Inglés

Pharmacogenetic Research

1 formularios  
Administrative Data
Descripción

Administrative Data

Alias
UMLS CUI-1
C1320722
date of visit/assessment
Descripción

date of visit/assessment

Tipo de datos

date

Alias
UMLS CUI [1]
C1320303
UMLS CUI [2]
C2985720
subject number
Descripción

subject ID

Tipo de datos

text

Alias
UMLS CUI [1]
C2348585
Pharmacogenetic (PGx) Research Consent/Blood Sample Collection
Descripción

Pharmacogenetic (PGx) Research Consent/Blood Sample Collection

Alias
UMLS CUI-1
C2347500
UMLS CUI-2
C0021430
UMLS CUI-3
C0005834
Has informed consent been obtained for PGx research?
Descripción

Informed consent for PGx research

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0021430
UMLS CUI [1,2]
C2347500
If yes, record Date informed consent obtained for PGx research
Descripción

Informed consent for PGx research, Date

Tipo de datos

date

Alias
UMLS CUI [1,1]
C0021430
UMLS CUI [1,2]
C2347500
UMLS CUI [1,3]
C0011008
Has blood sample been collected for PGx research?
Descripción

Blood sample for PGx research

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0005834
UMLS CUI [1,2]
C2347500
If yes, record Date sample taken
Descripción

Blood sample for PGx research, Date sample taken

Tipo de datos

date

Alias
UMLS CUI [1,1]
C0005834
UMLS CUI [1,2]
C2347500
UMLS CUI [1,3]
C1302413
If no, check reason
Descripción

No informed consent for PGx research, reason

Tipo de datos

text

Alias
UMLS CUI [1,1]
C1298908
UMLS CUI [1,2]
C0021430
UMLS CUI [1,3]
C2347500
UMLS CUI [1,4]
C0566251
If other, specify
Descripción

No informed consent for PGx research, other reason

Tipo de datos

text

Alias
UMLS CUI [1,1]
C1298908
UMLS CUI [1,2]
C0021430
UMLS CUI [1,3]
C2347500
UMLS CUI [1,4]
C0566251
UMLS CUI [1,5]
C0205394
Sample Type
Descripción

[hidden]

Tipo de datos

text

Alias
UMLS CUI [1]
C2347029
Withdrawal of Consent for PGx (DNA) / Blood Sample Destruction
Descripción

Withdrawal of Consent for PGx (DNA) / Blood Sample Destruction

Alias
UMLS CUI-1
C1707492
UMLS CUI-2
C2347500
UMLS CUI-3
C1948029
UMLS CUI-4
C0178913
Has subject withdrawn consent for PGx research?
Descripción

Consent withdrawn for PGx research

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C1707492
UMLS CUI [1,2]
C2347500
If yes, date informed consent withdrawn
Descripción

Consent withdrawn for PGx research, Date

Tipo de datos

partialDate

Alias
UMLS CUI [1,1]
C1707492
UMLS CUI [1,2]
C2347500
UMLS CUI [1,3]
C0011008
Has a request been made for (insert sample type) sample destruction?
Descripción

Please replace 'blood' with the appropriate sample type as specified in the protocol.

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C1272683
UMLS CUI [1,2]
C1948029
UMLS CUI [1,3]
C0178913
UMLS CUI [1,4]
C2347500
If yes, check reason
Descripción

Please replace 'blood' with the appropriate sample type as specified in the protocol. Screen failure is an optional choice.

Tipo de datos

text

Alias
UMLS CUI [1,1]
C1272683
UMLS CUI [1,2]
C1948029
UMLS CUI [1,3]
C0178913
UMLS CUI [1,4]
C0566251
UMLS CUI [1,5]
C2347500
If other, specify
Descripción

Please replace 'blood' with the appropriate sample type as specified in the protocol.

