Engelsk

Hematology (treatment period)

1 Formulär  
Administrative Data
Beskrivning

Administrative Data

Alias
UMLS CUI-1
C1320722
Site #
Beskrivning

Study centre number

Datatyp

integer

Alias
UMLS CUI [1,1]
C0600091
UMLS CUI [1,2]
C0019994
Patient #
Beskrivning

patient ID

Datatyp

integer

Alias
UMLS CUI [1]
C2348585
Visit Date
Beskrivning

visit date

Datatyp

date

Alias
UMLS CUI [1]
C1320303
Investigator Name
Beskrivning

Investigator Name

Datatyp

text

Alias
UMLS CUI [1]
C2826892
Check if (additional) supplemental instance of this form was used.
Beskrivning

Use one instance for every three lab result sets. Check this box on all instances except for the last one.

Datatyp

boolean

Alias
UMLS CUI [1]
C1706499
Instance Number
Beskrivning

Fill in the instance number, starting from 1. On all instances except for the last one, the preceding box has to be checked.

Datatyp

text

Alias
UMLS CUI [1,1]
C1516308
UMLS CUI [1,2]
C2348184
N/A
Beskrivning

Only for supplemental instances

Datatyp

boolean

Alias
UMLS CUI [1]
C1272460
Hematology
Beskrivning

Hematology

Alias
UMLS CUI-1
C0474523
Date:
Beskrivning

(dd-mmm-yyyy)

Datatyp

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0018941
Time:
Beskrivning

(0000-2359)

Datatyp

time

Alias
UMLS CUI [1,1]
C0040223
UMLS CUI [1,2]
C0018941
Not Done
Beskrivning

Laboratory procedures not performed - hematology

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0022885
UMLS CUI [1,2]
C0445106
UMLS CUI [1,3]
C0474523
Laboratory Name:
Beskrivning

(Lab name must match name on lab normals.)

Datatyp

text

Alias
UMLS CUI [1,1]
C3258037
UMLS CUI [1,2]
C0474523
Check to indicate copy of associated lab report for each draw is attached to CRF.
Beskrivning

Copy of hematology report attached

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0684224
UMLS CUI [1,2]
C0474523
Hemoglobin - Result
Beskrivning

(numeric value only)

Datatyp

float

Alias
UMLS CUI [1]
C0518015
Hemoglobin - Clinically Significant
Beskrivning

Hemoglobin measurement - clinical significance

Datatyp

text

Alias
UMLS CUI [1,1]
C0518015
UMLS CUI [1,2]
C2826293
Hemoglobin - If clinically significant, please comment
Beskrivning

Hemoglobin measurement - comment

Datatyp

text

Alias
UMLS CUI [1,1]
C0518015
UMLS CUI [1,2]
C0947611
Hematocrit - Result
Beskrivning

(numeric value only)

Datatyp

float

Alias
UMLS CUI [1]
C0518014
Hematocrit - Clinically Significant
Beskrivning

Hematocrit measurement - clinical significance

Datatyp

text

Alias
UMLS CUI [1,1]
C0518014
UMLS CUI [1,2]
C2826293
Hematocrit - If clinically significant, please comment
Beskrivning

Hematocrit measurement - comment

Datatyp

text

Alias
UMLS CUI [1,1]
C0518014
UMLS CUI [1,2]
C0947611
Platelets - Result
Beskrivning

(numeric value only)

Datatyp

float

Alias
UMLS CUI [1]
C0032181
Platelets - Clinically Significant
Beskrivning

Platelet count - clinical significance

Datatyp

text

Alias
UMLS CUI [1,1]
C0032181
UMLS CUI [1,2]
C2826293
Platelets - If clinically significant, please comment
Beskrivning

Platelet count - comment

Datatyp

text

Alias
UMLS CUI [1,1]
C0032181
UMLS CUI [1,2]
C0947611
WBC - Result
Beskrivning

(numeric value only)

Datatyp

float

Alias
UMLS CUI [1]
C0023508
WBC - Clincally Significant
Beskrivning

WBC count - clinical significance

Datatyp

text

Alias
UMLS CUI [1,1]
C0023508
UMLS CUI [1,2]
C2826293
WBC - If clinically significant, please comment
Beskrivning

WBC count - comment

Datatyp

text

Alias
UMLS CUI [1,1]
C0023508
UMLS CUI [1,2]
C0947611
Other - Specify:
Beskrivning

(specify test name)

Datatyp

text

Alias
UMLS CUI [1,1]
C0205394
UMLS CUI [1,2]
C0474523
UMLS CUI [1,3]
C1521902
Other - Result
Beskrivning

(numeric value only)

Datatyp

float

Alias
UMLS CUI [1,1]
C0205394
UMLS CUI [1,2]
C0474523
Other - Clincally Significant
Beskrivning

Other hematologic test - clinical significance

Datatyp

text

Alias
UMLS CUI [1,1]
C0205394
UMLS CUI [1,2]
C0474523
UMLS CUI [1,3]
C2826293
Other - If clinically significant, please comment
Beskrivning

