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Informed consent

32 forms  
Informed consent
Description

Informed consent

Record ID
Description

record_id

Data type

text

INFORMED CONSENT
Description

INFORMED CONSENT

Date of enrollment
Description

ic_datenrollment

Data type

date

Informed consent
Description

Informed consent

Version signed
Description

ic_versionsigned

Data type

text

Patient agreed to be recontacted for the purpose of obtaining additional information or biomaterials
Description

ic_recontactinfbio

Data type

integer

Patient agreed to be recontacted for the purpose of obtaining informed consent for data transfer to other medical data warehouses
Description

ic_recontacticdatatrans

Data type

integer

Patient agreed to be recontacted in case scientific analysis forwarded relevant novel genetic information in the concerned family with ILD
Description

ic_recontactinmild

Data type

integer

Patient agreed to be recontacted if patient's participation in a clinical trial could be possible based on the existing data set
Description

ic_recontactparticltrial

Data type

integer

Patient agreed that the data collected/results from data analyses may be forwarded to third parties in pseudonymised or anonymised form, incl. potentially forwarding data to partners in industry.
Description

ic_forwarddata

Data type

integer

Furthermore, I also consent to my biological samples and data being forwarded to countries outside of the EU, even if the European Commission has not adopted an adequacy decision and no agreements on data protection have been officially approved or adopted. The potential risks associated with this have been explained to me (item 6d on the information sheet).
Description

ic_biosample

Data type

integer

DZL consent signed (applicable to german sites only)
Description

ic_dzlconsentsigned

Data type

integer

Participation in eurIPFreg?
Description

ic_partiipfreg

Data type

integer

eurIPFreg ID
Description

ic_ipfregid

Data type

text

Participation in a clinical trial?
Description

ic_particlintrial

Data type

integer

EUDRA CT number or clinical.trials.gov entry number
Description

ic_eudractnumber

Data type

text

Please specify the investigational product:
Description

ic_investigproduct

Data type

text

EUDRA CT number or clinical.trials.gov entry number
Description

ic_eudractnumber_2

Data type

text

Please specify the investigational product:
Description

ic_investigproduct_2

Data type

text

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Similar models

Informed consent

32 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
record_id
Item
Record ID
text
ic_datenrollment
Item
Date of enrollment
date
Item
Version signed
text
ic_versionsigned
Code List
Version signed
CL Item
Version 2.1 eurILDreg (1)
Item
Patient agreed to be recontacted for the purpose of obtaining additional information or biomaterials
integer
ic_recontactinfbio
Code List
Patient agreed to be recontacted for the purpose of obtaining additional information or biomaterials
CL Item
Yes (1)
CL Item
No (0)
Item
Patient agreed to be recontacted for the purpose of obtaining informed consent for data transfer to other medical data warehouses
integer
ic_recontacticdatatrans
Code List
Patient agreed to be recontacted for the purpose of obtaining informed consent for data transfer to other medical data warehouses
CL Item
Yes (1)
CL Item
No (0)
Item
Patient agreed to be recontacted in case scientific analysis forwarded relevant novel genetic information in the concerned family with ILD
integer
ic_recontactinmild
Code List
Patient agreed to be recontacted in case scientific analysis forwarded relevant novel genetic information in the concerned family with ILD
CL Item
Yes (1)
CL Item
No (0)
Item
Patient agreed to be recontacted if patient's participation in a clinical trial could be possible based on the existing data set
integer
ic_recontactparticltrial
Code List
Patient agreed to be recontacted if patient's participation in a clinical trial could be possible based on the existing data set
CL Item
Yes (1)
CL Item
No (0)
Item
Patient agreed that the data collected/results from data analyses may be forwarded to third parties in pseudonymised or anonymised form, incl. potentially forwarding data to partners in industry.
integer
ic_forwarddata
Code List
Patient agreed that the data collected/results from data analyses may be forwarded to third parties in pseudonymised or anonymised form, incl. potentially forwarding data to partners in industry.
CL Item
Yes (1)
CL Item
No (0)
Item
Furthermore, I also consent to my biological samples and data being forwarded to countries outside of the EU, even if the European Commission has not adopted an adequacy decision and no agreements on data protection have been officially approved or adopted. The potential risks associated with this have been explained to me (item 6d on the information sheet).
integer
ic_biosample
Code List
Furthermore, I also consent to my biological samples and data being forwarded to countries outside of the EU, even if the European Commission has not adopted an adequacy decision and no agreements on data protection have been officially approved or adopted. The potential risks associated with this have been explained to me (item 6d on the information sheet).
CL Item
Yes (1)
CL Item
No (0)
Item
DZL consent signed (applicable to german sites only)
integer
ic_dzlconsentsigned
Code List
DZL consent signed (applicable to german sites only)
CL Item
Yes (1)
CL Item
No (0)
Item
Participation in eurIPFreg?
integer
ic_partiipfreg
Code List
Participation in eurIPFreg?
CL Item
Yes (1)
CL Item
No (0)
ic_ipfregid
Item
eurIPFreg ID
text
Item
Participation in a clinical trial?
integer
ic_particlintrial
Code List
Participation in a clinical trial?
CL Item
Yes (1)
CL Item
No (0)
ic_eudractnumber
Item
EUDRA CT number or clinical.trials.gov entry number
text
ic_investigproduct
Item
Please specify the investigational product:
text
ic_eudractnumber_2
Item
EUDRA CT number or clinical.trials.gov entry number
text
ic_investigproduct_2
Item
Please specify the investigational product:
text
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