Property-2
    C25275
    UMLS 2011AA Property
    C2745955
    Collection Time (24-hour clock)
    Description

    SpecimenCollectedTime

    Data type

    time

    Alias
    NCI Thesaurus ValueDomain
    C25207
    UMLS 2011AA ValueDomain
    C0040223
    NCI Thesaurus ObjectClass
    C19157
    UMLS 2011AA ObjectClass
    C0370003
    NCI Thesaurus Property
    C25452
    NCI Thesaurus Property-2
    C25275
    UMLS 2011AA Property
    C2745955
    Sample type (Mark all that apply with an X.)
    Description

    SpecimenGenomeAnalysisType

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    NCI Thesaurus Property
    C25391
    UMLS 2011AA Property
    C0936012
    NCI Thesaurus ObjectClass
    C19157
    UMLS 2011AA ObjectClass
    C0370003
    NCI Thesaurus Property-2
    C16629
    UMLS 2011AA Property-2
    C0017428
    Was blood sample collected in an EDTA Vacutainer tube (purple top)
    Description

    BloodSpecimenTubeCollectedInd-2

    Data type

    boolean

    Alias
    NCI Thesaurus ObjectClass
    C12434
    UMLS 2011AA ObjectClass
    C0229664
    NCI Thesaurus ObjectClass-2
    C19157
    UMLS 2011AA ObjectClass-2
    C0370003
    NCI Thesaurus Property
    C25452
    NCI Thesaurus Property-2
    C41277
    UMLS 2011AA Property
    C1561954
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    Was blood sample stored either at 4 degrees C or frozen within 24 hours of collection
    Description

    BloodSpecimenFrozenCollectedInd-2

    Data type

    boolean

    Alias
    NCI Thesaurus ObjectClass
    C12434
    UMLS 2011AA ObjectClass
    C0229664
    NCI Thesaurus ObjectClass-2
    C19157
    UMLS 2011AA ObjectClass-2
    C0370003
    NCI Metathesaurus Property
    CL267638
    NCI Thesaurus Property
    C25452
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    Was buccal cell sample immediately submersed in 250 microliters of lysis buffer
    Description

    CheekCellSpecimenLysisCollectedInd-2

    Data type

    boolean

    Alias
    NCI Thesaurus ObjectClass
    C12508
    UMLS 2011AA ObjectClass
    C0007634
    NCI Thesaurus ObjectClass-2
    C19157
    UMLS 2011AA ObjectClass-2
    C0370003
    NCI Thesaurus ObjectClass-3
    C13070
    UMLS 2011AA ObjectClass-3
    C0007966
    NCI Thesaurus Property
    C25452
    NCI Thesaurus Property-2
    C37889
    UMLS 2011AA Property
    C0024348
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    Was buccal cell sample stored at -20 degrees C
    Description

    CheekCellSpecimenFrozenCollectedInd-2

    Data type

    boolean

    Alias
    NCI Thesaurus ObjectClass
    C12508
    UMLS 2011AA ObjectClass
    C0007634
    NCI Thesaurus ObjectClass-2
    C19157
    UMLS 2011AA ObjectClass-2
    C0370003
    NCI Thesaurus ObjectClass-3
    C13070
    UMLS 2011AA ObjectClass-3
    C0007966
    NCI Metathesaurus Property
    CL267638
    NCI Thesaurus Property
    C25452
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    Biopsy and Cytology Specimens shipment
    Description

    Biopsy and Cytology Specimens shipment

    Date shipped (specimen)
    Description

    SpecimenLabSubmittedDate

    Data type

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus Property
    C25294
    UMLS 2011AA Property
    C0022885
    NCI Thesaurus ObjectClass
    C19157
    UMLS 2011AA ObjectClass
    C0370003
    NCI Thesaurus Property-2
    C25695
    UMLS 2011AA Property-2
    C1515023
    Time specimen shipped (24-hour clock)
    Description

