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- StudyEvent: AMC-059 AIDS and Cancer Specimen Resource (ACSR) Procurement Form (F37)
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Hospital Admission Number
Item
Visit number
text
C25337 (NCI Thesaurus ValueDomain)
C16696 (NCI Thesaurus ObjectClass)
C25385 (NCI Thesaurus Property)
C1549755 (UMLS CUI [1])
C16696 (NCI Thesaurus ObjectClass)
C25385 (NCI Thesaurus Property)
C1549755 (UMLS CUI [1])
Research Comments
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0947611 (UMLS CUI [1])
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0947611 (UMLS CUI [1])
Study Coordinator
Item
Study Coordinator's name
text
C25191 (NCI Thesaurus ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C19707 (NCI Thesaurus ObjectClass-2)
C51880 (NCI Thesaurus Property)
C1710220 (UMLS CUI [1])
C25190 (NCI Thesaurus ObjectClass)
C19707 (NCI Thesaurus ObjectClass-2)
C51880 (NCI Thesaurus Property)
C1710220 (UMLS CUI [1])
Email
Item
E-mail
text
C25704 (NCI Thesaurus ValueDomain)
C25657 (NCI Thesaurus ObjectClass)
C42775 (NCI Thesaurus Property)
C0013849 (UMLS CUI [1])
C25657 (NCI Thesaurus ObjectClass)
C42775 (NCI Thesaurus Property)
C0013849 (UMLS CUI [1])
Organization Phone Number
Item
Phone number
text
C25337 (NCI Thesaurus ValueDomain)
C25395 (NCI Thesaurus Property)
C19711 (NCI Thesaurus ObjectClass)
C0039457 (UMLS CUI [1])
C25395 (NCI Thesaurus Property)
C19711 (NCI Thesaurus ObjectClass)
C0039457 (UMLS CUI [1])
Specimen donation
Item
Specimen(s) obtained for donation to ACSR
boolean
C38147 (NCI Thesaurus ValueDomain)
C19157 (NCI Thesaurus ObjectClass)
C19707 (NCI Thesaurus ObjectClass-2)
C54153 (NCI Thesaurus Property)
C0080231 (UMLS CUI [1])
C19157 (NCI Thesaurus ObjectClass)
C19707 (NCI Thesaurus ObjectClass-2)
C54153 (NCI Thesaurus Property)
C0080231 (UMLS CUI [1])
Item
Specimen Type (check all that apply)
text
C25284 (NCI Thesaurus ValueDomain)
C19157 (NCI Thesaurus ObjectClass)
C25695 (NCI Thesaurus Property)
C0456204 (UMLS CUI [1])
C19157 (NCI Thesaurus ObjectClass)
C25695 (NCI Thesaurus Property)
C0456204 (UMLS CUI [1])
CL Item
Serum (Serum)
C13325 (NCI Thesaurus)
C13325 (NCI Thesaurus-3)
C0229671 (UMLS CUI-1)
(Comment:en)
C13325 (NCI Thesaurus-3)
C0229671 (UMLS CUI-1)
(Comment:en)
CL Item
Plasma (Plasma)
C13356 (NCI Thesaurus)
C13356 (NCI Thesaurus-3)
C0032105 (UMLS CUI-1)
(Comment:en)
C13356 (NCI Thesaurus-3)
C0032105 (UMLS CUI-1)
(Comment:en)
CL Item
Peripheral Blood Mononuclear Cells (PBMC)
C1321301 (UMLS CUI-1)
(Comment:en)
(Comment:en)
CL Item
Peripheral Blood (Blood)
C0229664 (NCI Metathesaurus)
C0229664 (NCI Metathesaurus-2)
C0229664 (UMLS CUI-1)
(Comment:en)
C0229664 (NCI Metathesaurus-2)
C0229664 (UMLS CUI-1)
(Comment:en)
CL Item
Tissue (Tissue)
C12801 (NCI Thesaurus)
C0040300 (UMLS CUI-1)
(Comment:en)
C0040300 (UMLS CUI-1)
(Comment:en)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS CUI-1)
(Comment:en)
C0205394 (UMLS CUI-1)
(Comment:en)
Specimen Cell Source
Item
Other specify
text
C25685 (NCI Thesaurus ValueDomain)
