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ID
2917
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
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Versions (2)
- 9/19/12 9/19/12 -
- 9/20/17 9/20/17 -
Uploaded on
September 19, 2012
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License
Creative Commons BY-NC 3.0 Legacy
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Sarcoma, Kaposi xxx On-Study - Specimen Procurement Form - RF36 - 2267294v3.0
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- StudyEvent: Specimen Procurement Form - RF36
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- StudyEvent: Specimen Procurement Form - RF36
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
PatientInitials
Item
Patient Initials
text
Study#
Item
Study#
text
Site#
Item
Site#
text
ID#
Item
ID#
text
Cycle#
Item
Cycle #
text
Seq#
Item
Seq #
text
DateSpecimenObtained
Item
Date Specimen Obtained
text
CL Item
Yes (Yes)
CL Item
No (No)
SpecimenTypeCode
Item
Specimen Type Code
text
SpecifyOther
Item
Specify Other
text
TotalVolume(ml)
Item
Total Volume (ml)
text
Stored/ShippedCode
Item
Stored/Shipped Code
text
SpecifyOther
Item
Specify Other
text
ReasonSampleObtainedCode
Item
Reason Sample Obtained Code
text
SpecifyOther
Item
Specify Other
text
PersonResponsibleforSample(s)
Item
Person Responsible for Sample(s)
text
DateFormCompleted
Item
Date Form Completed
text