ID

24051

Description

Urine Immune Electro form for C3D 3.12 Adopters Lab - URINE IMMUNE ELECTRO - 2403564v1.0 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=0033F840-D37F-09E4-E044-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=0033F840-D37F-09E4-E044-0003BA3F9857

Keywords

Versions (2)
  1. 9/19/12 9/19/12 -
  2. 7/24/17 7/24/17 - Martin Dugas
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July 24, 2017

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Creative Commons BY-NC 3.0
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C3D Adopter Template Forms

English

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1 forms  
  1. StudyEvent: URINE IMMUNE ELECTRO
    1. No Instruction available.
Urine Immune Electro
Description

Urine Immune Electro

Course Number
Description

Course Number

Data type

integer

Alias
NCI Thesaurus Property
C25337
NCI Thesaurus ValueDomain
C25337
NCI Thesaurus ObjectClass
C25379
UMLS CUI [1,1]
C0750729
UMLS CUI [1,2]
C0237753
Course Day Number
Description

Course Day Number

Data type

integer

Alias
NCI Thesaurus ValueDomain
C25337
NCI Thesaurus Property
C25301
NCI Thesaurus ObjectClass
C25379
UMLS CUI [1,1]
C0750729
UMLS CUI [1,2]
C0439228
Sample Collection Date
Description

Sample Collection Date

Data type

date

Alias
NCI Thesaurus Property
C25164
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ObjectClass
C25453
NCI Thesaurus ObjectClass-2
C19157
UMLS CUI [1]
C1302413
Time
Description

Lab Collection Time

Data type

time

Alias
NCI Thesaurus Property
C25453
NCI Thesaurus Property-2
C25207
NCI Thesaurus ValueDomain
C25207
NCI Thesaurus ObjectClass
C25294
UMLS CUI [1]
C0552379
Lab Test
Description

Laboratory Test Name

Data type

text

Alias
NCI Thesaurus ObjectClass
C38470
NCI Thesaurus ValueDomain
C25294
NCI Thesaurus Property
C42614
NCI Thesaurus ValueDomain-2
C42614
UMLS CUI [1]
C0022885
Lab Value
Description

Laboratory Result

Data type

text

Alias
NCI Thesaurus ObjectClass
C36292
NCI Thesaurus Property
C25712
NCI Thesaurus ValueDomain
C25712
NCI Thesaurus ValueDomain-2
C36292
NCI Thesaurus ValueDomain-3
C68805
UMLS CUI [1]
C0587081
Lab Unit of Measure Name
Description

UOM

Data type

text

Alias
NCI Thesaurus ObjectClass
C38470
NCI Thesaurus Property
C25709
NCI Thesaurus ValueDomain
C42614
UMLS CUI [1]
C1519795
Test Result Significance Indicator
Description

Test Result significant

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C27232
NCI Metathesaurus Property
C0814896
NCI Thesaurus ValueDomain
C25162
NCI Thesaurus ValueDomain-2
C25704
NCI Thesaurus ValueDomain-3
C25180
UMLS CUI [1]
C2826633
Laboratory Test Normal Reference Range Text
Description

Normal Reference Range

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
NCI Thesaurus ObjectClass
C38470
NCI Metathesaurus Property
C0034926
UMLS CUI [1]
C2826705
Laboratory Test Normal Range Indicator
Description

LaboratoryTestNormalRangeIndicator

Data type

text

Alias
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
NCI Thesaurus ObjectClass
C38470
NCI Metathesaurus Property
C0034926
Common Toxicity Criteria Adverse Event Grade
Description

CTCAE Grade

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
NCI Thesaurus Property
C18000
NCI Thesaurus ObjectClass
C25468
UMLS CUI [1]
C2985911
Comments
Description

Comments

Alias
UMLS CUI-1
C0947611
Note Date
Description

Note Date

Data type

date

Alias
NCI Thesaurus Property
C25164
NCI Thesaurus ValueDomain
C25164
NCI Metathesaurus ObjectClass
C1317574
UMLS CUI [1]
C0011008
Research Comments Text
Description

