ID

12412

Description

Items used as routine documentation for the SAL (Studienallianz Leukmie) study centre of university hospital dresden. ODM derived from original form "AML-Register Materialbegleitbogen für Biomaterialbank", converted to ODM format.

Keywords

  1. 11/17/15 11/17/15 -
  2. 11/27/15 11/27/15 -
  3. 2/11/16 2/11/16 -
  4. 9/20/21 9/20/21 -
Uploaded on

November 17, 2015

DOI

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License

Creative Commons BY-NC 3.0

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AML- Register_Accompanying Material Form_SAL_University hospital dresden

AML- Register_Accompanying Material Form_SAL_University hospital dresden

Patient information
Description

Patient information

Patient name:
Description

Patient name

Data type

text

Patient ID:
Description

Patient ID

Data type

integer

Clinic code:
Description

Clinic code

Data type

integer

Date of birth:
Description

Date of birth

Data type

date

Gender:
Description

gender

Data type

text

Collected material
Description

Collected material

Date of collection:
Description

date

Data type

date

Specimen collected during:
Description

SpecimenCollectedTime

Data type

text

Please state the month, if you chose "x month":
Description

month

Data type

text

Specimen sent to study centre:
Description

Specimen

Data type

text

Patient agrees with the transfer of ownership (transfer of ownership) of the tissue samples to the SAL biomaterial storage and use for scientific purposes?
Description

transfer of ownership

Data type

boolean

The following diagnostic desired:
Description

diagnostik

Data type

text

Sender information
Description

Sender information

Physician:
Description

physician

Data type

text

Clinic:
Description

Clinic

Data type

text

Telephone:
Description

telephone

Data type

integer

Similar models

AML- Register_Accompanying Material Form_SAL_University hospital dresden

Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Patient information
Patient name
Item
Patient name:
text
Patient ID
Item
Patient ID:
integer
Clinic code
Item
Clinic code:
integer
Date of birth
Item
Date of birth:
date
Item
Gender:
text
Code List
Gender:
CL Item
female (1)
CL Item
male (2)
Item Group
Collected material
date
Item
Date of collection:
date
Item
Specimen collected during:
text
Code List
Specimen collected during:
CL Item
first diagnosis (1)
CL Item
progress (2)
CL Item
recurrence (3)
CL Item
after end of treatment (4)
CL Item
3rd month (5)
CL Item
6th month (6)
CL Item
9th month (7)
CL Item
12th month (8)
CL Item
x month (9)
month
Item
Please state the month, if you chose "x month":
text
Item
Specimen sent to study centre:
text
Code List
Specimen sent to study centre:
CL Item
10 ml of heparinized bone marrow (1)
CL Item
50 ml of heparinized peripheral blood (2)
CL Item
min. 4 unstained bone marrow smears (if cytomorphology desired) (3)
CL Item
min. 3 unstained peripheral blood smear (if cytomorphology desired) (4)
transfer of ownership
Item
Patient agrees with the transfer of ownership (transfer of ownership) of the tissue samples to the SAL biomaterial storage and use for scientific purposes?
boolean
Item
The following diagnostic desired:
text
Code List
The following diagnostic desired:
CL Item
cytomorphology (1)
CL Item
Molecular Biology (2)
CL Item
immunophenotyping (3)
CL Item
cytogenetics (4)
Item Group
Sender information
physician
Item
Physician:
text
Clinic
Item
Clinic:
text
telephone
Item
Telephone:
integer

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