Subject Screening No.
Item
Subject Screening number
integer
C0220908 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
Subject Number
Item
Subject no.
integer
C2348585 (UMLS CUI [1])
Item
Study Visit
text
C0545082 (UMLS CUI [1])
CL Item
Treatment Period 1 (Treatment Period 1)
CL Item
Treatment Period 2 (Treatment Period 2)
CL Item
Treatment Period 3 (Treatment Period 3)
Informed Consent Pharmacogenetic Test
Item
Has informed consent been obtained for Pharmacogenetic research?
boolean
C2347500 (UMLS CUI [1,1])
C0021430 (UMLS CUI [1,2])
Informed Consent Date Pharmacogenetic Tests
Item
Date consent obtained for Pharmacogenetic research:
date
C2985782 (UMLS CUI [1,1])
C2347500 (UMLS CUI [1,2])
Item
Reason for not obtaining informed consent
integer
C0392360 (UMLS CUI [1,1])
C0021430 (UMLS CUI [1,2])
C2347500 (UMLS CUI [1,3])
C1882120 (UMLS CUI [1,4])
Code List
Reason for not obtaining informed consent
CL Item
Subject declined (1)
CL Item
Subject not asked by Investigator (2)
CL Item
Other, specify (3)
Other Reason for not Obatining Informed Consent for Pharmacogenetic Tests
Item
Specify the reason for not obtaining informed consent for pharmacogenetic tests
text
C0392360 (UMLS CUI [1,1])
C0021430 (UMLS CUI [1,2])
C2347500 (UMLS CUI [1,3])
C1882120 (UMLS CUI [1,4])
Physician's Initials
Item
Physician's Initials
text
C2986440 (UMLS CUI [1,1])
C0031831 (UMLS CUI [1,2])
Sample Collected for Pharmacogenetic Tests
Item
Has a sample been collected for Pharmacogenetic research?
boolean
C0200345 (UMLS CUI [1,1])
C2347500 (UMLS CUI [1,2])
Sample Collection Date
Item
If Yes, record the date informed sample taken
date
C1302413 (UMLS CUI [1])
Clinical Staff Initials
Item
Clinical Staff Initials
text
C2986440 (UMLS CUI [1,1])
C1552089 (UMLS CUI [1,2])
Informed Consent Withdrawal
Item
Has subject withdrawn consent for Pharmacogenetic research?
boolean
C1707492 (UMLS CUI [1,1])
C2347500 (UMLS CUI [1,2])
Sample Destruction Request
Item
Has a request been made for sample destruction?
boolean
C1948029 (UMLS CUI [1,1])
C0178913 (UMLS CUI [1,2])
C1272683 (UMLS CUI [1,3])
Item
If yes, tick one reason
integer
C1948029 (UMLS CUI [1,1])
C0178913 (UMLS CUI [1,2])
C1272683 (UMLS CUI [1,3])
C0392360 (UMLS CUI [1,4])
Code List
If yes, tick one reason
CL Item
Subject requested (1)
CL Item
Screen failure (2)
CL Item
Other, specify (3)
Other Reason for Sample Destruction Request
Item
Specify the other reason for sample destruction request
text
C1948029 (UMLS CUI [1,1])
C0178913 (UMLS CUI [1,2])
C1272683 (UMLS CUI [1,3])
C0392360 (UMLS CUI [1,4])
C0205394 (UMLS CUI [1,5])
Clinical Staff Initials
Item
Clinical Staff Initials
text
C2986440 (UMLS CUI [1,1])
C1552089 (UMLS CUI [1,2])