    SpecimenLaboratoryProcedureSubmissionTime

    Data type

    time

    Alias
    NCI Thesaurus ValueDomain
    C25207
    UMLS 2011AA ValueDomain
    C0040223
    NCI Thesaurus Property
    C25294
    UMLS 2011AA Property
    C0022885
    NCI Thesaurus ObjectClass
    C19157
    UMLS 2011AA ObjectClass
    C0370003
    NCI Thesaurus Property-2
    C25695
    UMLS 2011AA Property-2
    C1515023
    Shipment type (Mark one with an X.)
    Description

    SpecimenTransportDescriptionType

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    NCI Thesaurus ObjectClass
    C19157
    UMLS 2011AA ObjectClass
    C0370003
    NCI Thesaurus Property
    C25365
    UMLS 2011AA Property
    C0678257
    NCI Metathesaurus Property
    CL314684
    Specify reason (If Dry ice,)
    Description

    SpecimenTransportFrozenLaboratoryReason

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C19157
    UMLS 2011AA ObjectClass
    C0370003
    NCI Metathesaurus Property
    CL267638
    NCI Thesaurus Property
    C37984
    UMLS 2011AA Property
    C0022877
    NCI Metathesaurus Property-2
    CL314684
    NCI Thesaurus ValueDomain
    C25638
    UMLS 2011AA ValueDomain
    C0392360
    Other, specify
    Description

    SpecimenTransportFrozenLaboratorySpecify

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C19157
    UMLS 2011AA ObjectClass
    C0370003
    NCI Metathesaurus Property
    CL267638
    NCI Thesaurus Property
    C37984
    UMLS 2011AA Property
    C0022877
    NCI Metathesaurus Property-2
    CL314684
    NCI Thesaurus ValueDomain
    C25685
    UMLS 2011AA ValueDomain
    C1521902
    LabTrak sample ID
    Description

    LabSpecimenIdentifierNumber

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS 2011AA ValueDomain
    C0237753
    NCI Thesaurus Property
    C25364
    UMLS 2011AA Property
    C0600091
    NCI Thesaurus ObjectClass
    C37984
    UMLS 2011AA ObjectClass
    C0022877
    NCI Thesaurus Property-2
    C19157
    UMLS 2011AA Property-2
    C0370003
    LabTrak shipment ID
    Description

    LabTransportIdentifierNumber

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS 2011AA ValueDomain
    C0237753
    NCI Thesaurus Property
    C25364
    UMLS 2011AA Property
    C0600091
    NCI Thesaurus ObjectClass
    C37984
    UMLS 2011AA ObjectClass
    C0022877
    NCI Thesaurus Property-2
    C61560
    Submitted by
    Description

    PersonSpecimenSubmittedName

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS 2011AA ValueDomain
    C1547383
    NCI Thesaurus ObjectClass
    C25190
    UMLS 2011AA ObjectClass
    C0027361
    NCI Thesaurus Property
    C19157
    UMLS 2011AA Property
    C0370003
    NCI Thesaurus Property-2
    C25695
    UMLS 2011AA Property-2
    C1515023
    Phone Number
    Description

    OrganizationPhoneNumber

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS 2011AA ValueDomain
    C0237753
    NCI Thesaurus Property
    C25395
    UMLS 2011AA Property
    C0039457
    NCI Thesaurus ObjectClass
    C19711
    UMLS 2011AA ObjectClass
    C1522486
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    INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted.

