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Pharmacogenetics Research Consent Withdrawal

1 forms  
Administrative data
Description

Administrative data

Site
Description

Site

Data type

text

Patient
Description

Patient

Data type

text

Patient Number
Description

Patient Number

Data type

integer

Date of Visit/Assessment
Description

Date of Visit/Assessment

Data type

date

Date of Visit/Assessment
Description

Date of Visit/Assessment

Date
Description

Date

Data type

date

PGx Research Withdrawal of Consent
Description

PGx Research Withdrawal of Consent

Has subject withdrawn consent for PGx-Pharmacogenetic research?
Description

Has subject withdrawn consent for PGx-Pharmacogenetic research?

Data type

boolean

Has a request been made for sample destruction?
Description

Has a request been made for sample destruction?

Data type

boolean

If YES, check reason
Description

If YES, check reason

Data type

text

If Other, specify
Description

If Other, specify

Data type

text

Genetic Type
Description

Genetic Type

Data type

text

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Similar models

Pharmacogenetics Research Consent Withdrawal

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
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Has subject withdrawn consent for PGx-Pharmacogenetic research?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Has subject withdrawn consent for PGx-Pharmacogenetic research?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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