English

Pharmacogenetic Research Consent Withdrawal

1 forms  
Administrative Data
Description

Administrative Data

Alias
UMLS CUI-1
C1320722
Date of Visit/Assessment
Description

Date of Visit/Assessment

Data type

date

Alias
UMLS CUI [1]
C1320303
UMLS CUI [2]
C2985720
Site
Description

Study site

Data type

text

Alias
UMLS CUI [1]
C2825164
Patient
Description

Patient

Data type

text

Alias
UMLS CUI [1]
C1299487
Patient No.
Description

Subject No.

Data type

text

Alias
UMLS CUI [1]
C2348585
Withdrawal of consent for PGx (DNA) sample destruction
Description

Withdrawal of consent for PGx (DNA) sample destruction

Alias
UMLS CUI-1
C1707492
UMLS CUI-2
C0031325
UMLS CUI-3
C0035168
UMLS CUI-4
C1948029
UMLS CUI-5
C0444245
Has subject withdrawn consent for PGx research?
Description

If yes, record date

Data type

boolean

Alias
UMLS CUI [1,1]
C1707492
UMLS CUI [1,2]
C0031325
UMLS CUI [1,3]
C0035168
Date informed consent withdrawn
Description

If applicable

Data type

date

Alias
UMLS CUI [1,1]
C1707492
UMLS CUI [1,2]
C0031325
UMLS CUI [1,3]
C0035168
UMLS CUI [1,4]
C0011008
Has a request been made for sample destruction?
Description

If yes, record reason below

Data type

boolean

Alias
UMLS CUI [1,1]
C1272683
UMLS CUI [1,2]
C1948029
UMLS CUI [1,3]
C0444245
Check reason
Description

If other reason, specify below

Data type

text

Alias
UMLS CUI [1,1]
C0566251
UMLS CUI [1,2]
C1272683
UMLS CUI [1,3]
C1948029
UMLS CUI [1,4]
C0444245
Other reason, specify
Description

if applicable

Data type

text

Alias
UMLS CUI [1,1]
C1521902
UMLS CUI [1,2]
C3840932
UMLS CUI [1,3]
C1272683
UMLS CUI [1,4]
C1948029
UMLS CUI [1,5]
C0444245
Back to the top of the page

Similar models

Pharmacogenetic Research Consent Withdrawal

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Administrative Data
C1320722 (UMLS CUI-1)
Date of Visit/Assessment
Item
Date of Visit/Assessment
date
C1320303 (UMLS CUI [1])
C2985720 (UMLS CUI [2])
Study site
Item
Site
text
C2825164 (UMLS CUI [1])
Patient
Item
Patient
text
C1299487 (UMLS CUI [1])
Subject No.
Item
Patient No.
text
C2348585 (UMLS CUI [1])
Item Group
Withdrawal of consent for PGx (DNA) sample destruction
C1707492 (UMLS CUI-1)
C0031325 (UMLS CUI-2)
C0035168 (UMLS CUI-3)
C1948029 (UMLS CUI-4)
C0444245 (UMLS CUI-5)
Consent withdrawn for pharmacogenetic research?
Item
Has subject withdrawn consent for PGx research?
boolean
C1707492 (UMLS CUI [1,1])
C0031325 (UMLS CUI [1,2])
C0035168 (UMLS CUI [1,3])
Date consent withdrawn for pharmacogenetic research
Item
Date informed consent withdrawn
date
C1707492 (UMLS CUI [1,1])
C0031325 (UMLS CUI [1,2])
C0035168 (UMLS CUI [1,3])
C0011008 (UMLS CUI [1,4])
Request for DNA sample destruction?
Item
Has a request been made for sample destruction?
boolean
C1272683 (UMLS CUI [1,1])
C1948029 (UMLS CUI [1,2])
C0444245 (UMLS CUI [1,3])
Item
Check reason
text
C0566251 (UMLS CUI [1,1])
C1272683 (UMLS CUI [1,2])
C1948029 (UMLS CUI [1,3])
C0444245 (UMLS CUI [1,4])
If a request has been made for sample destruction check reason
Code List
Check reason
CL Item
Subject withdrew consent for PGx (Subject withdrew consent for PGx)
CL Item
Screen failure (Screen failure)
CL Item
Other, specify (Other, specify)
Specify other reason request made for DNA sample destruction
Item
Other reason, specify
text
C1521902 (UMLS CUI [1,1])
C3840932 (UMLS CUI [1,2])
C1272683 (UMLS CUI [1,3])
C1948029 (UMLS CUI [1,4])
C0444245 (UMLS CUI [1,5])
Back to the top of the page