    1 forms
    Name
    Type
    Description | Question | Decode (Coded Value)
    Data type
    Alias
    Item Group
    Header
    Form ID CALGB
    Item
    CALGB Form
    text
    C25337 (NCI Thesaurus ValueDomain)
    C3262252 (UMLS CUI-1)
    C19464 (NCI Thesaurus ObjectClass)
    C1516238 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25442 (NCI Thesaurus ObjectClass-2)
    Protocol ID CALGB
    Item
    CALGB Study No.
    text
    C25337 (NCI Thesaurus ValueDomain)
    C3274381 (UMLS CUI-1)
    C25320 (NCI Thesaurus ObjectClass)
    C1516238 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25442 (NCI Thesaurus Property-2)
    Trial subject ID CALGB
    Item
    CALGB Patient ID
    text
    C25337 (NCI Thesaurus ValueDomain)
    C2348585 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C1516238 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25442 (NCI Thesaurus Property-2)
    FormSubmissionDate
    Item
    Form Submission Date (MM/DD/YYYY)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C40988 (NCI Thesaurus ObjectClass)
    C1516308 (UMLS 2011AA ObjectClass)
    C25694 (NCI Thesaurus Property)
    C1515022 (UMLS 2011AA Property)
    Data amended
    Item
    Are data amended
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C0680532 (UMLS CUI-1)
    C25474 (NCI Thesaurus ObjectClass)
    C25416 (NCI Thesaurus Property)
    Item Group
    Patient demographics
    Patient Initials
    Item
    Patient Initials (Last, First Middle)
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2986440 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25536 (NCI Thesaurus Property)
    Patient Hospital No
    Item
    Patient Hospital No
    text
    C25337 (NCI Thesaurus ValueDomain)
    C0421459 (UMLS CUI-1)
    C16960 (NCI Thesaurus Property)
    C25364 (NCI Thesaurus Property-2)
    C16696 (NCI Thesaurus ObjectClass)
    Institution Name
    Item
    Institution/Affiliate
    text
    C25454 (NCI Thesaurus ObjectClass)
    C1301943 (UMLS CUI-1)
    C21541 (NCI Thesaurus ObjectClass-2)
    C25364 (NCI Thesaurus Property)
    C25191 (NCI Thesaurus ValueDomain)
    C21541 (NCI Thesaurus ValueDomain-2)
    Participating Group
    Item
    Participating Group
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2347449 (UMLS CUI-1)
    C25608 (NCI Thesaurus ObjectClass)
    C17005 (NCI Thesaurus ObjectClass-2)
    C25364 (NCI Thesaurus Property)
    Study Number Participating Group
    Item
    Participating Group Study No.
    text
    C25337 (NCI Thesaurus ValueDomain)
    C3274381 (UMLS CUI-1)
    C25320 (NCI Thesaurus ObjectClass)
    C2347449 (UMLS CUI-2)
    C25608 (NCI Thesaurus Property)
    C25364 (NCI Thesaurus Property-2)
    Trial subject ID Participating Group
    Item
    Participating Group Patient ID
    text
    C25337 (NCI Thesaurus ValueDomain)
    C2348585 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C2347449 (UMLS CUI-2)
    C25608 (NCI Thesaurus Property)
    C25364 (NCI Thesaurus Property-2)
    Item Group
    Biopsy specimen
    SpecimenFormSubmittedInd-2
    Item
    Does specimen accompany this form
    boolean
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    C19464 (NCI Thesaurus Property)
    C0376315 (UMLS 2011AA Property)
    C19157 (NCI Thesaurus ObjectClass)
    C0370003 (UMLS 2011AA ObjectClass)
    C25695 (NCI Thesaurus Property-2)
    C1515023 (UMLS 2011AA Property-2)
    Item
    Specify reason (If no,)
    text
    C25638 (NCI Thesaurus ValueDomain)
    C0392360 (UMLS 2011AA ValueDomain)
    C25594 (NCI Thesaurus Property)
    C1518422 (UMLS 2011AA Property)
