PGx-PHARMACOGENETIC RESEARCH INSTRUCTIONS
The question "Has informed consent been obtained for PGx-Pharmacogenetic research?" should be completed at the beginning of the study. If the question is answered No, I/ one box for reason and do not complete the remainder of the page. WITHDRAWAL OF CONSENT The question "Has the subject withdrawn consent for PGx-Pharmacogenetic research?" must be completed immediately if the subject withdraws consent. Otherwise, it must be completed when the subject leaves the study. It must be completed for all subjects for whom informed consent was obtained for PGx-Pharmacogenetic research. If consent is withdrawn, a request for destruction must be made and Blood Sample Destruction section below completed. BLOOD SAMPLE DESTRUCT/ON Do not complete this section if a blood sample was not collected. The question "Has a request been made for sample destruction?" must be completed immediately if there is a request for sample destruction. Otherwise, it must be completed when the subject leaves the study. It must be completed for all subjects for whom a blood sample was obtained for PGx-Pharmacogenetic research. If the question is answered Yes, I/one box for reason.
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PGx-PHARMACOGENETIC RESEARCH
CONSENT FOR PGx-PHARMACOGENETIC RESEARCH
boolean
Informed consent if yes
date
Informed consent if no
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BLOOD SAMPLE COLLECTION
boolean
If Yes, record the date sample taken
date
WITHDRAWAL OF CONSENT
boolean
BLOOD SAMPLE DESTRUCTION
boolean
If Yes: BLOOD SAMPLE DESTRUCTION
integer
The following lists of abbreviations are examples which can be used to aid the completion of the appropriate items on the Concomitant Medications page. These are not all inclusive lists and are for guidance only, other abbreviations not listed may be used if necessary.
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UNITS
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