English

No Instruction available.

1 forms  
  1. StudyEvent: Procurement Form - RF37
    1. No Instruction available.
Ccrr Module For Procurement Form - Rf37
Description

Ccrr Module For Procurement Form - Rf37

Patient Initials
Description

PatientInitials

Data type

text

Study#
Description

Study#

Data type

text

Site#
Description

Site#

Data type

text

ID#
Description

ID#

Data type

text

Cycle #
Description

Cycle#

Data type

text

Date Specimen Obtained
Description

DateSpecimenObtained

Data type

text

Specimen(s) obtained for donation to ACSB?
Description

Specimen(s)obtainedfordonationtoACSB?

Data type

text

Types of specimens collected:
Description

Typesofspecimenscollected:

Data type

text

ACSB site the specimen(s) shipped to
Description

ACSBsitethespecimen(s)shippedto

Data type

text

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

IfspecimenswerenotobtainedforACSB,pleaseindicatereason

Data type

text

Patient previously donated specimens to ACSB, Indicate date
Description

PatientpreviouslydonatedspecimenstoACSB,Indicatedate

Data type

text

Other, Specify
Description

Other,Specify

Data type

text

Study Coordinator's Name
Description

StudyCoordinator'sName

Data type

text

Phone Number
Description

PhoneNumber

Data type

text

E-mail Address
Description

E-mailAddress

Data type

text

Back to the top of the page

Similar models

No Instruction available.

1 forms
  1. StudyEvent: Procurement Form - RF37
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
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
Back to the top of the page