ID

43224

Description

AMC-052 Serum HPV Antibody Collection and Shipping Form Human Papillomavirus Vaccine Therapy in Treating Men With HIV-1 Infection NCT00513526 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=546E2EAC-07C0-32E8-E044-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=546E2EAC-07C0-32E8-E044-0003BA3F9857

Keywords

Versions (4)
  1. 9/19/12 9/19/12 -
  2. 1/16/15 1/16/15 - Martin Dugas
  3. 1/16/15 1/16/15 - Martin Dugas
  4. 9/20/21 9/20/21 -
Uploaded on

September 20, 2021

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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HPV Antibody Collection and Shipping Form (NCT00513526)

German English

Please indicate whether serum HPV antibody specimens were collected and shipped to Merck.

1 forms  
  1. StudyEvent: AMC-052 Serum HPV Antibody Collection and Shipping Form
    1. Please indicate whether serum HPV antibody specimens were collected and shipped to Merck.
Specimen Information
Description

Specimen Information

Alias
UMLS CUI-1
C0370003
Specimen ID (Merck ID BN from the specimen label Visit 0 only)
Description

SpecimenIdentifierNumber

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
NCI Thesaurus Property
C25364
NCI Thesaurus ObjectClass
C19157
UMLS CUI-1
C1299222
Visit number
Description

HospitalAdmissionOrdinalNumber

Data type

integer

Alias
NCI Thesaurus ValueDomain
C25337
NCI Thesaurus ObjectClass
C16696
NCI Thesaurus Property
C25385
UMLS CUI-1
C1549755
Were specimens obtained
Description

SpecimenCollectedInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
NCI Thesaurus ObjectClass
C19157
NCI Thesaurus Property
C25452
UMLS CUI-1
C0370003
UMLS CUI-2
C1516698
Date Obtained
Description

SpecimenCollectedDate

Data type

date

Measurement units
  • mm/dd/yyyy
Alias
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ObjectClass
C19157
NCI Thesaurus Property
C25452
NCI Thesaurus Property-2
C25275
UMLS CUI-1
C1302413
mm/dd/yyyy
Number of specimens (xx)
Description

SpecimenSubmittedCount

Data type

integer

Alias
NCI Thesaurus ValueDomain
C25463
NCI Thesaurus ObjectClass
C19157
NCI Thesaurus Property
C25695
UMLS CUI-1
C0370003
UMLS CUI-2
C0750480
Was a specimen shipped
Description

SpecimenSubmittedInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
NCI Thesaurus ObjectClass
C19157
NCI Thesaurus Property
C25695
UMLS CUI-1
C0370003
UMLS CUI-2
C1524049
Retention specimen shipped
Description

AdditionalSpecimenSubmissionInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
NCI Thesaurus ObjectClass
C25406
NCI Thesaurus ObjectClass-2
C19157
NCI Thesaurus Property
C25695
UMLS CUI-1
C1524062
UMLS CUI-2
C0370003
UMLS CUI-3
C1515023
Specify destination
Description

AdditionalSpecimenSubmissionStatus

Data type

text

Alias
NCI Thesaurus ObjectClass
C25406
NCI Thesaurus ObjectClass-2
C19157
NCI Thesaurus ValueDomain
C25688
NCI Thesaurus Property
C25695
UMLS CUI-1
C0370003
UMLS CUI-2
C0079220
Date shipped
Description

SpecimenLabSubmittedDate

Data type

date

Measurement units
  • mm/dd/yyyy
Alias
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus Property
C25294
NCI Thesaurus ObjectClass
C19157
NCI Thesaurus Property-2
C25695
UMLS CUI-1
C0370003
UMLS CUI-2
C1515023
UMLS CUI-3
C0011008
mm/dd/yyyy
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Similar models

Please indicate whether serum HPV antibody specimens were collected and shipped to Merck.

1 forms
  1. StudyEvent: AMC-052 Serum HPV Antibody Collection and Shipping Form
    1. Please indicate whether serum HPV antibody specimens were collected and shipped to Merck.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Specimen Information
C0370003 (UMLS CUI-1)
Specimen ID
Item
Specimen ID (Merck ID BN from the specimen label Visit 0 only)
text
C25337 (NCI Thesaurus ValueDomain)
C25364 (NCI Thesaurus Property)
C19157 (NCI Thesaurus ObjectClass)
C1299222 (UMLS CUI-1)
Hospital Admission Ordinal Number
Item
Visit number
integer
C25337 (NCI Thesaurus ValueDomain)
C16696 (NCI Thesaurus ObjectClass)
C25385 (NCI Thesaurus Property)
C1549755 (UMLS CUI-1)
Specimen collected
Item
Were specimens obtained
boolean
C38147 (NCI Thesaurus ValueDomain)
C19157 (NCI Thesaurus ObjectClass)
C25452 (NCI Thesaurus Property)
C0370003 (UMLS CUI-1)
C1516698 (UMLS CUI-2)
Specimen collection date
Item
Date Obtained
date
C25164 (NCI Thesaurus ValueDomain)
C19157 (NCI Thesaurus ObjectClass)
C25452 (NCI Thesaurus Property)
C25275 (NCI Thesaurus Property-2)
C1302413 (UMLS CUI-1)
Specimen Count
Item
Number of specimens (xx)
integer
C25463 (NCI Thesaurus ValueDomain)
C19157 (NCI Thesaurus ObjectClass)
C25695 (NCI Thesaurus Property)
C0370003 (UMLS CUI-1)
C0750480 (UMLS CUI-2)
Specimen shipped
Item
Was a specimen shipped
boolean
C38147 (NCI Thesaurus ValueDomain)
C19157 (NCI Thesaurus ObjectClass)
C25695 (NCI Thesaurus Property)
C0370003 (UMLS CUI-1)
C1524049 (UMLS CUI-2)
Additional Specimen submitted
Item
Retention specimen shipped
boolean
C38147 (NCI Thesaurus ValueDomain)
C25406 (NCI Thesaurus ObjectClass)
C19157 (NCI Thesaurus ObjectClass-2)
C25695 (NCI Thesaurus Property)
C1524062 (UMLS CUI-1)
C0370003 (UMLS CUI-2)
C1515023 (UMLS CUI-3)
Item
Specify destination
text
C25406 (NCI Thesaurus ObjectClass)
C19157 (NCI Thesaurus ObjectClass-2)
C25688 (NCI Thesaurus ValueDomain)
C25695 (NCI Thesaurus Property)
C0370003 (UMLS CUI-1)
C0079220 (UMLS CUI-2)
CL.4
Code List
Specify destination
CL Item
Acsr (ACSR)
CL Item
Merck And Co., Inc. (Merck)
Specimen shipping date
Item
Date shipped
date
C25164 (NCI Thesaurus ValueDomain)
C25294 (NCI Thesaurus Property)
C19157 (NCI Thesaurus ObjectClass)
C25695 (NCI Thesaurus Property-2)
C0370003 (UMLS CUI-1)
C1515023 (UMLS CUI-2)
C0011008 (UMLS CUI-3)
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