ID

26128

Beskrivning

AMC-051 AIDS and Cancer Specimen Resource (ACSR) Procurement Form (F51) Sirolimus in Treating Patients With HIV-Related Kaposi's Sarcoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=2FDFA89A-059A-6018-E044-0003BA3F9857

Länk

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=2FDFA89A-059A-6018-E044-0003BA3F9857

Nyckelord

Versioner (1)
  1. 2017-10-09 2017-10-09 -
Rättsinnehavare

AIDS Malignancy Consortium

Uppladdad den

9 oktober 2017

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Creative Commons BY-NC 3.0
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AMC-051 AIDS and Cancer Specimen Resource (ACSR) Procurement Form (F37)

Engelsk

No Instruction available.

1 Formulär  
  1. StudyEvent: AMC-048 AIDS and Cancer Specimen Resource (ACSR) Procurement Form (F37)
    1. No Instruction available.
Header - AIDS and Cancer Specimen Resource (ACSR) Procurement Form
Beskrivning

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

Alias
UMLS CUI-1
C0370003
UMLS CUI-2
C1709695
UMLS CUI-3
C0276535
UMLS CUI-4
C0072980
Visit number
Beskrivning

Visit number

Datatyp

integer

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

Specimen Procurement

Alias
UMLS CUI-1
C0370003
UMLS CUI-2
C1709695
UMLS CUI-3
C0276535
Date Specimen Obtained
Beskrivning

Specimen Collected Date

Datatyp

date

Alias
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ObjectClass
C19157
NCI Thesaurus Property
C25452
NCI Thesaurus Property-2
C25275
UMLS CUI [1,1]
C0200345
UMLS CUI [1,2]
C0011008
Date Specimen Obtained
Beskrivning

Specimen Collected Date

Datatyp

date

Alias
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ObjectClass
C19157
NCI Thesaurus Property
C25452
NCI Thesaurus Property-2
C25275
UMLS CUI [1,1]
C0200345
UMLS CUI [1,2]
C0011008
Specimen(s) obtained for donation to ACSR
Beskrivning

AIDSMalignancyConsortiumSpecimenProcurementInd-2

Datatyp

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
Beskrivning

Specimen Submitted Type

Datatyp

integer

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

SpecimenCellSourceSpecify

Datatyp

text

Alias
NCI Thesaurus ValueDomain
C25685
NCI Thesaurus Property
C12508
NCI Thesaurus Property-2
C25683
NCI Thesaurus ObjectClass
C19157
UMLS CUI [1,1]
C2911685
UMLS CUI [1,2]
C1521902
ACSR site the specimen(s) shipped to
Beskrivning

AIDSMalignancyConsortiumSpecimenProcurementType

Datatyp

integer

Alias
NCI Thesaurus ValueDomain
C25284
NCI Thesaurus ObjectClass
C19157
NCI Thesaurus ObjectClass-2
C19707
NCI Thesaurus Property
C54153
UMLS CUI [1,1]
C0370003
UMLS CUI [1,2]
C1515830
UMLS CUI [1,3]
C0450429
Other, specify
Beskrivning

AIDSMalignancyConsortiumSpecimenProcurementSpecify

Datatyp

text

Alias
NCI Thesaurus ValueDomain
C25685
NCI Thesaurus ObjectClass
C19157
NCI Thesaurus ObjectClass-2
C19707
NCI Thesaurus Property
C54153
UMLS CUI [1,1]
C0370003
UMLS CUI [1,2]
C1515830
UMLS CUI [1,3]
C0450429
If specimens were not obtained for ACSR, please indicate reason
Beskrivning

AIDSMalignancyConsortiumSpecimenNotSubmittedReason

Datatyp

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
Beskrivning

AIDSMalignancyConsortiumSpecimenNotSubmittedSpecify

Datatyp

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
Study Coordinator
Beskrivning

Study Coordinator

Alias
UMLS CUI-1
C1880174
UMLS CUI-2
C1710220
UMLS CUI-3
C0276535
Study Coordinator's name
Beskrivning

AIDSMalignancyConsortiumPersonStudyCoordinatorName

Datatyp

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
Beskrivning

Responsible Person E-mail Address Text

Datatyp

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
Beskrivning

Organization Phone Number

Datatyp

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
Beskrivning

Comments

Alias
UMLS CUI-1
C0947611
UMLS CUI-2
C0276535
Comments
Beskrivning

Research Comments

Datatyp

text

Alias
NCI Thesaurus ValueDomain
C25704
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
UMLS CUI [1,1]
C0947611
UMLS CUI [1,2]
C0276535
Tillbaka till toppen

Similar models

No Instruction available.

1 Formulär
  1. StudyEvent: AMC-048 AIDS and Cancer Specimen Resource (ACSR) Procurement Form (F37)
    1. No Instruction available.
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
Header - AIDS and Cancer Specimen Resource (ACSR) Procurement Form
C0370003 (UMLS CUI-1)
C1709695 (UMLS CUI-2)
C0276535 (UMLS CUI-3)
C0072980 (UMLS CUI-4)
Visit number
Item
Visit number
integer
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)
C0276535 (UMLS CUI-3)
Specimen Collected Date
Item
Date Specimen Obtained
date
C25164 (NCI Thesaurus ValueDomain)
C19157 (NCI Thesaurus ObjectClass)
C25452 (NCI Thesaurus Property)
C25275 (NCI Thesaurus Property-2)
C0200345 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Specimen Collected Date
Item
Date Specimen Obtained
date
C25164 (NCI Thesaurus ValueDomain)
C19157 (NCI Thesaurus ObjectClass)
C25452 (NCI Thesaurus Property)
C25275 (NCI Thesaurus Property-2)
C0200345 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
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)
C2911685 (UMLS CUI [1,1])
C1521902 (UMLS CUI [1,2])
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)
C0370003 (UMLS CUI [1,1])
C1515830 (UMLS CUI [1,2])
C0450429 (UMLS CUI [1,3])
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)
C0370003 (UMLS CUI [1,1])
C1515830 (UMLS CUI [1,2])
C0450429 (UMLS CUI [1,3])
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])
Item Group
Study Coordinator
C1880174 (UMLS CUI-1)
C1710220 (UMLS CUI-2)
C0276535 (UMLS CUI-3)
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)
C0276535 (UMLS CUI-2)
Research Comments
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0947611 (UMLS CUI [1,1])
C0276535 (UMLS CUI [1,2])
Tillbaka till toppen 

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