Other hematologic test - comment

Datatyp

text

Alias
UMLS CUI [1,1]
C0205394
UMLS CUI [1,2]
C0474523
UMLS CUI [1,3]
C0947611
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Similar models

Hematology (treatment period)

1 Formulär
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
Administrative Data
C1320722 (UMLS CUI-1)
Study centre number
Item
Site #
integer
C0600091 (UMLS CUI [1,1])
C0019994 (UMLS CUI [1,2])
patient ID
Item
Patient #
integer
C2348585 (UMLS CUI [1])
visit date
Item
Visit Date
date
C1320303 (UMLS CUI [1])
Investigator Name
Item
Investigator Name
text
C2826892 (UMLS CUI [1])
Additional form
Item
Check if (additional) supplemental instance of this form was used.
boolean
C1706499 (UMLS CUI [1])
CRF Sequential Number
Item
Instance Number
text
C1516308 (UMLS CUI [1,1])
C2348184 (UMLS CUI [1,2])
N/A
Item
N/A
boolean
C1272460 (UMLS CUI [1])
Item Group
Hematology
C0474523 (UMLS CUI-1)
Date of hematologic test
Item
Date:
date
C0011008 (UMLS CUI [1,1])
C0018941 (UMLS CUI [1,2])
Time of hematologic test
Item
Time:
time
C0040223 (UMLS CUI [1,1])
C0018941 (UMLS CUI [1,2])
Laboratory procedures not performed - hematology
Item
Not Done
boolean
C0022885 (UMLS CUI [1,1])
C0445106 (UMLS CUI [1,2])
C0474523 (UMLS CUI [1,3])
Laboratory name - hematology
Item
Laboratory Name:
text
C3258037 (UMLS CUI [1,1])
C0474523 (UMLS CUI [1,2])
Copy of hematology report attached
Item
Check to indicate copy of associated lab report for each draw is attached to CRF.
boolean
C0684224 (UMLS CUI [1,1])
C0474523 (UMLS CUI [1,2])
Hemoglobin measurement
Item
Hemoglobin - Result
float
C0518015 (UMLS CUI [1])
Item
Hemoglobin - Clinically Significant
text
C0518015 (UMLS CUI [1,1])
C2826293 (UMLS CUI [1,2])
Laboratory procedures not performed - hematology
Code List
Hemoglobin - Clinically Significant
CL Item
Yes (Yes)
CL Item
No (No)
Hemoglobin measurement - comment
Item
Hemoglobin - If clinically significant, please comment
text
C0518015 (UMLS CUI [1,1])
C0947611 (UMLS CUI [1,2])
Hematocrit measurement
Item
Hematocrit - Result
float
C0518014 (UMLS CUI [1])
Item
Hematocrit - Clinically Significant
text
C0518014 (UMLS CUI [1,1])
C2826293 (UMLS CUI [1,2])
Laboratory procedures not performed - hematology
Code List
Hematocrit - Clinically Significant
CL Item
Yes (Yes)
CL Item
No (No)
Hematocrit measurement - comment
Item
Hematocrit - If clinically significant, please comment
text
C0518014 (UMLS CUI [1,1])
C0947611 (UMLS CUI [1,2])
Platelet count
Item
Platelets - Result
float
C0032181 (UMLS CUI [1])
Item
Platelets - Clinically Significant
text
C0032181 (UMLS CUI [1,1])
C2826293 (UMLS CUI [1,2])
Laboratory procedures not performed - hematology
Code List
Platelets - Clinically Significant
CL Item
Yes (Yes)
CL Item
No (No)
Platelet count - comment
Item
Platelets - If clinically significant, please comment
text
C0032181 (UMLS CUI [1,1])
C0947611 (UMLS CUI [1,2])
WBC count
Item
WBC - Result
float
C0023508 (UMLS CUI [1])
Item
WBC - Clincally Significant
text
C0023508 (UMLS CUI [1,1])
C2826293 (UMLS CUI [1,2])
Laboratory procedures not performed - hematology
Code List
WBC - Clincally Significant
CL Item
Yes (Yes)
CL Item
No (No)
WBC count - comment
Item
WBC - If clinically significant, please comment
text
C0023508 (UMLS CUI [1,1])
C0947611 (UMLS CUI [1,2])
Other hematologic test - specify
Item
Other - Specify:
text
C0205394 (UMLS CUI [1,1])
C0474523 (UMLS CUI [1,2])
C1521902 (UMLS CUI [1,3])
Other hematologic test - result
Item
Other - Result
float
C0205394 (UMLS CUI [1,1])
C0474523 (UMLS CUI [1,2])
Item
Other - Clincally Significant
text
C0205394 (UMLS CUI [1,1])
C0474523 (UMLS CUI [1,2])
C2826293 (UMLS CUI [1,3])
Laboratory procedures not performed - hematology
Code List
Other - Clincally Significant
CL Item
Yes (Yes)
CL Item
No (No)
Other hematologic test - comment
Item
Other - If clinically significant, please comment
text
C0205394 (UMLS CUI [1,1])
C0474523 (UMLS CUI [1,2])
C0947611 (UMLS CUI [1,3])
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