    C19157 (NCI Thesaurus ObjectClass)
    C0370003 (UMLS 2011AA ObjectClass)
    C25695 (NCI Thesaurus Property-2)
    C1515023 (UMLS 2011AA Property-2)
    CL.3
    Code List
    Specify reason (If no,)
    CL Item
    Institution Error (Institution error)
    CL Item
    Other (Other)
    C17649 (NCI Thesaurus)
    C0205394 (UMLS 2011AA)
    CL Item
    Patient Refusal (Patient refusal)
    CL Item
    Sample Lost Or Destroyed (Sample lost or destroyed)
    Item Group
    Biopsy and Cytology Specimens collection
    SpecimenCollectedDate
    Item
    Date Specimen Collected (MM DD YYYY)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C19157 (NCI Thesaurus ObjectClass)
    C0370003 (UMLS 2011AA ObjectClass)
    C25452 (NCI Thesaurus Property)
    C25275 (NCI Thesaurus Property-2)
    C2745955 (UMLS 2011AA Property)
    SpecimenCollectedTime
    Item
    Collection Time (24-hour clock)
    time
    C25207 (NCI Thesaurus ValueDomain)
    C0040223 (UMLS 2011AA ValueDomain)
    C19157 (NCI Thesaurus ObjectClass)
    C0370003 (UMLS 2011AA ObjectClass)
    C25452 (NCI Thesaurus Property)
    C25275 (NCI Thesaurus Property-2)
    C2745955 (UMLS 2011AA Property)
    Item
    Sample type (Mark all that apply with an X.)
    text
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    C25391 (NCI Thesaurus Property)
    C0936012 (UMLS 2011AA Property)
    C19157 (NCI Thesaurus ObjectClass)
    C0370003 (UMLS 2011AA ObjectClass)
    C16629 (NCI Thesaurus Property-2)
    C0017428 (UMLS 2011AA Property-2)
    CL.4
    Code List
    Sample type (Mark all that apply with an X.)
    CL Item
    Buccal Cells (Buccal cells)
    CL Item
    Whole Blood (Whole blood)
    C0370231 (NCI Metathesaurus)
    BloodSpecimenTubeCollectedInd-2
    Item
    Was blood sample collected in an EDTA Vacutainer tube (purple top)
    boolean
    C12434 (NCI Thesaurus ObjectClass)
    C0229664 (UMLS 2011AA ObjectClass)
    C19157 (NCI Thesaurus ObjectClass-2)
    C0370003 (UMLS 2011AA ObjectClass-2)
    C25452 (NCI Thesaurus Property)
    C41277 (NCI Thesaurus Property-2)
    C1561954 (UMLS 2011AA Property)
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    BloodSpecimenFrozenCollectedInd-2
    Item
    Was blood sample stored either at 4 degrees C or frozen within 24 hours of collection
    boolean
    C12434 (NCI Thesaurus ObjectClass)
    C0229664 (UMLS 2011AA ObjectClass)
    C19157 (NCI Thesaurus ObjectClass-2)
    C0370003 (UMLS 2011AA ObjectClass-2)
    CL267638 (NCI Metathesaurus Property)
    C25452 (NCI Thesaurus Property)
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    CheekCellSpecimenLysisCollectedInd-2
    Item
    Was buccal cell sample immediately submersed in 250 microliters of lysis buffer
    boolean
    C12508 (NCI Thesaurus ObjectClass)
    C0007634 (UMLS 2011AA ObjectClass)
    C19157 (NCI Thesaurus ObjectClass-2)
    C0370003 (UMLS 2011AA ObjectClass-2)
    C13070 (NCI Thesaurus ObjectClass-3)
    C0007966 (UMLS 2011AA ObjectClass-3)
    C25452 (NCI Thesaurus Property)
    C37889 (NCI Thesaurus Property-2)
    C0024348 (UMLS 2011AA Property)
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    CheekCellSpecimenFrozenCollectedInd-2
    Item
    Was buccal cell sample stored at -20 degrees C
    boolean
    C12508 (NCI Thesaurus ObjectClass)
    C0007634 (UMLS 2011AA ObjectClass)
    C19157 (NCI Thesaurus ObjectClass-2)
    C0370003 (UMLS 2011AA ObjectClass-2)
    C13070 (NCI Thesaurus ObjectClass-3)
    C0007966 (UMLS 2011AA ObjectClass-3)
    CL267638 (NCI Metathesaurus Property)
    C25452 (NCI Thesaurus Property)
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    Item Group
