C58776 |
Other clinical trial drug device investigational off-label past 3 month indicate code |
Code indicating whether in the past 3 months the subject/participant participated in another clinical trial of an investigational or off-label use of a drug or device.
|
Proposed |
1.00 |
2018-12-11 09:49:49.0 |
Haplo Sickle Cell Enrollment Form: Segment A |
False |
Sickle Cell Disease |
Sickle Cell Disease |
|
C58915 |
Nonmicrobiologically defined infection code |
Code indicating whether infection is nonmicrobiologically defined.
|
Proposed |
1.00 |
2018-12-17 15:35:14.0 |
Infection Form (IFN) |
False |
Sickle Cell Disease |
Sickle Cell Disease |
|
C58915 |
Nonmicrobiologically defined infection code |
Code indicating whether infection is nonmicrobiologically defined.
|
Supplemental |
1.00 |
2018-12-17 15:35:14.0 |
Infection Form - Adapted from BMTCTN 15070 |
False |
Sickle Cell Disease |
Sickle Cell Disease |
|
C59088 |
Future research blood sample consent withdrawal code |
Code indicating whether or not patient withdrew consent to provide optional blood samples for future research or ancillary studies
|
Proposed |
1.00 |
2019-01-14 14:21:41.0 |
Withdrawal of Consent Form (WOC) |
False |
Sickle Cell Disease |
Sickle Cell Disease |
|
C59078 |
Pain right upper quadrant indicate code |
Code indicating whether pain in the right upper quadrant indicative of abnormal liver function is exhibited by the patient.
|
Proposed |
1.00 |
2019-01-11 14:24:51.0 |
Toxicity Form |
False |
Sickle Cell Disease |
Sickle Cell Disease |
|
C59078 |
Pain right upper quadrant indicate code |
Code indicating whether pain in the right upper quadrant indicative of abnormal liver function is exhibited by the patient.
|
Supplemental |
1.00 |
2019-01-11 14:24:51.0 |
Toxicity Form |
False |
Sickle Cell Disease |
Sickle Cell Disease |
|
C59090 |
Consent withdrawn provide study data code |
Code indicating whether patient withdrew consent to provide data for the study
|
Proposed |
1.00 |
2019-01-14 14:50:45.0 |
Withdrawal of Consent Form (WOC) |
False |
Sickle Cell Disease |
Sickle Cell Disease |
|
C59091 |
Urine sample research consent withdrawal code |
Code indicating whether patient withdrew consent to provide optional urine samples for research or ancillary studies
|
Proposed |
1.00 |
2019-01-14 14:55:10.0 |
Withdrawal of Consent Form (WOC) |
False |
Sickle Cell Disease |
Sickle Cell Disease |
|
C59087 |
Investigational study drug consent withdrawal code |
Code indicating whether patient's consent to investigational study drug was withdrawn
|
Proposed |
1.00 |
2019-01-14 14:17:21.0 |
Withdrawal of Consent Form (WOC) |
False |
Sickle Cell Disease |
Sickle Cell Disease |
|
C59326 |
Prescription medication obtain refill last 6 month indicate code |
Code indicating whether prescription medications were obtained or refilled for the subject/participant in the last 6 months.
|
Proposed |
1.00 |
2019-04-01 11:19:28.0 |
PhenX Toolkit: Quality of Care - Children |
False |
Sickle Cell Disease |
Sickle Cell Disease |
|
C59288 |
Obtain attempt special therapy child last 6 month indicate code |
Code indicating whether special therapy was obtained or attempted to be obtained for the child in the last 6 months.
|
Proposed |
1.00 |
2019-03-29 09:15:44.0 |
PhenX Toolkit: Quality of Care - Children |
False |
Sickle Cell Disease |
Sickle Cell Disease |
|
C59285 |
Obtain attempt specialized medical equipment child last 6 month indicate code |
Code indicating whether specialized medical equipment or devices were obtained or attempted to be obtained for the child in the last 6 months.
|
Proposed |
1.00 |
2019-03-29 09:15:44.0 |
PhenX Toolkit: Quality of Care - Children |
False |
Sickle Cell Disease |
Sickle Cell Disease |
|
C59602 |
Hemophilia indicator code |
Code indicating whether subject/participant has hemophilia.
