ID

18746

Beschreibung

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

Stichworte

Versionen (2)
  1. 26.07.16 26.07.16 -
  2. 18.11.16 18.11.16 -
Hochgeladen am

18. November 2016

DOI

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Lizenz

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

Englisch

Research Sample Tracking: CRF Wisconsin Madison

1 Formulare  
Header
Beschreibung

Header

PI Name
Beschreibung

PI Name

Datentyp

text

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

Protocol or IRB Number

Datentyp

integer

Alias
UMLS CUI [1]
C2348563
Protocol Short Title
Beschreibung

Protocol Short Title

Datentyp

text

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

Subject ID

Datentyp

text

Alias
UMLS CUI [1]
C2348585
Number of Page
Beschreibung

Number of Page

Datentyp

integer

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

Total number of Pages

Datentyp

integer

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

Research Sample Tracking I

Storage Location (including building and room number)
Beschreibung

Storage Location

Datentyp

text

Alias
UMLS CUI [1]
C0337174
Freezer number
Beschreibung

Freezer number

Datentyp

integer

Alias
UMLS CUI [1]
C0175738
Shelf Number
Beschreibung

Shelf Number

Datentyp

integer

Alias
UMLS CUI [1]
C0727840
Rack Number
Beschreibung

Rack Number

Datentyp

integer

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

Research Sample Tracking II

Box Number
Beschreibung

Box Number

Datentyp

integer

Alias
UMLS CUI [1]
C0179400
Cell Number
Beschreibung

Cell Number

Datentyp

integer

Alias
UMLS CUI [1]
C1948049
Subject ID Number
Beschreibung

Subject ID

Datentyp

integer

Alias
UMLS CUI [1]
C2348585
Visit Number
Beschreibung

Visit Number

Datentyp

text

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

Date sample put in freezer

Datentyp

date

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

Time sample put in freezer

Datentyp

time

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

Time sample put in freezer

Datentyp

boolean

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

Time sample put in freezer

Datentyp

boolean

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

Date sample removed from freezer

Datentyp

date

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

Time sample removed from freezer

Datentyp

time

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

Time sample removed from freezer

Datentyp

boolean

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

Time sample removed from freezer

Datentyp

boolean

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

Sample Outcome

Datentyp

text

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

Sample Outcome

Datentyp

text

Alias
UMLS CUI [1,1]
C1274040
UMLS CUI [1,2]
C0370003
UMLS CUI [1,3]
C0205394
Zum Seitenanfang zurückkehren

Ähnliche Modelle

Research Sample Tracking: CRF Wisconsin Madison

1 Formulare
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
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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