    Biopsy and Cytology Specimens shipment
    SpecimenLabSubmittedDate
    Item
    Date shipped (specimen)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C25294 (NCI Thesaurus Property)
    C0022885 (UMLS 2011AA Property)
    C19157 (NCI Thesaurus ObjectClass)
    C0370003 (UMLS 2011AA ObjectClass)
    C25695 (NCI Thesaurus Property-2)
    C1515023 (UMLS 2011AA Property-2)
    SpecimenLaboratoryProcedureSubmissionTime
    Item
    Time specimen shipped (24-hour clock)
    time
    C25207 (NCI Thesaurus ValueDomain)
    C0040223 (UMLS 2011AA ValueDomain)
    C25294 (NCI Thesaurus Property)
    C0022885 (UMLS 2011AA Property)
    C19157 (NCI Thesaurus ObjectClass)
    C0370003 (UMLS 2011AA ObjectClass)
    C25695 (NCI Thesaurus Property-2)
    C1515023 (UMLS 2011AA Property-2)
    Item
    Shipment type (Mark one with an X.)
    text
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    C19157 (NCI Thesaurus ObjectClass)
    C0370003 (UMLS 2011AA ObjectClass)
    C25365 (NCI Thesaurus Property)
    C0678257 (UMLS 2011AA Property)
    CL314684 (NCI Metathesaurus Property)
    CL.9
    Code List
    Shipment type (Mark one with an X.)
    CL Item
    Cold Pack (Cold pack)
    CL Item
    Dry Ice (Dry ice)
    C63373 (NCI Thesaurus)
    C0013239 (UMLS 2011AA)
    Item
    Specify reason (If Dry ice,)
    text
    C19157 (NCI Thesaurus ObjectClass)
    C0370003 (UMLS 2011AA ObjectClass)
    CL267638 (NCI Metathesaurus Property)
    C37984 (NCI Thesaurus Property)
    C0022877 (UMLS 2011AA Property)
    CL314684 (NCI Metathesaurus Property-2)
    C25638 (NCI Thesaurus ValueDomain)
    C0392360 (UMLS 2011AA ValueDomain)
    CL.10
    Code List
    Specify reason (If Dry ice,)
    CL Item
    Buccal Sample (Buccal sample)
    CL Item
    Other (Other)
    C17649 (NCI Thesaurus)
    C0205394 (UMLS 2011AA)
    CL Item
    Sample Shipped After Being Stored (Sample shipped after being stored)
    CL Item
    Sample Shipped With Other Samples (Sample shipped with other samples)
    SpecimenTransportFrozenLaboratorySpecify
    Item
    Other, specify
    text
    C19157 (NCI Thesaurus ObjectClass)
    C0370003 (UMLS 2011AA ObjectClass)
    CL267638 (NCI Metathesaurus Property)
    C37984 (NCI Thesaurus Property)
    C0022877 (UMLS 2011AA Property)
    CL314684 (NCI Metathesaurus Property-2)
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    LabSpecimenIdentifierNumber
    Item
    LabTrak sample ID
    text
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    C37984 (NCI Thesaurus ObjectClass)
    C0022877 (UMLS 2011AA ObjectClass)
    C19157 (NCI Thesaurus Property-2)
    C0370003 (UMLS 2011AA Property-2)
    LabTransportIdentifierNumber
    Item
    LabTrak shipment ID
    text
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    C37984 (NCI Thesaurus ObjectClass)
    C0022877 (UMLS 2011AA ObjectClass)
    C61560 (NCI Thesaurus Property-2)
    PersonSpecimenSubmittedName
    Item
    Submitted by
    text
    C25191 (NCI Thesaurus ValueDomain)
    C1547383 (UMLS 2011AA ValueDomain)
    C25190 (NCI Thesaurus ObjectClass)
    C0027361 (UMLS 2011AA ObjectClass)
    C19157 (NCI Thesaurus Property)
    C0370003 (UMLS 2011AA Property)
    C25695 (NCI Thesaurus Property-2)
    C1515023 (UMLS 2011AA Property-2)
    OrganizationPhoneNumber
    Item
    Phone Number
    text
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    C25395 (NCI Thesaurus Property)
    C0039457 (UMLS 2011AA Property)
    C19711 (NCI Thesaurus ObjectClass)
    C1522486 (UMLS 2011AA ObjectClass)
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