Form:Pancreatic Cystic Fluid Reference Set: Consent Documentation v2.0


CDE IDCDE Description
* 421EDRN Participant ID (Go To: 423)
* 423EDRN Protocol ID (Go To: 422)
* 422EDRN Site ID (Go To: 929)
* 929EDRN Staff ID of the person who collected the data: (Go To: 1319)
* 1319Date participant signed consent form (MM/DD/YYYY): (Go To: 2824)
* 2824Has the participant authorized sending his or her genetic information to one or more databases for future research? (Go To: 3256)
 
Permissible Values (value):No (0)
 
 Yes (1)
 
 Not collected (2)
 
 Refused (88)
 
 Unknown (99)
* 3256Consensus guidelines (Check all that apply): (Go To: 3257)
 
Permissible Values (value):Symptomatic from pancreatic cyst (1)
 
 Side branch cyst along with main duct involvement (mixed main duct-side branch IPMN) (2)
 
 Presence of mural nodules in cyst (3)
 
 At least one cyst greater than 3 cm in size (4)
 
 Surgeon decided to remove cyst (5) (Go To: 3994)
 
 None (44) (Go To: End of Form)
* 3994Reason for surgeon’s decision to remove cyst (check all that apply) (Go To: 3257)
 
Permissible Values (value):Patient age (1)
 
 Emotional desire to remove cyst (2)
 
 Other, specify: (97) (Go To: 3995)
* 3995Reason for surgeon’s decision to remove cyst (Other, specify) (Go To: 3257)
* 3257Type of referral: (Go To: 2631)
 
Permissible Values (value):Surgery (3)
 
 EUS (Endoscopic Ultrasound) (5)
 
 None (44) (Go To: End of Form)
* 2631Has the participant authorized future contact for research purposes? (Go To: 3316)
 
Permissible Values (value):No (0)
 
 Yes (1)
 
 Not collected (2)
 
 Refused (88)
 
 Unknown (99)
* 3316Has the participant authorized access to their medical records for research purposes? (Go To: 1097)
 
Permissible Values (value):No (0)
 
 Yes (1)
 
 Not collected (2)
 
 Refused (88)
 
 Unknown (99)
   1097Comments (do not include any participant identifiers) (Go To: End of Form)