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25167

Descrizione

AMC-064 AIDS and Cancer Specimen Resource (ACSR) Procurement Form (F37) Study of Blood and Tissue Samples From Patients With Aggressive Non-Hodgkin B-Cell Lymphoma or Hodgkin Lymphoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=7C993962-2829-EDFE-E040-BB89AD43562B

collegamento

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=7C993962-2829-EDFE-E040-BB89AD43562B

Keywords

versioni (2)
  1. 19/09/12 19/09/12 -
  2. 28/08/17 28/08/17 -
Caricato su

28 agosto 2017

DOI

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Creative Commons BY-NC 3.0 Legacy
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    AMC-064 AIDS and Cancer Specimen Resource (ACSR) Procurement Form (F37)

    Inglese

    No Instruction available.

    1 moduli  
    1. StudyEvent: AMC-064 AIDS and Cancer Specimen Resource (ACSR) Procurement Form (F37)
      1. No Instruction available.
    Header - AIDS and Cancer Specimen Resource (ACSR) Procurement Form
    Descrizione

    Header - AIDS and Cancer Specimen Resource (ACSR) Procurement Form

    Alias
    UMLS CUI-1
    C0370003
    UMLS CUI-2
    C1709695
    UMLS CUI-3
    C0079731
    UMLS CUI-4
    C0019829
    UMLS CUI-5
    C0019682
    Visit number
    Descrizione

    Visit number

    Tipo di dati

    float

    Alias
    NCI Thesaurus ValueDomain
    C25337
    NCI Thesaurus ObjectClass
    C16696
    NCI Thesaurus Property
    C25385
    UMLS CUI [1]
    C1549755
    Specimen Procurement
    Descrizione

    Specimen Procurement

    Alias
    UMLS CUI-1
    C0370003
    UMLS CUI-2
    C1709695
    Specimen(s) obtained for donation to ACSR
    Descrizione

    AIDSMalignancyConsortiumSpecimenProcurementInd-2

    Tipo di dati

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38147
    NCI Thesaurus ObjectClass
    C19157
    NCI Thesaurus ObjectClass-2
    C19707
    NCI Thesaurus Property
    C54153
    UMLS CUI [1,1]
    C0370003
    UMLS CUI [1,2]
    C0680854
    UMLS CUI [1,3]
    C1515830
    Specimen Type
    Descrizione

    Specimen Submitted Type

    Tipo di dati

    integer

    Alias
    NCI Thesaurus ValueDomain
    C25284
    NCI Thesaurus ObjectClass
    C19157
    NCI Thesaurus Property
    C25695
    UMLS CUI [1]
    C0456204
    Other specify
    Descrizione

    SpecimenCellSourceSpecify

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    NCI Thesaurus Property
    C12508
    NCI Thesaurus Property-2
    C25683
    NCI Thesaurus ObjectClass
    C19157
    UMLS CUI [1]
    C0456204
    ACSR site the specimen(s) shipped to
    Descrizione

    AIDSMalignancyConsortiumSpecimenProcurementType

    Tipo di dati

    integer

    Alias
    NCI Thesaurus ValueDomain
    C25284
    NCI Thesaurus ObjectClass
    C19157
    NCI Thesaurus ObjectClass-2
    C19707
    NCI Thesaurus Property
    C54153
    UMLS CUI [1,1]
    C1515830
    UMLS CUI [1,2]
    C0450429
    Other, specify
    Descrizione

    AIDSMalignancyConsortiumSpecimenProcurementSpecify

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    NCI Thesaurus ObjectClass
    C19157
    NCI Thesaurus ObjectClass-2
    C19707
    NCI Thesaurus Property
    C54153
    UMLS CUI [1,1]
    C1515830
    UMLS CUI [1,2]
    C0450429
    If specimens were not obtained for ACSR, please indicate reason
    Descrizione

    AIDSMalignancyConsortiumSpecimenNotSubmittedReason

    Tipo di dati

    integer

    Alias
    NCI Thesaurus ObjectClass
    C19157
    NCI Thesaurus ObjectClass-2
    C19707
    NCI Thesaurus Property
    C25594
    NCI Thesaurus Property-2
    C25695
    NCI Thesaurus ValueDomain
    C25638
    UMLS CUI [1,1]
    C0370003
    UMLS CUI [1,2]
    C1515830
    UMLS CUI [1,3]
    C0392360
    Other, specify
    Descrizione

    AIDSMalignancyConsortiumSpecimenNotSubmittedSpecify

    Tipo di dati

    text

    Alias
    NCI Thesaurus ObjectClass
    C19157
    NCI Thesaurus ObjectClass-2
    C19707
    NCI Thesaurus Property
    C25594
    NCI Thesaurus Property-2
    C25695
    NCI Thesaurus ValueDomain
    C25685
    UMLS CUI [1,1]
    C0370003
    UMLS CUI [1,2]
    C1515830
    UMLS CUI [1,3]
    C0392360
    Date Specimen Obtained
    Descrizione

