0 Ratings

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

  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

    No Instruction available.

    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

    Similar models

    No Instruction available.

    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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