Protocol Identifier
Item
Protocol Identifier: AVA100193
boolean
Subject Identifier
Item
Subject Identifier
integer
Informed Consent
Item
Has informed consent been obtained for PGx-Pharmacogenetic/PGm-Transcriptomic/PGm-Proteomic Research?
boolean
Date
Item
If yes, record the date informed consent obtained for PGx-Pharmacogenetic/PGm-Transcriptomic/PGm-Proteomic research
date
Item
If no, select one reason
text
Code List
If no, select one reason
CL Item
Subject declined (1)
CL Item
Subject not asked by Investigator (2)
CL Item
Other (specify) (3)
Specification of Other
Item
If Other, please specify
text
Has a blood sample been collected for PGx-pharmacogenetic research?
Item
Has a blood sample been collected for PGx-pharmacogenetic research?
boolean
Date
Item
If yes, record the date samples taken.
date
Has subject withdrawn consent for PGx-Pharmacogenetic/PGm-Transcriptomic/PGm-Proteomic research?
Item
Has subject withdrawn consent for PGx-Pharmacogenetic/PGm-Transcriptomic/PGm-Proteomic research?
boolean
Has a request been made for sample destruction?
Item
Has a request been made for sample destruction?
boolean
Item
If yes, specify reason
text
Code List
If yes, specify reason
CL Item
Subject requested (1)
CL Item
Other (specify) (2)
Other
Item
If other, please specify
text
C0205394 (UMLS CUI [1])