ID
10088
Beschrijving
E1609 Hematology/Chemistry Form Ipilimumab or High-Dose Interferon Alfa-2b in Treating Patients With High-Risk Stage III or Stage IV Melanoma That Has Been Removed by Surgery NCT01274338 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=97E7C12F-E851-FFC2-E040-BB89AD43160A
Link
Trefwoorden
Versies (3)
- 19-09-12 19-09-12 -
- 08-01-15 08-01-15 - Martin Dugas
- 25-03-15 25-03-15 - Martin Dugas
Geüploaded op
25 maart 2015
DOI
Voor een aanvraag inloggen.
Licentie
Creative Commons BY-NC 3.0 Legacy
Model Commentaren :
Hier kunt u commentaar leveren op het model. U kunt de tekstballonnen bij de itemgroepen en items gebruiken om er specifiek commentaar op te geven.
Itemgroep Commentaren voor :
Item Commentaren voor :
U moet ingelogd zijn om formulieren te downloaden. AUB inloggen of schrijf u gratis in.
Melanoma (Skin) NCT01274338 On-Study Form
INSTRUCTIONS: Complete this form and submit original to the ECOG Coordinating Center within one week of registration. Keep a copy for your files
- StudyEvent: E1609 Hematology/Chemistry Form
Beschrijving
On Treatment
Alias
- UMLS CUI-1
- C3538994
Beschrijving
On Treatment Report Period (Choose one x)
Datatype
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- NCI Thesaurus Property
- C25214
- NCI Thesaurus Property-2
- C25616
- NCI Thesaurus ObjectClass
- C15368
- UMLS CUI-1
- C2045829
Beschrijving
PersonOff-TreatmentTimePeriodType
Datatype
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C25616
- UMLS 2011AA Property
- C1948053
- NCI Thesaurus Property-2
- C25601
- UMLS 2011AA Property-2
- C1518544
- NCI Thesaurus Property-3
- C25207
- UMLS 2011AA Property-3
- C0040223
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
Beschrijving
HematologyAssessedInd-3
Datatype
boolean
Alias
- NCI Thesaurus ValueDomain
- C38148
- NCI Thesaurus Property
- C25217
- NCI Thesaurus ObjectClass
- C16673
- UMLS CUI-1
- C0474523
Beschrijving
HematologySpecimenCollectedDate
Datatype
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- NCI Thesaurus ObjectClass
- C16673
- NCI Thesaurus ObjectClass-2
- C19157
- NCI Thesaurus Property
- C25452
- UMLS CUI-1
- C0474523
- UMLS CUI-2
- C0011008
Beschrijving
LaboratoryProcedureNotPerformedText
Datatype
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- NCI Thesaurus Property
- C25594
- NCI Thesaurus Property-2
- C38000
- NCI Thesaurus ObjectClass
- C25294
- UMLS CUI-1
- C0022885
- UMLS CUI-2
- C0445106
Beschrijving
LaboratoryProcedureC-ReactiveProteinResultUpperLimitofNormalValue
Datatype
float
Maateenheden
- mg/dL
Alias
- NCI Thesaurus ObjectClass
- C25294
- NCI Thesaurus Property
- C20200
- NCI Thesaurus Property-2
- C60651
- NCI Thesaurus ValueDomain
- C25712
- NCI Thesaurus ValueDomain-2
- C25706
- UMLS CUI-1
- C0006560
- UMLS CUI-2
- C1519815
Beschrijving
LaboratoryProcedureC-ReactiveProteinResultSpecifiedValue
Datatype
float
Alias
- NCI Thesaurus Property
- C20200
- NCI Thesaurus ObjectClass
- C25294
- NCI Thesaurus ValueDomain
- C25712
- NCI Thesaurus Property-2
- C60651
- UMLS CUI-1
- C0006560
Beschrijving
LaboratoryProcedureLactateDehydrogenaseResultUpperLimitofNormalValue
Datatype
float
Alias
- NCI Thesaurus ObjectClass
- C25294
- NCI Thesaurus Property
- C20200
- NCI Thesaurus Property-2
- C25184
- NCI Thesaurus ValueDomain
- C25712
- NCI Thesaurus ValueDomain-2
- C25706
- UMLS CUI-1
- C0202113
- UMLS CUI-2
- C1519815
Beschrijving
LaboratoryProcedureLactateDehydrogenaseResultSpecifiedValue
Datatype
float
Maateenheden
- U/L
Alias
- NCI Thesaurus Property
- C20200
- NCI Thesaurus ObjectClass
