ID

18746

Description

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

Keywords

Versions (2)
  1. 7/26/16 7/26/16 -
  2. 11/18/16 11/18/16 -
Uploaded on

November 18, 2016

DOI

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License

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

English

Research Sample Tracking: CRF Wisconsin Madison

1 forms  
Header
Description

Header

PI Name
Description

PI Name

Data type

text

Alias
UMLS CUI [1,1]
C0027365
UMLS CUI [1,2]
C1521895
Protocol or IRB Number
Description

Protocol or IRB Number

Data type

integer

Alias
UMLS CUI [1]
C2348563
Protocol Short Title
Description

Protocol Short Title

Data type

text

Alias
UMLS CUI [1,1]
C2348563
UMLS CUI [1,2]
C1705824
Subject ID
Description

Subject ID

Data type

text

Alias
UMLS CUI [1]
C2348585
Number of Page
Description

Number of Page

Data type

integer

Alias
UMLS CUI [1,1]
C1704732
UMLS CUI [1,2]
C0449788
Total number of Pages
Description

Total number of Pages

Data type

integer

Alias
UMLS CUI [1,1]
C1704732
UMLS CUI [1,2]
C0449788
Research Sample Tracking I
Description

Research Sample Tracking I

Storage Location (including building and room number)
Description

Storage Location

Data type

text

Alias
UMLS CUI [1]
C0337174
Freezer number
Description

Freezer number

Data type

integer

Alias
UMLS CUI [1]
C0175738
Shelf Number
Description

Shelf Number

Data type

integer

Alias
UMLS CUI [1]
C0727840
Rack Number
Description

Rack Number

Data type

integer

Alias
UMLS CUI [1]
C0182576
Research Sample Tracking II
Description

Research Sample Tracking II

Box Number
Description

Box Number

Data type

integer

Alias
UMLS CUI [1]
C0179400
Cell Number
Description

Cell Number

Data type

integer

Alias
UMLS CUI [1]
C1948049
Subject ID Number
Description

Subject ID

Data type

integer

Alias
UMLS CUI [1]
C2348585
Visit Number
Description

Visit Number

Data type

text

Alias
UMLS CUI [1]
C1549755
Date sample put in freezer
Description

Date sample put in freezer

Data type

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0370003
UMLS CUI [1,3]
C0175738
Time sample put in freezer
Description

Time sample put in freezer

Data type

time

Alias
UMLS CUI [1,1]
C0040223
UMLS CUI [1,2]
C0370003
UMLS CUI [1,3]
C0175738
Time sample put in freezer: AM
Description

Time sample put in freezer

Data type

boolean

Alias
UMLS CUI [1,1]
C0040223
UMLS CUI [1,2]
C0370003
UMLS CUI [1,3]
C0175738
Time sample put in freezer: PM
Description

Time sample put in freezer

Data type

boolean

Alias
UMLS CUI [1,1]
C0040223
UMLS CUI [1,2]
C0370003
UMLS CUI [1,3]
C0175738
Date sample removed from freezer
Description

Date sample removed from freezer

Data type

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0370003
UMLS CUI [1,3]
C0175738
Time sample removed from freezer
Description

Time sample removed from freezer

Data type

time

Alias
UMLS CUI [1,1]
C0040223
UMLS CUI [1,2]
C0370003
UMLS CUI [1,3]
C0175738
Time sample removed from freezer: AM
Description

Time sample removed from freezer

Data type

boolean

Alias
UMLS CUI [1,1]
C0040223
UMLS CUI [1,2]
C0370003
UMLS CUI [1,3]
C0175738
Time sample removed from freezer: PM
Description

Time sample removed from freezer

Data type

boolean

Alias
UMLS CUI [1,1]
C0040223
UMLS CUI [1,2]
C0370003
UMLS CUI [1,3]
C0175738
Sample Outcome
Description

Sample Outcome

Data type

text

Alias
UMLS CUI [1,1]
C1274040
UMLS CUI [1,2]
C0370003
If Other, please specify
Description

Sample Outcome

Data type

text

Alias
UMLS CUI [1,1]
C1274040
UMLS CUI [1,2]
C0370003
UMLS CUI [1,3]
C0205394
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Similar models

Research Sample Tracking: CRF Wisconsin Madison

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Header
PI Name
Item
PI Name
text
C0027365 (UMLS CUI [1,1])
C1521895 (UMLS CUI [1,2])
Protocol or IRB Number
Item
Protocol or IRB Number
integer
C2348563 (UMLS CUI [1])
Protocol Short Title
Item
Protocol Short Title
text
C2348563 (UMLS CUI [1,1])
C1705824 (UMLS CUI [1,2])
Subject ID
Item
Subject ID
text
C2348585 (UMLS CUI [1])
Number of Page
Item
Number of Page
integer
C1704732 (UMLS CUI [1,1])
C0449788 (UMLS CUI [1,2])
Total number of Pages
Item
Total number of Pages
integer
C1704732 (UMLS CUI [1,1])
C0449788 (UMLS CUI [1,2])
Item Group
Research Sample Tracking I
Storage Location
Item
Storage Location (including building and room number)
text
C0337174 (UMLS CUI [1])
Freezer number
Item
Freezer number
integer
C0175738 (UMLS CUI [1])
Shelf Number
Item
Shelf Number
integer
C0727840 (UMLS CUI [1])
Rack Number
Item
Rack Number
integer
C0182576 (UMLS CUI [1])
Item Group
Research Sample Tracking II
Box Number
Item
Box Number
integer
C0179400 (UMLS CUI [1])
Cell Number
Item
Cell Number
integer
C1948049 (UMLS CUI [1])
Subject ID
Item
Subject ID Number
integer
C2348585 (UMLS CUI [1])
Item
Visit Number
text
C1549755 (UMLS CUI [1])
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
C0011008 (UMLS CUI [1,1])
C0370003 (UMLS CUI [1,2])
C0175738 (UMLS CUI [1,3])
Time sample put in freezer
Item
Time sample put in freezer
time
C0040223 (UMLS CUI [1,1])
C0370003 (UMLS CUI [1,2])
C0175738 (UMLS CUI [1,3])
Time sample put in freezer
Item
Time sample put in freezer: AM
boolean
C0040223 (UMLS CUI [1,1])
C0370003 (UMLS CUI [1,2])
C0175738 (UMLS CUI [1,3])
Time sample put in freezer
Item
Time sample put in freezer: PM
boolean
C0040223 (UMLS CUI [1,1])
C0370003 (UMLS CUI [1,2])
C0175738 (UMLS CUI [1,3])
Date sample removed from freezer
Item
Date sample removed from freezer
date
C0011008 (UMLS CUI [1,1])
C0370003 (UMLS CUI [1,2])
C0175738 (UMLS CUI [1,3])
Time sample removed from freezer
Item
Time sample removed from freezer
time
C0040223 (UMLS CUI [1,1])
C0370003 (UMLS CUI [1,2])
C0175738 (UMLS CUI [1,3])
Time sample removed from freezer
Item
Time sample removed from freezer: AM
boolean
C0040223 (UMLS CUI [1,1])
C0370003 (UMLS CUI [1,2])
C0175738 (UMLS CUI [1,3])
Time sample removed from freezer
Item
Time sample removed from freezer: PM
boolean
C0040223 (UMLS CUI [1,1])
C0370003 (UMLS CUI [1,2])
C0175738 (UMLS CUI [1,3])
Item
Sample Outcome
text
C1274040 (UMLS CUI [1,1])
C0370003 (UMLS CUI [1,2])
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
C1274040 (UMLS CUI [1,1])
C0370003 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
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