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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

Lien

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

Mots-clés

  1. 19/09/2012 19/09/2012 -
  2. 20/09/2017 20/09/2017 -
Téléchargé le

20 septembre 2017

DOI

Pour une demande vous connecter.

Licence

Creative Commons BY-NC 3.0 Legacy

Modèle Commentaires :

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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 (Administrative documentation)
    SNOMED
    405624007
    UMLS CUI-2
    C0370003 (Specimen)
    SNOMED
    123038009
    LOINC
    LP7593-9
    UMLS CUI-3
    C1709695 (Procurement)
    UMLS CUI-4
    C0276535 (AIDS with Kaposi's sarcoma)
    SNOMED
    420524008
    Patient Initials
    Description

    Patient Initials

    Type de données

    text

    Alias
    UMLS CUI [1]
    C2986440 (Person Initials)
    Study ID
    Description

    Study ID

    Type de données

    text

    Alias
    UMLS CUI [1]
    C2826693 (Study Identifier)
    Site ID
    Description

    Site ID

    Type de données

    text

    Alias
    UMLS CUI [1]
    C2826692 (Study Site Identifier)
    ID Number
    Description

    ID Number

    Type de données

    text

    Alias
    UMLS CUI [1]
    C2348585 (Clinical Trial Subject Unique Identifier)
    Cycle Number
    Description

    Cycle Number

    Type de données

    text

    Alias
    UMLS CUI [1]
    C2045829 (chemotherapeutics regimen status cycle number)
    Seq Number
    Description

    Seq Number

    Type de données

    text

    Alias
    UMLS CUI [1]
    C0600091 (Identifier)
    SNOMED
    118522005
    LOINC
    LP31795-5
    Date Specimen Obtained
    Description

    Date Specimen Obtained

    Type de données

    text

    Alias
    UMLS CUI [1,1]
    C0200345 (Specimen Collection)
    SNOMED
    17636008
    UMLS CUI [1,2]
    C0011008 (Date in time)
    SNOMED
    410671006
    Were specimens collected
    Description

    specimens collected

    Type de données

    boolean

    Alias
    UMLS CUI [1]
    C0200345 (Specimen Collection)
    SNOMED
    17636008
    Specimen Type Code
    Description

    Specimen Type Code

    Type de données

    text

    Alias
    UMLS CUI [1]
    C2987119 (Specimen Type Code)
    Specify Other
    Description

    SpecifyOther

    Type de données

    text

    Alias
    UMLS CUI [1]
    C2987119 (Specimen Type Code)
    Total Volume
    Description

    Total Volume (ml)

    Type de données

    text

    Alias
    UMLS CUI [1,1]
    C0449468 (Volume)
    SNOMED
    118565006
    LOINC
    LP73697-2
    UMLS CUI [1,2]
    C0370003 (Specimen)
    SNOMED
    123038009
    LOINC
    LP7593-9
    Stored/Shipped Code
    Description

    Stored/Shipped Code

    Type de données

    text

    Alias
    UMLS CUI [1,1]
    C1698986 (Storage)
    SNOMED
    440276004
    UMLS CUI [1,2]
    C0805701 (Code)
    UMLS CUI [2]
    C0370003 (Specimen)
    SNOMED
    123038009
    LOINC
    LP7593-9
    Specify Other
    Description

    SpecifyOther

    Type de données

    text

    Alias
    UMLS CUI [1,1]
    C1698986 (Storage)
    SNOMED
    440276004
    UMLS CUI [1,2]
    C0805701 (Code)
    UMLS CUI [2]
    C0370003 (Specimen)
    SNOMED
    123038009
    LOINC
    LP7593-9
    Reason Sample Obtained Code
    Description

    Reason Sample Obtained Code

    Type de données

    text

    Alias
    UMLS CUI [1,1]
    C0200345 (Specimen Collection)
    SNOMED
    17636008
    UMLS CUI [1,2]
    C0392360 (Indication of (contextual qualifier))
    SNOMED
    230165009
    LOINC
    MTHU008319
    Specify Other
    Description

    SpecifyOther

    Type de données

    text

    Alias
    UMLS CUI [1,1]
    C0200345 (Specimen Collection)
    SNOMED
    17636008
    UMLS CUI [1,2]
    C0392360 (Indication of (contextual qualifier))
    SNOMED
    230165009
    LOINC
    MTHU008319
    Person Responsible for Sample
    Description

    Person Responsible for Sample

    Type de données

    text

    Alias
    UMLS CUI [1,1]
    C0680379 (person with responsibility)
    UMLS CUI [1,2]
    C0370003 (Specimen)
    SNOMED
    123038009
    LOINC
    LP7593-9
    Date Form Completed
    Description

    Date Form Completed

    Type de données

    date

    Alias
    UMLS CUI [1]
    C1115437 (Date form completed)
    LOINC
    MTHU014518

    Similar models

    No Instruction available.

    1. StudyEvent: Specimen Procurement Form - RF36
      1. No Instruction available.
    Name
    Type
    Description | Question | Decode (Coded Value)
    Type de données
    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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