Consent for PGx-Pharmacogenetic Research (DNA)
Item
Consent for PGx-Pharmacogenetic Research (DNA)
text
Has informed consent been obtained for PGx-Pharmacigenetic research?
Item
Has informed consent been obtained for PGx-Pharmacigenetic research?
boolean
If YES, record the date informed consent obtained for PGx-Pharmacogenetic research
Item
If YES, record the date informed consent obtained for PGx-Pharmacogenetic research
date
Item
If NO, mark one reason:
text
Code List
If NO, mark one reason:
CL Item
[1] Subject declined (1)
CL Item
[2] Subject not asked by Investigator (2)
CL Item
[Z] Other, specify__________________________ (3)
Has a blood sample been collected for PGx-Pharmacocinetic research?
Item
Has a blood sample been collected for PGx-Pharmacocinetic research?
boolean
If YES, record the date sample taken
Item
If YES, record the date sample taken
date
Has subject withdrawn consent for PGx-Pharmacogenetic research?
Item
Has subject withdrawn consent for PGx-Pharmacogenetic research?
boolean
Has a request been made for blood sample destruction?
Item
Has a request been made for blood sample destruction?
boolean
Item
If YES, mark one reason:
text
Code List
If YES, mark one reason:
CL Item
[1] Subject requested (1)
CL Item
[2] Screen failure (2)
CL Item
[Z] Other, specify________________________ (3)