Engelsk

Pharmacogenetics Research Consent Form

1 Formulär  
Administrative data
Beskrivning

Administrative data

Site
Beskrivning

Site

Datatyp

text

Patient
Beskrivning

Patient

Datatyp

text

Patient Number
Beskrivning

Patient Number

Datatyp

integer

Date of Visit/Assessment
Beskrivning

Date of Visit/Assessment

Datatyp

date

Date of Visit/Assessment
Beskrivning

Date of Visit/Assessment

Date
Beskrivning

Date

Datatyp

date

PGx Research Consent
Beskrivning

PGx Research Consent

Has informed consent been obtained for PGx-Pharmacogenetic research?
Beskrivning

Has informed consent been obtained for PGx-Pharmacogenetic research?

Datatyp

boolean

If YES, record date informed consent obtained for PGx-Pharmacogenetic research
Beskrivning

If YES, record date informed consent obtained for PGx-Pharmacogenetic research

Datatyp

date

Has a blood sample been collected for PGx-Pharmacogenetic (DNA) research
Beskrivning

Has a blood sample been collected for PGx-Pharmacogenetic (DNA) research

Datatyp

boolean

If YES, record date sample taken
Beskrivning

If YES, record date sample taken

Datatyp

date

If NO informed consent obtained, check reason
Beskrivning

If NO informed consent obtained, check reason

Datatyp

text

If Other, specify
Beskrivning

If Other, specify

Datatyp

text

Genetics Type
Beskrivning

Genetics Type

Datatyp

text

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Similar models

Pharmacogenetics Research Consent Form

1 Formulär
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
Administrative data
Site
Item
Site
text
Patient
Item
Patient
text
Patient Number
Item
Patient Number
integer
Date of Visit/Assessment
Item
Date of Visit/Assessment
date
Item Group
Date of Visit/Assessment
Date
Item
Date
date
Item Group
PGx Research Consent
Has informed consent been obtained for PGx-Pharmacogenetic research?
Item
Has informed consent been obtained for PGx-Pharmacogenetic research?
boolean
If YES, record date informed consent obtained for PGx-Pharmacogenetic research
Item
If YES, record date informed consent obtained for PGx-Pharmacogenetic research
date
Has a blood sample been collected for PGx-Pharmacogenetic (DNA) research
Item
Has a blood sample been collected for PGx-Pharmacogenetic (DNA) research
boolean
If YES, record date sample taken
Item
If YES, record date sample taken
date
Item
If NO informed consent obtained, check reason
text
If NO informed consent obtained, check reason
Code List
If NO informed consent obtained, check reason
CL Item
Subject declined (1)
CL Item
Subject not asked by Investigator (2)
CL Item
Other (3)
If Other, specify
Item
If Other, specify
text
Genetics Type
Item
Genetics Type
text
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