ID

16619

Descripción

ODM Form derived from: https://ictr.wisc.edu/CaseReptTempt. Template Name: Research Sample Tracking. Case Report Form (CRF)/Source Document templates were created for University of Wisconsin-Madison researchers. These templates are consistent with the FDA's CDASH (Clinical Data Acquisition Standards Harmonization) standards. The CDASH standards identify those elements that should be captured on a Case Report Form (CRF). The forms serve only as templates, and must be edited to meet the study data collection needs as described in the protocol.

Link

https://ictr.wisc.edu/CaseReptTempt

Palabras clave

Versiones (2)
  1. 26/7/16 26/7/16 -
  2. 18/11/16 18/11/16 -
Subido en

26 de julio de 2016

DOI

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Licencia

Creative Commons BY-NC 3.0
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Research Sample Tracking: CRF Wisconsin Madison

Inglés

Research Sample Tracking: CRF Wisconsin Madison

1 formularios  
Header
Descripción

Header

PI Name
Descripción

PI Name

Tipo de datos

text

Protocol or IRB Number
Descripción

Protocol or IRB Number

Tipo de datos

integer

Protocol Short Title
Descripción

Protocol Short Title

Tipo de datos

text

Subject ID
Descripción

Subject ID

Tipo de datos

text

Number of Page
Descripción

Number of Page

Tipo de datos

integer

Total number of Pages
Descripción

Total number of Pages

Tipo de datos

integer

Research Sample Tracking I
Descripción

Research Sample Tracking I

Storage Location (including building and room number)
Descripción

Storage Location

Tipo de datos

text

Freezer number
Descripción

Freezer number

Tipo de datos

integer

Shelf Number
Descripción

Shelf Number

Tipo de datos

integer

Rack Number
Descripción

Rack Number

Tipo de datos

integer

Research Sample Tracking II
Descripción

Research Sample Tracking II

Box Number
Descripción

Box Number

Tipo de datos

integer

Cell Number
Descripción

Cell Number

Tipo de datos

integer

Subject ID Number
Descripción

Subject ID Number

Tipo de datos

integer

Visit Number
Descripción

Visit Number

Tipo de datos

text

Date sample put in freezer
Descripción

Date sample put in freezer

Tipo de datos

date

Time sample put in freezer
Descripción

Time sample put in freezer

Tipo de datos

time

Time sample put in freezer: AM
Descripción

Time sample put in freezer

Tipo de datos

boolean

Time sample put in freezer: PM
Descripción

Time sample put in freezer

Tipo de datos

boolean

Date sample removed from freezer
Descripción

Date sample removed from freezer

Tipo de datos

date

Time sample removed from freezer
Descripción

Time sample removed from freezer

Tipo de datos

time

Time sample removed from freezer: AM
Descripción

Time sample removed from freezer

Tipo de datos

boolean

Time sample removed from freezer: PM
Descripción

Time sample removed from freezer

Tipo de datos

boolean

Sample Outcome
Descripción

Sample Outcome

Tipo de datos

text

If Other, please specify
Descripción

Sample Outcome

Tipo de datos

text

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Similar models

Research Sample Tracking: CRF Wisconsin Madison

1 formularios
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
Header
PI Name
Item
PI Name
text
Protocol or IRB Number
Item
Protocol or IRB Number
integer
Protocol Short Title
Item
Protocol Short Title
text
Subject ID
Item
Subject ID
text
Number of Page
Item
Number of Page
integer
Total number of Pages
Item
Total number of Pages
integer
Item Group
Research Sample Tracking I
Storage Location
Item
Storage Location (including building and room number)
text
Freezer number
Item
integer
Shelf Number
Item
Shelf Number
integer
Rack Number
Item
Rack Number
integer
Item Group
Research Sample Tracking II
Box Number
Item
Box Number
integer
Cell Number
Item
Cell Number
integer
Subject ID Number
Item
Subject ID Number
integer
Item
Visit Number
text
Visit Number
Code List
Visit Number
CL Item
Visit 1 - Initial (1)
CL Item
Visit 2 - Mo. 6 (2)
CL Item
Visit 3 - Mo. 12 (3)
CL Item
Visit 4 - Mo. 18 (4)
CL Item
Visit 5 - Mo. 24 (5)
Date sample put in freezer
Item
Date sample put in freezer
date
Time sample put in freezer
Item
Time sample put in freezer
time
Time sample put in freezer
Item
Time sample put in freezer: AM
boolean
Time sample put in freezer
Item
Time sample put in freezer: PM
boolean
Date sample removed from freezer
Item
Date sample removed from freezer
date
Time sample removed from freezer
Item
Time sample removed from freezer
time
Time sample removed from freezer
Item
Time sample removed from freezer: AM
boolean
Time sample removed from freezer
Item
Time sample removed from freezer: PM
boolean
Item
Sample Outcome
text
Sample Outcome
Code List
Sample Outcome
CL Item
Shipped (1)
CL Item
Analyzed (2)
CL Item
Lost (3)
CL Item
Other (4)
Sample Outcome
Item
If Other, please specify
text
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