ID

25815

Description

Specimen Procurement Form - RF36 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=CCE3BBB6-B025-5069-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=CCE3BBB6-B025-5069-E034-0003BA12F5E7

Keywords

Versions (2)
  1. 9/19/12 9/19/12 -
  2. 9/20/17 9/20/17 -
Uploaded on

September 20, 2017

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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Specimen Procurement Form - RF36

English

No Instruction available.

1 forms  
  1. StudyEvent: Specimen Procurement Form - RF36
    1. No Instruction available.
Ccrr Module For Specimen Procurement Form - Rf36
Description

Ccrr Module For Specimen Procurement Form - Rf36

Alias
UMLS CUI-1
C1320722
UMLS CUI-2
C0370003
UMLS CUI-3
C1709695
UMLS CUI-4
C0276535
Patient Initials
Description

Patient Initials

Data type

text

Alias
UMLS CUI [1]
C2986440
Study ID
Description

Study ID

Data type

text

Alias
UMLS CUI [1]
C2826693
Site ID
Description

Site ID

Data type

text

Alias
UMLS CUI [1]
C2826692
ID Number
Description

ID Number

Data type

text

Alias
UMLS CUI [1]
C2348585
Cycle Number
Description

Cycle Number

Data type

text

Alias
UMLS CUI [1]
C2045829
Seq Number
Description

Seq Number

Data type

text

Alias
UMLS CUI [1]
C0600091
Date Specimen Obtained
Description

Date Specimen Obtained

Data type

text

Alias
UMLS CUI [1,1]
C0200345
UMLS CUI [1,2]
C0011008
Were specimens collected
Description

specimens collected

Data type

boolean

Alias
UMLS CUI [1]
C0200345
Specimen Type Code
Description

Specimen Type Code

Data type

text

Alias
UMLS CUI [1]
C2987119
Specify Other
Description

SpecifyOther

Data type

text

Alias
UMLS CUI [1]
C2987119
Total Volume
Description

Total Volume (ml)

Data type

text

Alias
UMLS CUI [1,1]
C0449468
UMLS CUI [1,2]
C0370003
Stored/Shipped Code
Description

Stored/Shipped Code

Data type

text

Alias
UMLS CUI [1,1]
C1698986
UMLS CUI [1,2]
C0805701
UMLS CUI [2]
C0370003
Specify Other
Description

SpecifyOther

Data type

text

Alias
UMLS CUI [1,1]
C1698986
UMLS CUI [1,2]
C0805701
UMLS CUI [2]
C0370003
Reason Sample Obtained Code
Description

Reason Sample Obtained Code

Data type

text

Alias
UMLS CUI [1,1]
C0200345
UMLS CUI [1,2]
C0392360
Specify Other
Description

SpecifyOther

Data type

text

Alias
UMLS CUI [1,1]
C0200345
UMLS CUI [1,2]
C0392360
Person Responsible for Sample
Description

Person Responsible for Sample

Data type

text

Alias
UMLS CUI [1,1]
C0680379
UMLS CUI [1,2]
C0370003
Date Form Completed
Description

Date Form Completed

Data type

date

Alias
UMLS CUI [1]
C1115437
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Similar models

No Instruction available.

1 forms
  1. StudyEvent: Specimen Procurement Form - RF36
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Ccrr Module For Specimen Procurement Form - Rf36
C1320722 (UMLS CUI-1)
C0370003 (UMLS CUI-2)
C1709695 (UMLS CUI-3)
C0276535 (UMLS CUI-4)
Patient Initials
Item
Patient Initials
text
C2986440 (UMLS CUI [1])
Study ID
Item
Study ID
text
C2826693 (UMLS CUI [1])
Site ID
Item
Site ID
text
C2826692 (UMLS CUI [1])
ID Number
Item
ID Number
text
C2348585 (UMLS CUI [1])
Cycle Number
Item
Cycle Number
text
C2045829 (UMLS CUI [1])
Seq Number
Item
Seq Number
text
C0600091 (UMLS CUI [1])
Date Specimen Obtained
Item
Date Specimen Obtained
text
C0200345 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
specimens collected
Item
Were specimens collected
boolean
C0200345 (UMLS CUI [1])
Specimen Type Code
Item
Specimen Type Code
text
C2987119 (UMLS CUI [1])
SpecifyOther
Item
Specify Other
text
C2987119 (UMLS CUI [1])
Total Volume (ml)
Item
Total Volume
text
C0449468 (UMLS CUI [1,1])
C0370003 (UMLS CUI [1,2])
Stored/Shipped Code
Item
Stored/Shipped Code
text
C1698986 (UMLS CUI [1,1])
C0805701 (UMLS CUI [1,2])
C0370003 (UMLS CUI [2])
SpecifyOther
Item
Specify Other
text
C1698986 (UMLS CUI [1,1])
C0805701 (UMLS CUI [1,2])
C0370003 (UMLS CUI [2])
Reason Sample Obtained Code
Item
Reason Sample Obtained Code
text
C0200345 (UMLS CUI [1,1])
C0392360 (UMLS CUI [1,2])
SpecifyOther
Item
Specify Other
text
C0200345 (UMLS CUI [1,1])
C0392360 (UMLS CUI [1,2])
Person Responsible for Sample
Item
Person Responsible for Sample
text
C0680379 (UMLS CUI [1,1])
C0370003 (UMLS CUI [1,2])
Date Form Completed
Item
Date Form Completed
date
C1115437 (UMLS CUI [1])
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