Tipo de datos

text

Alias
UMLS CUI [1,1]
C1272683
UMLS CUI [1,2]
C1948029
UMLS CUI [1,3]
C0178913
UMLS CUI [1,4]
C0566251
UMLS CUI [1,5]
C0205394
UMLS CUI [1,6]
C2347500
Sample type
Descripción

[hidden]

Tipo de datos

text

Alias
UMLS CUI [1]
C2347029
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Similar models

Pharmacogenetic Research

1 formularios
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
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])
subject ID
Item
subject number
text
C2348585 (UMLS CUI [1])
Item Group
Pharmacogenetic (PGx) Research Consent/Blood Sample Collection
C2347500 (UMLS CUI-1)
C0021430 (UMLS CUI-2)
C0005834 (UMLS CUI-3)
Informed consent for PGx research
Item
Has informed consent been obtained for PGx research?
boolean
C0021430 (UMLS CUI [1,1])
C2347500 (UMLS CUI [1,2])
Informed consent for PGx research, Date
Item
If yes, record Date informed consent obtained for PGx research
date
C0021430 (UMLS CUI [1,1])
C2347500 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
Blood sample for PGx research
Item
Has blood sample been collected for PGx research?
boolean
C0005834 (UMLS CUI [1,1])
C2347500 (UMLS CUI [1,2])
Blood sample for PGx research, Date sample taken
Item
If yes, record Date sample taken
date
C0005834 (UMLS CUI [1,1])
C2347500 (UMLS CUI [1,2])
C1302413 (UMLS CUI [1,3])
Item
If no, check reason
text
C1298908 (UMLS CUI [1,1])
C0021430 (UMLS CUI [1,2])
C2347500 (UMLS CUI [1,3])
C0566251 (UMLS CUI [1,4])
No informed consent for PGx research, reason
Code List
If no, check reason
CL Item
Subject declined (1)
CL Item
Subject not asked by Investigator (2)
CL Item
Other, specify (Z)
No informed consent for PGx research, other reason
Item
If other, specify
text
C1298908 (UMLS CUI [1,1])
C0021430 (UMLS CUI [1,2])
C2347500 (UMLS CUI [1,3])
C0566251 (UMLS CUI [1,4])
C0205394 (UMLS CUI [1,5])
Sample Type
Item
Sample Type
text
C2347029 (UMLS CUI [1])
Item Group
Withdrawal of Consent for PGx (DNA) / Blood Sample Destruction
C1707492 (UMLS CUI-1)
C2347500 (UMLS CUI-2)
C1948029 (UMLS CUI-3)
C0178913 (UMLS CUI-4)
Consent withdrawn for PGx research
Item
Has subject withdrawn consent for PGx research?
boolean
C1707492 (UMLS CUI [1,1])
C2347500 (UMLS CUI [1,2])
Consent withdrawn for PGx research, Date
Item
If yes, date informed consent withdrawn
partialDate
C1707492 (UMLS CUI [1,1])
C2347500 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
Request for sample destruction
Item
Has a request been made for (insert sample type) sample destruction?
boolean
C1272683 (UMLS CUI [1,1])
C1948029 (UMLS CUI [1,2])
C0178913 (UMLS CUI [1,3])
C2347500 (UMLS CUI [1,4])
Item
If yes, check reason
text
C1272683 (UMLS CUI [1,1])
C1948029 (UMLS CUI [1,2])
C0178913 (UMLS CUI [1,3])
C0566251 (UMLS CUI [1,4])
C2347500 (UMLS CUI [1,5])
Request for sample destruction, reason
Code List
If yes, check reason
CL Item
Subject withdrew consent for PGx (3)
CL Item
Other (Z)
CL Item
Screen failure (1)
Request for sample destruction, other reason
Item
If other, specify
text
C1272683 (UMLS CUI [1,1])
C1948029 (UMLS CUI [1,2])
C0178913 (UMLS CUI [1,3])
C0566251 (UMLS CUI [1,4])
C0205394 (UMLS CUI [1,5])
C2347500 (UMLS CUI [1,6])
Sample type
Item
Sample type
text
C2347029 (UMLS CUI [1])
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