Engelsk

Pharmacogenetics Research Consent Withdrawal

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 Withdrawal of Consent
Beskrivning

PGx Research Withdrawal of Consent

Has subject withdrawn consent for PGx-Pharmacogenetic research?
Beskrivning

Has subject withdrawn consent for PGx-Pharmacogenetic research?

Datatyp

boolean

Has a request been made for sample destruction?
Beskrivning

Has a request been made for sample destruction?

Datatyp

boolean

If YES, check reason
Beskrivning

If YES, check reason

Datatyp

text

If Other, specify
Beskrivning

If Other, specify

Datatyp

text

Genetic Type
Beskrivning

Genetic Type

Datatyp

text

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Similar models

Pharmacogenetics Research Consent Withdrawal

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 Withdrawal of Consent
Has subject withdrawn consent for PGx-Pharmacogenetic research?
Item
Has subject withdrawn consent for PGx-Pharmacogenetic research?
boolean
Has a request been made for sample destruction?
Item
Has a request been made for sample destruction?
boolean
Item
If YES, check reason
text
If YES, check reason
Code List
If YES, check reason
CL Item
Subject requested (1)
CL Item
Screen failure (2)
CL Item
Other (3)
If Other, specify
Item
If Other, specify
text
Genetic Type
Item
Genetic Type
text
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