ID

16619

Beskrivning

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.

Länk

https://ictr.wisc.edu/CaseReptTempt

Nyckelord

Versioner (2)
  1. 2016-07-26 2016-07-26 -
  2. 2016-11-18 2016-11-18 -
Uppladdad den

26 juli 2016

DOI

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Licens

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

Engelsk

Research Sample Tracking: CRF Wisconsin Madison

1 Formulär  
Header
Beskrivning

Header

PI Name
Beskrivning

PI Name

Datatyp

text

Protocol or IRB Number
Beskrivning

Protocol or IRB Number

Datatyp

integer

Protocol Short Title
Beskrivning

Protocol Short Title

Datatyp

text

Subject ID
Beskrivning

Subject ID

Datatyp

text

Number of Page
Beskrivning

Number of Page

Datatyp

integer

Total number of Pages
Beskrivning

Total number of Pages

Datatyp

integer

Research Sample Tracking I
Beskrivning

Research Sample Tracking I

Storage Location (including building and room number)
Beskrivning

Storage Location

Datatyp

text

Freezer number
Beskrivning

Freezer number

Datatyp

integer

Shelf Number
Beskrivning

Shelf Number

Datatyp

integer

Rack Number
Beskrivning

Rack Number

Datatyp

integer

Research Sample Tracking II
Beskrivning

Research Sample Tracking II

Box Number
Beskrivning

Box Number

Datatyp

integer

Cell Number
Beskrivning

Cell Number

Datatyp

integer

Subject ID Number
Beskrivning

Subject ID Number

Datatyp

integer

Visit Number
Beskrivning

Visit Number

Datatyp

text

Date sample put in freezer
Beskrivning

Date sample put in freezer

Datatyp

date

Time sample put in freezer
Beskrivning

Time sample put in freezer

Datatyp

time

Time sample put in freezer: AM
Beskrivning

Time sample put in freezer

Datatyp

boolean

Time sample put in freezer: PM
Beskrivning

Time sample put in freezer

Datatyp

boolean

Date sample removed from freezer
Beskrivning

Date sample removed from freezer

Datatyp

date

Time sample removed from freezer
Beskrivning

Time sample removed from freezer

Datatyp

time

Time sample removed from freezer: AM
Beskrivning

Time sample removed from freezer

Datatyp

boolean

Time sample removed from freezer: PM
Beskrivning

Time sample removed from freezer

Datatyp

boolean

Sample Outcome
Beskrivning

Sample Outcome

Datatyp

text

If Other, please specify
Beskrivning

Sample Outcome

Datatyp

text

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Similar models

Research Sample Tracking: CRF Wisconsin Madison

1 Formulär
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
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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