Research Comments

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
UMLS CUI [1]
C0947611
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1 forms
  1. StudyEvent: URINE IMMUNE ELECTRO
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Urine Immune Electro
Course Number
Item
Course Number
integer
C25337 (NCI Thesaurus Property)
C25337 (NCI Thesaurus ValueDomain)
C25379 (NCI Thesaurus ObjectClass)
C0750729 (UMLS CUI [1,1])
C0237753 (UMLS CUI [1,2])
Course Day Number
Item
Course Day Number
integer
C25337 (NCI Thesaurus ValueDomain)
C25301 (NCI Thesaurus Property)
C25379 (NCI Thesaurus ObjectClass)
C0750729 (UMLS CUI [1,1])
C0439228 (UMLS CUI [1,2])
Sample Collection Date
Item
Sample Collection Date
date
C25164 (NCI Thesaurus Property)
C25164 (NCI Thesaurus ValueDomain)
C25453 (NCI Thesaurus ObjectClass)
C19157 (NCI Thesaurus ObjectClass-2)
C1302413 (UMLS CUI [1])
Lab Collection Time
Item
Time
time
C25453 (NCI Thesaurus Property)
C25207 (NCI Thesaurus Property-2)
C25207 (NCI Thesaurus ValueDomain)
C25294 (NCI Thesaurus ObjectClass)
C0552379 (UMLS CUI [1])
Item
Lab Test
text
C38470 (NCI Thesaurus ObjectClass)
C25294 (NCI Thesaurus ValueDomain)
C42614 (NCI Thesaurus Property)
C42614 (NCI Thesaurus ValueDomain-2)
C0022885 (UMLS CUI [1])
CL.1
Code List
Lab Test
CL Item
Immunoglobulin M (IGM)
C0020861 (UMLS CUI-1)
(Comment:en)
CL Item
Immunoelectrophoresis (Immunoelectrophoresis)
C2188711 (UMLS CUI-1)
(Comment:en)
CL Item
Spot Urine (Spot Urine)
C0457208 (UMLS CUI-1)
(Comment:en)
Laboratory Result
Item
Lab Value
text
C36292 (NCI Thesaurus ObjectClass)
C25712 (NCI Thesaurus Property)
C25712 (NCI Thesaurus ValueDomain)
C36292 (NCI Thesaurus ValueDomain-2)
C68805 (NCI Thesaurus ValueDomain-3)
C0587081 (UMLS CUI [1])
Item
Lab Unit of Measure Name
text
C38470 (NCI Thesaurus ObjectClass)
C25709 (NCI Thesaurus Property)
C42614 (NCI Thesaurus ValueDomain)
C1519795 (UMLS CUI [1])
CL.2
Code List
Lab Unit of Measure Name
CL Item
Percent (%)
C48570 (NCI Thesaurus)
C0439165 (UMLS CUI-1)
(Comment:en)
CL Item
Percent Per 100 Wbc (%/100 WBC)
(Comment:en)
CL Item
Per 100 Identifiable White Blood Cells (/100 WBC)
(Comment:en)
CL Item
Per Millimeter Cubed (/mm3)
C1300557 (UMLS CUI-1)
(Comment:en)
CL Item
10e12 Cells Per Liter (10E12 Cells/L)
(Comment:en)
CL Item
10e3 Cells Per Microliter (10E3 Cells/microL)
(Comment:en)
CL Item
10e6 Cells (10E6 Cells)
(Comment:en)
CL Item
10e6 Cells Per Microliter (10E6 Cells/microL)
(Comment:en)
CL Item
10e6 Cells Per Millimeter Cubed (10E6 Cells/mm3)
(Comment:en)
CL Item
10e7 Cells Per Kilogram (10E7 Cells/kg)
(Comment:en)
CL Item
10e8 Cells (10E8 Cells)
(Comment:en)
CL Item
10e9 Cells (10E9 Cells)
(Comment:en)
CL Item
10e9 Cells Per Liter (10E9 Cells/L)
(Comment:en)
CL Item
Complement Activity Enzyme Unit (CAE Unit)
(Comment:en)
CL Item
Cells Per Microliter (Cells/microL)
(Comment:en)
CL Item
Copies (Copies)
C1948062 (UMLS CUI-1)
(Comment:en)
CL Item
Cubic Microns (cubic microns)
(Comment:en)
CL Item
Enzyme Unit (EU)
C64778 (NCI Thesaurus)
C1880519 (UMLS CUI-1)
(Comment:en)
CL Item
Enzyme Units Per Deciliter (EU/dL)
(Comment:en)
CL Item
Enzyme Units Per Milliliter (EU/mL)
(Comment:en)
CL Item
Femtoliter (fL)
C64780 (NCI Thesaurus)
C0475213 (UMLS CUI-1)
(Comment:en)
CL Item
Grams (g) (g)
C48155 (NCI Thesaurus)
C0439208 (UMLS CUI-1)
(Comment:en)
CL Item
Gram Per 24 Hours (g/24hr)
(Comment:en)
CL Item
Gram Per Deciliter (g/dL)
C0439267 (UMLS CUI-1)
(Comment:en)
CL Item
Gram Per Liter (g/L)
C0439294 (UMLS CUI-1)
(Comment:en)
CL Item
Gram Per Microliter (g/microL)
(Comment:en)
CL Item
Per High Power Field (HPF)
(Comment:en)
CL Item
International Unit (Iunit)
C28255 (NCI Thesaurus)
C0439453 (UMLS CUI-1)
(Comment:en)
CL Item
International Unit Per Liter (IUnit/L)
C67376 (NCI Thesaurus)
C0439457 (UMLS CUI-1)
(Comment:en)
CL Item
International Unit Per Meter Squared (IUnit/m2)
(Comment:en)
CL Item
Iu/ml (IUnit/mL)
(Comment:en)
CL Item
Iu/ml (IUnit/mL)
CL Item
Kilounit Per Liter (kU/L)
C67382 (NCI Thesaurus)
C1532633 (UMLS CUI-1)
(Comment:en)
CL Item
Liter (L)
C0475211 (UMLS CUI-1)
(Comment:en)
CL Item
Liters Per Minute (L/min)
C67388 (NCI Thesaurus)
C0439393 (UMLS CUI-1)
(Comment:en)
CL Item
Per Low Power Field (LPF)
(Comment:en)
CL Item
Microgram Per 24 Hours (mcg/24hr)
(Comment:en)
CL Item
Microgram Per Deciliter (mcg/dL)
(Comment:en)
CL Item
Microgram Per Liter (mcg/L)
C0439275 (UMLS CUI-1)
(Comment:en)
CL Item
Microgram Per Milliliter (mcg/mL)
C0439268 (UMLS CUI-1)
(Comment:en)
CL Item
Microgram Per Specimen (mcg/spec)
(Comment:en)
CL Item
Milliequivalent (mEq)
C48512 (NCI Thesaurus)
C0439152 (UMLS CUI-1)
(Comment:en)
CL Item
Milliequivalents Per 24 Hours (mEq/24hr)
(Comment:en)
CL Item
Milliequivalent Per Deciliter (mEq/dL)
C67473 (NCI Thesaurus)
C1532568 (UMLS CUI-1)
(Comment:en)
CL Item
Milliequivalent Per Kilogram (mEq/kg)
(Comment:en)
CL Item
Milliequivalent Per Liter (mEq/L)
C67474 (NCI Thesaurus)
C0439375 (UMLS CUI-1)
(Comment:en)
CL Item
Milligram (mg)
C28253 (NCI Thesaurus)
C0439210 (UMLS CUI-1)
(Comment:en)
CL Item
Milligram Per 24 Hours (mg/24hr)
C67399 (NCI Thesaurus)
C0439422 (UMLS CUI-1)
(Comment:en)
CL Item
Milligram Per Deciliter (mg/dL)
C0439269 (UMLS CUI-1)
(Comment:en)
CL Item
Milligram Per Kilogram (mg/kg)
C1627892 (UMLS CUI-1)
(Comment:en)
CL Item
Milligram Per Liter (mg/L)
C0439268 (UMLS CUI-1)
(Comment:en)
CL Item
Milligram Per Milliliter (mg/mL)
(Comment:en)
CL Item
Milligram Per Milliliter Per Minute (mg/mL/min)
(Comment:en)
CL Item
Micro International Unit Per Milliliter (microIU/mL)
(Comment:en)
CL Item
Microliter (microL)
C0439243 (UMLS CUI-1)