- C25294
- NCI Thesaurus ValueDomain
- C25712
- NCI Thesaurus Property-2
- C25184
- UMLS CUI-1
- C0202113
Beschrijving
LaboratoryProcedureLymphocyteOutcomeCount
Datatype
float
Alias
- NCI Thesaurus Property
- C12535
- NCI Thesaurus Property-2
- C20200
- NCI Thesaurus ValueDomain
- C25463
- NCI Thesaurus ObjectClass
- C25294
- UMLS CUI-1
- C0024264
Beschrijving
LaboratoryProcedureLymphocyteOutcomeLowerLimitofNormalValue
Datatype
float
Alias
- NCI Thesaurus ObjectClass
- C25294
- NCI Thesaurus Property
- C12535
- NCI Thesaurus Property-2
- C20200
- NCI Thesaurus ValueDomain
- C25712
- NCI Thesaurus ValueDomain-2
- C25555
- UMLS CUI-1
- C0024264
- UMLS CUI-2
- C1518030
Beschrijving
AnticardiolipinAntibodyOutcomeStatus
Datatype
text
Alias
- NCI Thesaurus Property
- C20200
- NCI Thesaurus ObjectClass
- C95408
- NCI Thesaurus ValueDomain
- C25688
- UMLS CUI-1
- C0201535
Beschrijving
ThyroidAntimicrosomalAntibodyMeasurementOutcomeStatus
Datatype
text
Alias
- NCI Thesaurus Property
- C20200
- NCI Thesaurus ObjectClass
- C81991
- NCI Thesaurus ValueDomain
- C25688
- UMLS CUI-1
- C2825872
Beschrijving
AntinuclearAntibodyOutcomeStatus
Datatype
text
Alias
- NCI Thesaurus Property
- C20200
- NCI Thesaurus ObjectClass
- C70547
- NCI Thesaurus ValueDomain
- C25688
- UMLS CUI-1
- C0003243
Beschrijving
ThyroidAntithyroglobulinAntibodyMeasurementOutcomeStatus
Datatype
text
Alias
- NCI Thesaurus Property
- C20200
- NCI Thesaurus ObjectClass
- C81992
- NCI Thesaurus ValueDomain
- C25688
- UMLS CUI-1
- C2825873
Beschrijving
ThyroidPeroxidaseOutcomeStatus
Datatype
text
Alias
- NCI Thesaurus Property
- C20200
- NCI Thesaurus ObjectClass
- C16752
- NCI Thesaurus ValueDomain
- C25688
- UMLS CUI-1
- C0021965
Beschrijving
ThyroidHormoneStimulationImmunoglobulinOutcomeStatus
Datatype
text
Alias
- NCI Thesaurus ObjectClass
- C61406
- NCI Thesaurus ObjectClass-2
- C572
- NCI Thesaurus ObjectClass-3
- C886
- NCI Thesaurus Property
- C20200
- NCI Thesaurus ValueDomain
- C25688
- UMLS CUI-1
- C0040139
Beschrijving
Assessment Date
Datatype
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C2985720
- NCI Thesaurus ObjectClass
- C25367
- NCI Thesaurus ValueDomain-2
- C25367
- NCI Thesaurus Property
- C38000
Beschrijving
Explain equivocal results
Datatype
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- NCI Thesaurus ObjectClass
- C20989
- NCI Thesaurus ValueDomain-2
- C25651
- NCI Thesaurus Property
- C19477
- UMLS CUI-1
- C1704254
Similar models
INSTRUCTIONS: Complete this form and submit original to the ECOG Coordinating Center within one week of registration. Keep a copy for your files
- StudyEvent: E1609 Hematology/Chemistry Form
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1512162 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25491 (NCI Thesaurus Property-2)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1512162 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25491 (NCI Thesaurus Property-2)
C3242750 (UMLS CUI-1)
C19464 (NCI Thesaurus Property)
C25474 (NCI Thesaurus ObjectClass)
C25452 (NCI Thesaurus ObjectClass-2)
C1514821 (UMLS CUI-1)
C25646 (NCI Thesaurus ObjectClass)
C0237753 (UMLS CUI-2)
C16154 (NCI Thesaurus Property)
C16154 (NCI Thesaurus ValueDomain-2)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
C25191 (NCI Thesaurus ValueDomain)
C21541 (NCI Thesaurus ValueDomain-2)
C0680532 (UMLS CUI-1)
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)
C0680532 (UMLS CUI-1)
C25474 (NCI Thesaurus ObjectClass)
C0011008 (UMLS CUI-2)
C25416 (NCI Thesaurus Property)
C25367 (NCI Thesaurus ValueDomain-2)
C2346576 (UMLS CUI-1)
C25678 (NCI Thesaurus Property)
C17089 (NCI Thesaurus ObjectClass)
C2346576 (UMLS CUI-1)
C25678 (NCI Thesaurus Property)
C0011008 (UMLS CUI-2)
C25367 (NCI Thesaurus ValueDomain-2)
C17089 (NCI Thesaurus ObjectClass)
C25214 (NCI Thesaurus Property)
C25616 (NCI Thesaurus Property-2)
C15368 (NCI Thesaurus ObjectClass)
C2045829 (UMLS CUI-1)
C25213 (NCI Thesaurus-3)
C1442488 (UMLS CUI-1)
C0205449 (UMLS CUI-2)
C0205452 (UMLS CUI-2)
C0205455 (UMLS CUI-2)
C0205458 (UMLS CUI-2)
C0277556 (UMLS CUI-1)
C0027361 (UMLS 2011AA ObjectClass)
C25616 (NCI Thesaurus Property)
C1948053 (UMLS 2011AA Property)
C25601 (NCI Thesaurus Property-2)
C1518544 (UMLS 2011AA Property-2)
C25207 (NCI Thesaurus Property-3)
C0040223 (UMLS 2011AA Property-3)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25217 (NCI Thesaurus Property)
C16673 (NCI Thesaurus ObjectClass)
C0474523 (UMLS CUI-1)
C16673 (NCI Thesaurus ObjectClass)
C19157 (NCI Thesaurus ObjectClass-2)
C25452 (NCI Thesaurus Property)
C0474523 (UMLS CUI-1)
C0011008 (UMLS CUI-2)
C25594 (NCI Thesaurus Property)
C38000 (NCI Thesaurus Property-2)
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS CUI-1)
C0445106 (UMLS CUI-2)
C20200 (NCI Thesaurus Property)
C60651 (NCI Thesaurus Property-2)
C25712 (NCI Thesaurus ValueDomain)
C25706 (NCI Thesaurus ValueDomain-2)
C0006560 (UMLS CUI-1)
C1519815 (UMLS CUI-2)
C25294 (NCI Thesaurus ObjectClass)
C25712 (NCI Thesaurus ValueDomain)
C60651 (NCI Thesaurus Property-2)
C0006560 (UMLS CUI-1)
C20200 (NCI Thesaurus Property)
C25184 (NCI Thesaurus Property-2)
C25712 (NCI Thesaurus ValueDomain)
C25706 (NCI Thesaurus ValueDomain-2)
C0202113 (UMLS CUI-1)
C1519815 (UMLS CUI-2)
C25294 (NCI Thesaurus ObjectClass)
C25712 (NCI Thesaurus ValueDomain)
C25184 (NCI Thesaurus Property-2)
C0202113 (UMLS CUI-1)
C20200 (NCI Thesaurus Property-2)
C25463 (NCI Thesaurus ValueDomain)
C25294 (NCI Thesaurus ObjectClass)
C0024264 (UMLS CUI-1)
C12535 (NCI Thesaurus Property)
C20200 (NCI Thesaurus Property-2)
C25712 (NCI Thesaurus ValueDomain)
C25555 (NCI Thesaurus ValueDomain-2)
C0024264 (UMLS CUI-1)
C1518030 (UMLS CUI-2)
C95408 (NCI Thesaurus ObjectClass)
C25688 (NCI Thesaurus ValueDomain)
C0201535 (UMLS CUI-1)
C0205160 (UMLS 2011AA)
C1446409 (UMLS 2011AA)
C0332241 (UMLS 2011AA)
C1272696 (UMLS 2011AA)
C81991 (NCI Thesaurus ObjectClass)
C25688 (NCI Thesaurus ValueDomain)
C2825872 (UMLS CUI-1)
C0205160 (UMLS 2011AA)
C1446409 (UMLS 2011AA)
C0332241 (UMLS 2011AA)
C1272696 (UMLS 2011AA)
C70547 (NCI Thesaurus ObjectClass)
C25688 (NCI Thesaurus ValueDomain)
C0003243 (UMLS CUI-1)
C0205160 (UMLS 2011AA)
C1446409 (UMLS 2011AA)
C0332241 (UMLS 2011AA)
C1272696 (UMLS 2011AA)
C81992 (NCI Thesaurus ObjectClass)
C25688 (NCI Thesaurus ValueDomain)
C2825873 (UMLS CUI-1)
C0205160 (UMLS 2011AA)
C1446409 (UMLS 2011AA)
C0332241 (UMLS 2011AA)
C1272696 (UMLS 2011AA)
C16752 (NCI Thesaurus ObjectClass)
C25688 (NCI Thesaurus ValueDomain)
C0021965 (UMLS CUI-1)
C0205160 (UMLS 2011AA)
C1446409 (UMLS 2011AA)
C0332241 (UMLS 2011AA)
C1272696 (UMLS 2011AA)
C572 (NCI Thesaurus ObjectClass-2)
C886 (NCI Thesaurus ObjectClass-3)
C20200 (NCI Thesaurus Property)
C25688 (NCI Thesaurus ValueDomain)
C0040139 (UMLS CUI-1)
C0205160 (UMLS 2011AA)
C1446409 (UMLS 2011AA)
C0332241 (UMLS 2011AA)
C1272696 (UMLS 2011AA)
C2985720 (UMLS CUI-1)
C25367 (NCI Thesaurus ObjectClass)
C25367 (NCI Thesaurus ValueDomain-2)
C38000 (NCI Thesaurus Property)
C20989 (NCI Thesaurus ObjectClass)
C25651 (NCI Thesaurus ValueDomain-2)
C19477 (NCI Thesaurus Property)
C1704254 (UMLS CUI-1)