    Specimen Date

    Tipo di dati

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    NCI Thesaurus ObjectClass
    C19157
    NCI Thesaurus Property
    C25452
    NCI Thesaurus Property-2
    C25275
    UMLS CUI [1,1]
    C0370003
    UMLS CUI [1,2]
    C1516698
    UMLS CUI [1,3]
    C0011008
    Date Specimen Obtained
    Descrizione

    Specimen Date

    Tipo di dati

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    NCI Thesaurus ObjectClass
    C19157
    NCI Thesaurus Property
    C25452
    NCI Thesaurus Property-2
    C25275
    UMLS CUI [1,1]
    C0370003
    UMLS CUI [1,2]
    C1516698
    UMLS CUI [1,3]
    C0011008
    Study Coordinator
    Descrizione

    Study Coordinator

    Alias
    UMLS CUI-1
    C1880174
    UMLS CUI-2
    C1710220
    UMLS CUI-3
    C0079731
    UMLS CUI-4
    C0019829
    Study Coordinator's name
    Descrizione

    AIDSMalignancyConsortiumPersonStudyCoordinatorName

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    NCI Thesaurus ObjectClass
    C25190
    NCI Thesaurus ObjectClass-2
    C19707
    NCI Thesaurus Property
    C51880
    UMLS CUI [1,1]
    C1547383
    UMLS CUI [1,2]
    C1710220
    E-mail
    Descrizione

    Responsible Person E-mail Address Text

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704
    NCI Thesaurus ObjectClass
    C25657
    NCI Thesaurus Property
    C42775
    UMLS CUI [1,1]
    C1705961
    UMLS CUI [1,2]
    C1710220
    Phone Number
    Descrizione

    Organization Phone Number

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    NCI Thesaurus Property
    C25395
    NCI Thesaurus ObjectClass
    C19711
    UMLS CUI [1,1]
    C1515258
    UMLS CUI [1,2]
    C1710220
    Comments
    Descrizione

    Comments

    Alias
    UMLS CUI-1
    C0947611
    UMLS CUI-2
    C0079731
    UMLS CUI-3
    C0019829
    Comments
    Descrizione

    Research Comments

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704
    NCI Thesaurus ObjectClass
    C15319
    NCI Thesaurus Property
    C25393
    UMLS CUI [1,1]
    C0947611
    UMLS CUI [1,2]
    C0079731
    UMLS CUI [1,3]
    C0019829
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    Similar models

    No Instruction available.