(Comment:en)
CL Item
Micromole Per 24 Hours (micromol/24hr)
(Comment:en)
CL Item
Micromole Per Deciliter (micromol/dL)
(Comment:en)
CL Item
Micromole Per Liter (micromol/L)
(Comment:en)
CL Item
Million Plaque Forming Units (mill PFU)
C67268 (NCI Thesaurus)
C1881844 (UMLS CUI-1)
(Comment:en)
CL Item
Million (Million)
C67238 (NCI Thesaurus)
C1881839 (UMLS CUI-1)
(Comment:en)
CL Item
Million Per Microliter (Million/microL)
(Comment:en)
CL Item
Million Per Millimeter Cubed (Million/mm3)
(Comment:en)
CL Item
Milliinternational Unit (miu)
(Comment:en)
CL Item
Milliinternational Units Per Meter Squared (miu/m2)
(Comment:en)
CL Item
Milliinternational Unit Per Milliliter (miu/mL)
(Comment:en)
CL Item
Milliter (mL)
C0439242 (UMLS CUI-1)
(Comment:en)
CL Item
Milliliter Per Minute (mL/min)
C0439445 (UMLS CUI-1)
(Comment:en)
CL Item
Milliliter Per Minute Times 1.73 Times Bsa (mL/min/1.73/BSA)
(Comment:en)
CL Item
Milliter Per Minute Per Millimeters Of Mercury (mL/minute/mmHg)
(Comment:en)
CL Item
Millimeter Per Hour (mm/hr)
(Comment:en)
CL Item
Millimeter Cubed (mm3)
C0439243 (UMLS CUI-1)
(Comment:en)
CL Item
Millimeter Of Mercury (mmHg)
C49670 (NCI Thesaurus)
C0439475 (UMLS CUI-1)
(Comment:en)
CL Item
Millimole (mmol)
C0439190 (UMLS CUI-1)
(Comment:en)
CL Item
Millimole Per 24 Hours (mmol/24hr)
(Comment:en)
CL Item
Millimole Per Liter (mmol/L)
C1532563 (UMLS CUI-1)
(Comment:en)
CL Item
Milliosmole Per Kilogram (mosmol/kg)
(Comment:en)
CL Item
Million Units Per Milliliter (MU/mL)
(Comment:en)
CL Item
Not Applicable; No Uom Required (NA)
C1272460 (UMLS CUI-1)
(Comment:en)
CL Item
Nanogram Per Deciliter (ng/dL)
(Comment:en)
CL Item
Nanograms Per Milliliter (ng/mL)
(Comment:en)
CL Item
Nanogram Per Milliliter Per Hour (ng/mL/hr)
C67430 (NCI Thesaurus)
C1533072 (UMLS CUI-1)
(Comment:en)
CL Item
Nanomole Per Liter (nmol/L)
C67432 (NCI Thesaurus)
C0439282 (UMLS CUI-1)
(Comment:en)
CL Item
Nanomole Per Milligram Of Protein (nMol/mg protein)
(Comment:en)
CL Item
Nanomole Per Milliliter (nmol/mL)
(Comment:en)
CL Item
No Source Data (No Srce)
C53269 (NCI Thesaurus)
C1546437 (UMLS CUI-1)
(Comment:en)
CL Item
Picograms (pg)
C0439213 (UMLS CUI-1)
(Comment:en)
CL Item
Picogram Per Deciliter (pg/dL)
(Comment:en)
CL Item
Picrogram Per Milliliter (pg/mL)
(Comment:en)
CL Item
Pgpge2/mg Protein (pgPGE2/mg protein)
(Comment:en)
CL Item
Picomole Per Liter (pmol/L)
C67434 (NCI Thesaurus)
C0439284 (UMLS CUI-1)
(Comment:en)
CL Item
Ratio (Ratio)
C0456603 (UMLS CUI-1)
(Comment:en)
CL Item
Rna Copies Per Milliliter (RNA copies/mL)
(Comment:en)
CL Item
Seconds (sec)
C0457385 (NCI Metathesaurus)
C0457385 (UMLS CUI-1)
(Comment:en)
CL Item
Thousand (Thousand)
C67234 (NCI Thesaurus)
C1883310 (UMLS CUI-1)
(Comment:en)
CL Item
Thousand Per Microliter (Thousand/microL)
(Comment:en)
