ID

18746

Beschrijving

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

Trefwoorden

Versies (2)
  1. 26-07-16 26-07-16 -
  2. 18-11-16 18-11-16 -
Geüploaded op

18 november 2016

DOI

Voor een aanvraag inloggen.

Licentie

Creative Commons BY-NC 3.0
Model Commentaren :

Hier kunt u commentaar leveren op het model. U kunt de tekstballonnen bij de itemgroepen en items gebruiken om er specifiek commentaar op te geven.

Terug naar het model Commentaren
Itemgroep Commentaren voor :

Item Commentaren voor :

U moet ingelogd zijn om formulieren te downloaden. AUB inloggen of schrijf u gratis in.

Research Sample Tracking: CRF Wisconsin Madison

Engels

Research Sample Tracking: CRF Wisconsin Madison

1 Formulieren  
Header
Beschrijving

Header

PI Name
Beschrijving

PI Name

Datatype

text

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

Protocol or IRB Number

Datatype

integer

Alias
UMLS CUI [1]
C2348563
Protocol Short Title
Beschrijving

Protocol Short Title

Datatype

text

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

Subject ID

Datatype

text

Alias
UMLS CUI [1]
C2348585
Number of Page
Beschrijving

Number of Page

Datatype

integer

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

Total number of Pages

Datatype

integer

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

Research Sample Tracking I

Storage Location (including building and room number)
Beschrijving

Storage Location

Datatype

text

Alias
UMLS CUI [1]
C0337174
Freezer number
Beschrijving

Freezer number

Datatype

integer

Alias
UMLS CUI [1]
C0175738
Shelf Number
Beschrijving

Shelf Number

Datatype

integer

Alias
UMLS CUI [1]
C0727840
Rack Number
Beschrijving

Rack Number

Datatype

integer

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

Research Sample Tracking II

Box Number
Beschrijving

Box Number

Datatype

integer

Alias
UMLS CUI [1]
C0179400
Cell Number
Beschrijving

Cell Number

Datatype

integer

Alias
UMLS CUI [1]
C1948049
Subject ID Number
Beschrijving

Subject ID

Datatype

integer

Alias
UMLS CUI [1]
C2348585
Visit Number
Beschrijving

Visit Number

Datatype

text

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

Date sample put in freezer

Datatype

date

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

Time sample put in freezer

Datatype

time

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

Time sample put in freezer

Datatype

boolean

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

Time sample put in freezer

Datatype

boolean

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

Date sample removed from freezer

Datatype

date

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

Time sample removed from freezer

Datatype

time

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

Time sample removed from freezer

Datatype

boolean

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

Time sample removed from freezer

Datatype

boolean

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

Sample Outcome

Datatype

text

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

Sample Outcome

Datatype

text

Alias
UMLS CUI [1,1]
C1274040
UMLS CUI [1,2]
C0370003
UMLS CUI [1,3]
C0205394
Terug naar het begin van de pagina

Similar models

Research Sample Tracking: CRF Wisconsin Madison

1 Formulieren
Name
Type
Description | Question | Decode (Coded Value)
Datatype
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])
Terug naar het begin van de pagina 

Contact

Gebruik dit formulier voor feedback, vragen en verbeteringsvoorstellen.

Velden gemarkeerd met een * zijn verplicht.

Help

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial