Example Case Report Forms for LB domain
Sources: DB1 | Forms loaded: 6
Form: Bone Marrow Aspirate
Show domain info
Primary Domain
LB
All Domains
LB
# Question Response
1
Specimen Material Type
field_001
2
Date of assessment
field_002
3
Specimen Condition
field_003
4
Differential Cell Count
field_004
5
Number of Cells Counted
field_005
6
Percent Myeloblasts (%)
field_006
7
Percent Promyelocytes (%)
field_007
8
Percent Myelocytes (%)
field_008
9
Percent Mature Granulocytes (%)
field_009
10
Percent Erythroid Cells (%)
field_010
11
Percent Monocytes (%)
field_011
12
Percent Eosinophils (%)
field_012
13
M:E Ratio
field_013
14
Percent lymphocytes (%)
field_014
Example Case Report Forms for LB domain
Sources: DB1 | Forms loaded: 6
Form: Laboratory Chemistry
Show domain info
Primary Domain
LB
All Domains
LB
# Question Response
1
Date Collected
field_001
2
Time Collected
field_002
3
Was Sample Collected in a Fasti
field_003
4
Potassium
field_004
5
Sodium
field_005
6
Chloride
field_006
7
Bicarbonate
field_007
8
Total Protein
field_008
9
Albumin
field_009
10
Calcium
field_010
11
Magnesium
field_011
12
Phosphorus
field_012
13
Urea Nitrogen
field_013
14
Urea
field_014
15
Creatinine
field_015
16
Total Bilirubin
field_016
17
Direct Bilirubin
field_017
18
Lipase
field_018
19
Amylase
field_019
20
LDH
field_020
21
AST
field_021
22
ALT
field_022
23
Cholesterol
field_023
24
HDL
field_024
25
LDL
field_025
26
Triglyceride
field_026
27
GGT
field_027
28
Derived Parameters:
field_028
29
Glomerular Filtration Rate
field_029
30
Estimated Creatinine Clearance
field_030
31
Calcium Corrected
field_031
32
Cholesterol/HDL-Cholesterol 
field_032
Example Case Report Forms for LB domain
Sources: DB1 | Forms loaded: 6
Form: Lab Coagulation
Show domain info
Primary Domain
LB
All Domains
LB
# Question Response
1
Date Collected
field_001
2
Time Collected
field_002
3
Was Sample Collected in a Fasti
field_003
4
Prothrombin Time
field_004
5
International Normalized Ratio
field_005
6
Fibrinogen
field_006
7
Fibrin Split Product
field_007
8
Fibrin D-Dimer
field_008
Example Case Report Forms for LB domain
Sources: DB1 | Forms loaded: 6
Form: Laboratory Hematology
Show domain info
Primary Domain
LB
All Domains
LB
# Question Response
1
Date Collected
lbdat_raw
2
Time Collected
lbtm
3
Was Sample Collected in a Fasting state?
lbfast
4
RBC
field_004
5
HGB
field_005
6
HCT
field_006
7
MCV
field_007
8
MCH
field_008
9
MCHC
field_009
10
RDW
field_010
11
Reticulocytes
field_011
12
Platelets
field_012
13
WBC
field_013
14
Total Neutrophils
field_014
15
Segmented Neutrophils
field_015
16
Bands/Stabs
field_016
17
Granulocytes
field_017
18
Eosinophils
field_018
19
Basophils
field_019
20
Lymphocytes
field_020
21
Monocytes
field_021
22
Mid Cell Fraction
field_022
23
Myeloblasts
field_023
24
Promyelocytes
field_024
25
Myelocytes
field_025
26
Metamyelocytes
field_026
27
Atypical Lymphocytes
field_027
28
Blasts
field_028
29
Nucleated RBC
field_029
30
Derived parameters:
field_030
31
Calculated Absolute Neutrophil
field_031
Example Case Report Forms for LB domain
Sources: DB1 | Forms loaded: 6
Form: Pregnancy Test
Annotations
Domain name annotations
LB (Laboratory Test Results)
Form annotations
LBCAT=PREGNANCY
Show domain info
Primary Domain
LB
All Domains
LB
# Question Response
1
Form Not Done
LBSTAT
2
Reason Pregnancy Test Not Done
LBREASND
3
If 'OTHER', specify
LBREASNDOTH
4
If Test Performed,
field_004
5
Date sample taken
LBDAT
6
Specimen
LBSPEC
7
Result of pregnancy test
field_007
Example Case Report Forms for LB domain
Sources: DB1 | Forms loaded: 6
Form: Lab Urinalysis
Show domain info
Primary Domain
LB
All Domains
LB
# Question Response
1
Date Collected
field_001
2
Time Collected
field_002
3
Was Sample Collected in a Fasti
field_003
4
Specific Gravity
field_004
5
pH
field_005
6
Calcium Urine
field_006
7
Creatinine Urine
field_007
8
Calcium Urine (24 hr)
field_008
9
Creatinine Urine (24 hr)
field_009
10
Derived parameters:
field_010
11
Urine Calcium Creatinine Ratio
field_011
12
Urine Calcium Creatinine Ratio
field_012
13
Blood
field_013
14
Protein
field_014
15
Glucose
field_015
16
Bilirubin
field_016
17
WBC Urine
field_017
18
RBC Urine
field_018
19
Epithelial Cells Urine
field_019
20
Bacteria Urine
field_020
21
Casts Urine
field_021
22
Crystals Urine
field_022
23
field_023