CL Item
Thousand Per Millimeter Squared (Thousand/mm2)
(Comment:en)
CL Item
Thousand Per Millimeter Cubed (Thousand/mm3)
(Comment:en)
CL Item
Titer (Titer)
C0475208 (UMLS CUI-1)
(Comment:en)
CL Item
Unit (Unit)
C44278 (NCI Thesaurus)
C0439148 (UMLS CUI-1)
(Comment:en)
CL Item
Unit Per 24 Hours (Unit/24hr)
(Comment:en)
CL Item
Unit Per Liter (Unit/L)
(Comment:en)
CL Item
Unit Per Meter Squared (Unit/m2)
(Comment:en)
CL Item
Unit Per Millilliter (Unit/mL)
C2945590 (UMLS CUI-1)
(Comment:en)
CL Item
Unit Per Millimeters Cubed (Unit/mm3)
(Comment:en)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS CUI-1)
(Comment:en)
Test Result significant
Item
Test Result Significance Indicator
boolean
C27232 (NCI Thesaurus ObjectClass)
C0814896 (NCI Metathesaurus Property)
C25162 (NCI Thesaurus ValueDomain)
C25704 (NCI Thesaurus ValueDomain-2)
C25180 (NCI Thesaurus ValueDomain-3)
C2826633 (UMLS CUI [1])
Normal Reference Range
Item
Laboratory Test Normal Reference Range Text
text
C25704 (NCI Thesaurus ValueDomain)
C38470 (NCI Thesaurus ObjectClass)
C0034926 (NCI Metathesaurus Property)
C2826705 (UMLS CUI [1])
Item
Laboratory Test Normal Range Indicator
text
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C38470 (NCI Thesaurus ObjectClass)
C0034926 (NCI Metathesaurus Property)
CL.4
Code List
Laboratory Test Normal Range Indicator
CL Item
High (High)
C25227 (NCI Thesaurus)
C0205250 (UMLS 2011AA)
CL Item
Low (Low)
C54722 (NCI Thesaurus)
C0205251 (UMLS 2011AA)
CL Item
Nonnumeric (Nonnum)
CL Item
No Range (Norang)
CL Item
Normal (Normal)
C14165 (NCI Thesaurus)
C0205307 (UMLS 2011AA)
Item
Common Toxicity Criteria Adverse Event Grade
text
C25337 (NCI Thesaurus ValueDomain)
C18000 (NCI Thesaurus Property)
C25468 (NCI Thesaurus ObjectClass)
C2985911 (UMLS CUI [1])
CL.5
Code List
Common Toxicity Criteria Adverse Event Grade
CL Item
No Adverse Event Or Within Normal Limits (0)
C1963761 (UMLS CUI-1)
(Comment:en)
CL Item
Mild Adverse Event (1)
C41338 (NCI Thesaurus)
C1513302 (UMLS CUI-1)
(Comment:en)
CL Item
Moderate Adverse Event (2)
C41339 (NCI Thesaurus)
C1513374 (UMLS CUI-1)
(Comment:en)
CL Item
Severe And Undesirable Adverse Event (3)
C1519275 (UMLS CUI-1)
(Comment:en)
CL Item
Life-threatening Or Disabling Adverse Event (4)
C1517874 (UMLS CUI-1)
(Comment:en)
CL Item
Death Related To Adverse Event (5)
C48275 (NCI Thesaurus)
C1705232 (UMLS CUI-1)
(Comment:en)
Item Group
Comments
C0947611 (UMLS CUI-1)
Note Date
Item
Note Date
date
C25164 (NCI Thesaurus Property)
C25164 (NCI Thesaurus ValueDomain)
C1317574 (NCI Metathesaurus ObjectClass)
C0011008 (UMLS CUI [1])
Research Comments
Item
Research Comments Text
text
C25704 (NCI Thesaurus ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0947611 (UMLS CUI [1])
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