ID

25167

Description

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

Lien

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

Mots-clés

Versions (2)
  1. 19/09/2012 19/09/2012 -
  2. 28/08/2017 28/08/2017 -
Téléchargé le

28 août 2017

DOI

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Licence

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

Anglais

No Instruction available.

1 Formulaires  
  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
Description

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
Description

Visit number

Type de données

float

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

Specimen Procurement

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

AIDSMalignancyConsortiumSpecimenProcurementInd-2

Type de données

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
Description

Specimen Submitted Type

Type de données

integer

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

SpecimenCellSourceSpecify

Type de données

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
Description

AIDSMalignancyConsortiumSpecimenProcurementType

Type de données

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
Description

AIDSMalignancyConsortiumSpecimenProcurementSpecify

Type de données

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
Description

AIDSMalignancyConsortiumSpecimenNotSubmittedReason

Type de données

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
Description

AIDSMalignancyConsortiumSpecimenNotSubmittedSpecify

Type de données

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
Description

Specimen Date

Type de données

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
Description

Specimen Date

Type de données

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
Description

Study Coordinator

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

AIDSMalignancyConsortiumPersonStudyCoordinatorName

Type de données

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
Description

Responsible Person E-mail Address Text

Type de données

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
Description

Organization Phone Number

Type de données

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
Description

Comments

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

Research Comments

Type de données

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 Formulaires
  1. StudyEvent: AMC-064 AIDS and Cancer Specimen Resource (ACSR) Procurement Form (F37)
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Type de données
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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