    1 moduli
    1. StudyEvent: AMC-064 AIDS and Cancer Specimen Resource (ACSR) Procurement Form (F37)
      1. No Instruction available.
    Name
    genere
    Description | Question | Decode (Coded Value)
    Tipo di dati
    Alias
    Item Group
    Header - AIDS and Cancer Specimen Resource (ACSR) Procurement Form
    C0370003 (UMLS CUI-1)
    C1709695 (UMLS CUI-2)
    C0079731 (UMLS CUI-3)
    C0019829 (UMLS CUI-4)
    C0019682 (UMLS CUI-5)
    Visit number
    Item
    Visit number
    float
    C25337 (NCI Thesaurus ValueDomain)
    C16696 (NCI Thesaurus ObjectClass)
    C25385 (NCI Thesaurus Property)
    C1549755 (UMLS CUI [1])
    Item Group
    Specimen Procurement
    C0370003 (UMLS CUI-1)
    C1709695 (UMLS CUI-2)
    Specimen(s) obtained for donation to ACSR
    Item
    Specimen(s) obtained for donation to ACSR
    boolean
    C38147 (NCI Thesaurus ValueDomain)
    C19157 (NCI Thesaurus ObjectClass)
    C19707 (NCI Thesaurus ObjectClass-2)
    C54153 (NCI Thesaurus Property)
    C0370003 (UMLS CUI [1,1])
    C0680854 (UMLS CUI [1,2])
    C1515830 (UMLS CUI [1,3])
    Item
    Specimen Type
    integer
    C25284 (NCI Thesaurus ValueDomain)
    C19157 (NCI Thesaurus ObjectClass)
    C25695 (NCI Thesaurus Property)
    C0456204 (UMLS CUI [1])
    CL.2
    Code List
    Specimen Type
    CL Item
    Serum (1)
    CL Item
    Plasma (2)
    CL Item
    Pbmc (peripheral Blood Mononuclear Cells) (3)
    CL Item
    Peripheral Blood (4)
    CL Item
    Tissue (5)
    CL Item
    Other (6)
    Other specify
    Item
    Other specify
    text
    C25685 (NCI Thesaurus ValueDomain)
    C12508 (NCI Thesaurus Property)
    C25683 (NCI Thesaurus Property-2)
    C19157 (NCI Thesaurus ObjectClass)
    C0456204 (UMLS CUI [1])
    Item
    ACSR site the specimen(s) shipped to
    integer
    C25284 (NCI Thesaurus ValueDomain)
    C19157 (NCI Thesaurus ObjectClass)
    C19707 (NCI Thesaurus ObjectClass-2)
    C54153 (NCI Thesaurus Property)
    C1515830 (UMLS CUI [1,1])
    C0450429 (UMLS CUI [1,2])
    CL.3
    Code List
    ACSR site the specimen(s) shipped to
    CL Item
    Gwu (1)
    CL Item
    Ucla (2)
    CL Item
    Ucsf (3)
    CL Item
    Osu (4)
    CL Item
    Suny/hscb (5)
    CL Item
    Jhu (6)
    CL Item
    Other (7)
    Other, specify
    Item
    Other, specify
    text
    C25685 (NCI Thesaurus ValueDomain)
    C19157 (NCI Thesaurus ObjectClass)
    C19707 (NCI Thesaurus ObjectClass-2)
    C54153 (NCI Thesaurus Property)
    C1515830 (UMLS CUI [1,1])
    C0450429 (UMLS CUI [1,2])
    Item
    If specimens were not obtained for ACSR, please indicate reason
    integer
    C19157 (NCI Thesaurus ObjectClass)
    C19707 (NCI Thesaurus ObjectClass-2)
    C25594 (NCI Thesaurus Property)
    C25695 (NCI Thesaurus Property-2)
    C25638 (NCI Thesaurus ValueDomain)
    C0370003 (UMLS CUI [1,1])
    C1515830 (UMLS CUI [1,2])
    C0392360 (UMLS CUI [1,3])
    CL.4
    Code List
    If specimens were not obtained for ACSR, please indicate reason
    CL Item
    Patient Had Previously Donated Specimen To Acsr (1)
    CL Item
    Patient Refused To Give Informed Consent For Acsr Specimen Donation (2)
    CL Item
    Patient Was Not Asked To Consider Acsr Specimen Donation (3)
    CL Item
    Other (4)
    Other, specify
    Item
    Other, specify
    text
    C19157 (NCI Thesaurus ObjectClass)
    C19707 (NCI Thesaurus ObjectClass-2)
    C25594 (NCI Thesaurus Property)
    C25695 (NCI Thesaurus Property-2)
    C25685 (NCI Thesaurus ValueDomain)
    C0370003 (UMLS CUI [1,1])
    C1515830 (UMLS CUI [1,2])
    C0392360 (UMLS CUI [1,3])
    Specimen Date
    Item
    Date Specimen Obtained
    date
    C25164 (NCI Thesaurus ValueDomain)
    C19157 (NCI Thesaurus ObjectClass)
    C25452 (NCI Thesaurus Property)
    C25275 (NCI Thesaurus Property-2)
    C0370003 (UMLS CUI [1,1])
    C1516698 (UMLS CUI [1,2])
    C0011008 (UMLS CUI [1,3])
    Specimen Date
    Item
    Date Specimen Obtained
    date
    C25164 (NCI Thesaurus ValueDomain)
    C19157 (NCI Thesaurus ObjectClass)
    C25452 (NCI Thesaurus Property)
    C25275 (NCI Thesaurus Property-2)
    C0370003 (UMLS CUI [1,1])
    C1516698 (UMLS CUI [1,2])
    C0011008 (UMLS CUI [1,3])
    Item Group
    Study Coordinator
    C1880174 (UMLS CUI-1)
    C1710220 (UMLS CUI-2)
    C0079731 (UMLS CUI-3)
    C0019829 (UMLS CUI-4)
    Study Coordinator's name
    Item
    Study Coordinator's name
    text
    C25191 (NCI Thesaurus ValueDomain)
    C25190 (NCI Thesaurus ObjectClass)
    C19707 (NCI Thesaurus ObjectClass-2)
    C51880 (NCI Thesaurus Property)
    C1547383 (UMLS CUI [1,1])
    C1710220 (UMLS CUI [1,2])
    Responsible Person E-mail Address Text
    Item
    E-mail
    text
    C25704 (NCI Thesaurus ValueDomain)
    C25657 (NCI Thesaurus ObjectClass)
    C42775 (NCI Thesaurus Property)
    C1705961 (UMLS CUI [1,1])
    C1710220 (UMLS CUI [1,2])
    Organization Phone Number
    Item
    Phone Number
    text
    C25337 (NCI Thesaurus ValueDomain)
    C25395 (NCI Thesaurus Property)
    C19711 (NCI Thesaurus ObjectClass)
    C1515258 (UMLS CUI [1,1])
    C1710220 (UMLS CUI [1,2])
    Item Group
    Comments
    C0947611 (UMLS CUI-1)
    C0079731 (UMLS CUI-2)
    C0019829 (UMLS CUI-3)
    Research Comments
    Item
    Comments
    text
    C25704 (NCI Thesaurus ValueDomain)
    C15319 (NCI Thesaurus ObjectClass)
    C25393 (NCI Thesaurus Property)
    C0947611 (UMLS CUI [1,1])
    C0079731 (UMLS CUI [1,2])
    C0019829 (UMLS CUI [1,3])
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