Form:UL Ineligibility v2.0


CDE IDCDE Description
* 421EDRN Participant ID (Go To: 1832)
* 423EDRN Protocol ID (Go To: 422)
* 422EDRN Site ID (Go To: 929)
* 929EDRN Staff ID of the person who collected the data: (Go To: 1066)
* 1066Date participant was determined to be ineligible (MM/DD/YYYY): (Go To: 2186)
* 2186Reason(s) for ineligibility: (Go To: 1097)
 
Permissible Values (value):Participant decided not to participate (10)
 
 Collected less than minimum set of specimens (42)
 
 Participant did not meet age requirement (45)
 
 Specimens collected outside the time period described in the protocol (67)
 
 Participant is pregnant (89)
 
 Does not have intact uterus (130)
 
 History of uterine ablation, tubal ligation or bilateral salpingectomy (131)
 
 Prior history of ovarian or endometrial cancer (132)
 
 Participant did not proceed to surgery (133)
 
 Treatment within the past year (excluding hormone therapy) for any cancer that spread beyond its origin (135)
 
 Diagnosed with Lynch syndrome (136)
 
 Current diagnosis of any cancer (137)
 
 Did not meet criteria for suspicion of ovarian cancer (138)
 
 History of untreated high-grade cervical dysplasia (CIN3) (147)
 
 History of treated high grade cervical dysplasia (CIN3) with a cytologically abnormal pap smear within the past year. If there is no post treatment Pap smear in the medical record, perform a Pap smear prior to the day of surgery. If this Pap smear is abnormal, the patient is ineligible. (178)
 
 Other, specify: (97) (Go To: 2184)
* 2184Reason for ineligibility (Other, specify): (Go To: 1097)
   1097Comments (do not include any participant identifiers) (Go To: End of Form)