C12508 (NCI Thesaurus Property)
C25683 (NCI Thesaurus Property-2)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS CUI [1,1])
C0449416 (UMLS CUI [1,2])
C12508 (NCI Thesaurus Property)
C25683 (NCI Thesaurus Property-2)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS CUI [1,1])
C0449416 (UMLS CUI [1,2])
Item
ACSR site the specimen(s) shipped to
integer
C25284 (NCI Thesaurus ValueDomain)
C19157 (NCI Thesaurus ObjectClass)
C19707 (NCI Thesaurus ObjectClass-2)
C54153 (NCI Thesaurus Property)
C1515830 (UMLS CUI [1,1])
C1524049 (UMLS CUI [1,2])
C19157 (NCI Thesaurus ObjectClass)
C19707 (NCI Thesaurus ObjectClass-2)
C54153 (NCI Thesaurus Property)
C1515830 (UMLS CUI [1,1])
C1524049 (UMLS CUI [1,2])
CL Item
GWU (1)
CL Item
UCLA (2)
CL Item
UCSF (3)
CL Item
OSU (4)
CL Item
SUNY/HSCB (5)
CL Item
JHU (6)
CL Item
Other (7)
ACSR site
Item
Other, specify
text
C25685 (NCI Thesaurus ValueDomain)
C19157 (NCI Thesaurus ObjectClass)
C19707 (NCI Thesaurus ObjectClass-2)
C54153 (NCI Thesaurus Property)
C1515830 (UMLS CUI [1,1])
C1524049 (UMLS CUI [1,2])
C19157 (NCI Thesaurus ObjectClass)
C19707 (NCI Thesaurus ObjectClass-2)
C54153 (NCI Thesaurus Property)
C1515830 (UMLS CUI [1,1])
C1524049 (UMLS CUI [1,2])
Item
If specimens were not obtained for ACSR, please indicate reason
text
C19157 (NCI Thesaurus ObjectClass)
C19707 (NCI Thesaurus ObjectClass-2)
C25594 (NCI Thesaurus Property)
C25695 (NCI Thesaurus Property-2)
C25638 (NCI Thesaurus ValueDomain)
C0566251 (UMLS CUI [1,1])
C3640292 (UMLS CUI [1,2])
C19707 (NCI Thesaurus ObjectClass-2)
C25594 (NCI Thesaurus Property)
C25695 (NCI Thesaurus Property-2)
C25638 (NCI Thesaurus ValueDomain)
C0566251 (UMLS CUI [1,1])
C3640292 (UMLS CUI [1,2])
CL Item
Patient Was Not Asked To Consider ACSR Specimen Donation (not asked)
C1548670 (UMLS CUI-1)
(Comment:en)
(Comment:en)
CL Item
Patient Refused To Give Informed Consent For Acsr Specimen Donation (Patient refused)
C1705116 (UMLS CUI-1)
(Comment:en)
(Comment:en)
CL Item
Patient Had Previously Donated Specimen To Acsr (previous donation)
C0013018 (UMLS CUI-1)
C0332152 (UMLS CUI-2)
(Comment:en)
C0332152 (UMLS CUI-2)
(Comment:en)
CL Item
Other (other)
C0205394 (UMLS CUI-1)
(Comment:en)
(Comment:en)
reason not submitted
Item
Other, specify
text
C19157 (NCI Thesaurus ObjectClass)
C19707 (NCI Thesaurus ObjectClass-2)
C25594 (NCI Thesaurus Property)
C25695 (NCI Thesaurus Property-2)
C25685 (NCI Thesaurus ValueDomain)
C0566251 (UMLS CUI [1,1])
C3640292 (UMLS CUI [1,2])
C19707 (NCI Thesaurus ObjectClass-2)
C25594 (NCI Thesaurus Property)
C25695 (NCI Thesaurus Property-2)
C25685 (NCI Thesaurus ValueDomain)
C0566251 (UMLS CUI [1,1])
C3640292 (UMLS CUI [1,2])
Specimen collection date
Item
Date Specimen Obtained (for previously donated specimens)
date
C25164 (NCI Thesaurus ValueDomain)
C19157 (NCI Thesaurus ObjectClass)
C25452 (NCI Thesaurus Property)
C25275 (NCI Thesaurus Property-2)
C1302413 (UMLS CUI [1])
C19157 (NCI Thesaurus ObjectClass)
C25452 (NCI Thesaurus Property)
C25275 (NCI Thesaurus Property-2)
C1302413 (UMLS CUI [1])