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Purpose

Record the transplant date and related pre and post test results.

Chimerism eCRF:

Field Descriptions and Instructions

Field Name

Description / Instructions

Format

Visit Date(m)

Date the first test was performed.

DD-MMM-YYYY

Date of Transplant(m)

Date the transplant was performed.

DD-MMM-YYYY

Course #(d)

Indicates the course number the test is related to based on their date and the Course Initiation start dates.

5 digits

Day in Course(d)

Indicates the day since the beginning of course the test is related to based on their date and the Course Initiation start dates.

5 digits

Day in Course(d)

Enter the time the procedure was performed.

HH(24):MM

Date of Test(m)

Date the test was performed

DD-MMM-YYYY

Time of Test

Time the test was performed.

HH(24):MM

Days Post Transplant(d)

Number of days before or after the transplant that the test was done. It will be a negative number if test was done before the transplant.

5 digits

Specimen(m)

Select a specimen from the pick list.
A- Apheresis Cells
B- Whole Blood
C- CSF
D- CD33 Myeloid Cells
L- CD33 Lymphoid Cells
M- PBMC
O- Bone Marrow
P- Plasma
S- Serum
T- Tumor Tissue
U- Urine
V- Saliva
Y- CD14/15 Myeloid

Use pick list.

Result (%)(m)

Test results in percentage.

12 digits and 5 decimal

Comments

Enter comments applicable to the test.

200 characters

Legend: (d) derived field, (m) RDC mandatory, (c) for CTEP reporting only.

Validations

Code

Description

Resolutions

CHM01

Duplicate Specimen, Date of Test and Time of Test.

A Specimen must have a unique Date of Test and Time of Test. Review the Specimen and/or the Date of Test and Time of Test.

CHM02

Result (%) is out of range.

Result % must be between 0 and 100%.

Derivations

Code

Field Name

Description

CHM1001

Course #

Course number is derived based on the course initiation start dates and the Date of Test.

CHM1002

Day in Course

Number of days since the beginning of the course is derived from the course initiation start date and the Date of Test.

CHM1003

Days Post Transplant

Number of days before or after the transplant that the test was done. It will be a negative number if test was done before the transplant.