|
Proposed |
1.00 |
2019-04-15 13:19:19.0 |
PhenX Protocol: Complete Blood Count (CBC) |
False |
Sickle Cell Disease |
Sickle Cell Disease |
|
C59299 |
Gender code |
Code indicating whether subject/participant is male, female, unsure, or refused to answer.
|
Proposed |
1.00 |
2019-03-29 12:26:21.0 |
PhenX Toolkit: Quality of Care - Children |
False |
Sickle Cell Disease |
Sickle Cell Disease |
|
C59299 |
Gender code |
Code indicating whether subject/participant is male, female, unsure, or refused to answer.
|
Proposed |
1.00 |
2019-03-29 12:26:21.0 |
PhenX Toolkit: Gender Data Collection Worksheet |
False |
Sickle Cell Disease |
Sickle Cell Disease |
|
C59603 |
Cancer chemotherapy four week code |
Code indicating whether subject/participant received cancer chemotherapy in the past four weeks or anticipates such therapy in the next four weeks.
|
Proposed |
1.00 |
2019-04-15 14:26:51.0 |
PhenX Protocol: Complete Blood Count (CBC) |
False |
Sickle Cell Disease |
Sickle Cell Disease |
|
C59296 |
Child have personal physician indicate code |
Code indicating whether the child has a personal physician
|
Proposed |
1.00 |
2019-03-29 10:08:55.0 |
PhenX Toolkit: Quality of Care - Children |
False |
Sickle Cell Disease |
Sickle Cell Disease |
|
C59311 |
Child medical behavioral other health condition persist 3 month indicate code |
Code indicating whether the child has any medical, behavioral, or other health conditions that have persisted for 3 months or longer
|
Proposed |
1.00 |
2019-04-01 09:49:52.0 |
PhenX Toolkit: Quality of Care - Children |
False |
Sickle Cell Disease |
Sickle Cell Disease |
|
C59306 |
Child able talk about health care indicate code |
Code indicating whether the child is able to talk to doctors about his or her health care
|
Proposed |
1.00 |
2019-04-01 09:24:49.0 |
PhenX Toolkit: Quality of Care - Children |
False |
Sickle Cell Disease |
Sickle Cell Disease |
|
C59276 |
Child enroll school daycare indicate code |
Code indicating whether the child is currently enrolled in school or daycare.
|
Proposed |
1.00 |
2019-03-28 15:40:46.0 |
PhenX Toolkit: Quality of Care - Children |
False |
Sickle Cell Disease |
Sickle Cell Disease |
|
C59266 |
Child need urgent care last 6 month indicate code |
Code indicating whether the child needed urgent care in the last 6 months.
|
Proposed |
1.00 |
2019-03-28 11:52:32.0 |
PhenX Toolkit: Quality of Care - Children |
False |
Sickle Cell Disease |
Sickle Cell Disease |
|
C59314 |
Appointment specialist attempt make for child last 6 month indicate code |
Code indicating whether the child's caregiver attempted to make an appointment with a specialist for the child in the last 6 months
|
Proposed |
1.00 |
2019-04-01 09:59:58.0 |
PhenX Toolkit: Quality of Care - Children |
False |
Sickle Cell Disease |
Sickle Cell Disease |
|
C59277 |
Child health care provider contact school daycare last 6 month indicate code |
Code indicating whether the child's health care providers contacted school or daycare about the child's health or care in the last 6 months.
|
Proposed |
1.00 |
2019-03-28 15:44:38.0 |
PhenX Toolkit: Quality of Care - Children |
False |
Sickle Cell Disease |
Sickle Cell Disease |
|
C59278 |
Child health care provider help contact school daycare last 6 month indicate code |
Code indicating whether the child's health care providers helped contact school or daycare about the child's health or care in the last 6 months.
|
Proposed |
1.00 |
2019-03-28 15:44:38.0 |
PhenX Toolkit: Quality of Care - Children |
False |
Sickle Cell Disease |
Sickle Cell Disease |
|
C59309 |
Child personal physician talk about child feel grow behave last 6 month indicate code |
Code indicating whether the child's personal physician talked in the last 6 months about how the child is feeling, growing, or behaving
|
Proposed |
1.00 |
2019-04-01 09:24:49.0 |
PhenX Toolkit: Quality of Care - Children |
False |
Sickle Cell Disease |
Sickle Cell Disease |
|