Inglés

No Instruction available.

1 formularios  
  1. StudyEvent: Procurement Form - RF37
    1. No Instruction available.
Ccrr Module For Procurement Form - Rf37
Descripción

Ccrr Module For Procurement Form - Rf37

Patient Initials
Descripción

PatientInitials

Tipo de datos

text

Study#
Descripción

Study#

Tipo de datos

text

Site#
Descripción

Site#

Tipo de datos

text

ID#
Descripción

ID#

Tipo de datos

text

Cycle #
Descripción

Cycle#

Tipo de datos

text

Date Specimen Obtained
Descripción

DateSpecimenObtained

Tipo de datos

text

Specimen(s) obtained for donation to ACSB?
Descripción

Specimen(s)obtainedfordonationtoACSB?

Tipo de datos

text

Types of specimens collected:
Descripción

Typesofspecimenscollected:

Tipo de datos

text

ACSB site the specimen(s) shipped to
Descripción

ACSBsitethespecimen(s)shippedto

Tipo de datos

text

If specimens were not obtained for ACSB, please indicate reason
Descripción

IfspecimenswerenotobtainedforACSB,pleaseindicatereason

Tipo de datos

text

Patient previously donated specimens to ACSB, Indicate date
Descripción

PatientpreviouslydonatedspecimenstoACSB,Indicatedate

Tipo de datos

text

Other, Specify
Descripción

Other,Specify

Tipo de datos

text

Study Coordinator's Name
Descripción

StudyCoordinator'sName

Tipo de datos

text

Phone Number
Descripción

PhoneNumber

Tipo de datos

text

E-mail Address
Descripción

E-mailAddress

Tipo de datos

text

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Similar models

No Instruction available.

1 formularios
  1. StudyEvent: Procurement Form - RF37
    1. No Instruction available.
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
Ccrr Module For Procurement Form - Rf37
PatientInitials
Item
Patient Initials
text
Study#
Item
Study#
text
Site#
Item
Site#
text
ID#
Item
ID#
text
Cycle#
Item
Cycle #
text
DateSpecimenObtained
Item
Date Specimen Obtained
text
Item
Specimen(s) obtained for donation to ACSB?
text
CL.1
Code List
Specimen(s) obtained for donation to ACSB?
CL Item
Yes (Yes)
CL Item
No (No)
Item
Types of specimens collected:
text
CL.2
Code List
Types of specimens collected:
CL Item
Serum (Serum)
CL Item
Plasma (Plasma)
CL Item
PBMC (PBMC)
CL Item
Whole Blood (Whole Blood)
CL Item
Tissue (Tissue)
CL Item
Other, Specify (Other, Specify)
Item
ACSB site the specimen(s) shipped to
text
CL.3
Code List
ACSB site the specimen(s) shipped to
CL Item
GWU (GWU)
CL Item
UCLA (UCLA)
CL Item
UCSF (UCSF)
CL Item
OSU (OSU)
CL Item
SUNY/HSCB (SUNY/HSCB)
CL Item
Other, Specify (Other, Specify)
Item
If specimens were not obtained for ACSB, please indicate reason
text
CL.4
Code List
If specimens were not obtained for ACSB, please indicate reason
CL Item
Patient had previously donated specimens to ACSB. (Patient had previously donated specimens to ACSB.)
CL Item
Patient refused to give informed consent for ACSB specimen donation (Patient refused to give informed consent for ACSB specimen donation)
CL Item
Patient was not asked to consider ACSB specimen donation (Patient was not asked to consider ACSB specimen donation)
CL Item
Other, Specify (Other, Specify)
PatientpreviouslydonatedspecimenstoACSB,Indicatedate
Item
Patient previously donated specimens to ACSB, Indicate date
text
Other,Specify
Item
Other, Specify
text
StudyCoordinator'sName
Item
Study Coordinator's Name
text
PhoneNumber
Item
Phone Number
text
E-mailAddress
Item
E-mail Address
text
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