ID

11762

Description

On-Study - Physical Exam - 2803173v1.0 The Division of Cancer Prevention's physical exam case report form (CRF) template. Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=5C0F9C5A-FB66-15A0-E044-0003BA3F9857

Lien

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=5C0F9C5A-FB66-15A0-E044-0003BA3F9857

Mots-clés

Versions (3)
  1. 19/09/2012 19/09/2012 -
  2. 09/01/2015 09/01/2015 - Martin Dugas
  3. 30/07/2015 30/07/2015 - Martin Dugas
Téléchargé le

30 juillet 2015

DOI

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Licence

Creative Commons BY-NC 3.0 Legacy
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Physical Exam Cancer Prevention

Anglais

No Instruction available.

1 Formulaires  
  1. StudyEvent: Physical Exam
    1. No Instruction available.
Header
Description

Header

Alias
UMLS CUI-1
C1320722
DCP Protocol #
Description

Protocol ID NCI

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C3274381
NCI Thesaurus ObjectClass
C25320
UMLS CUI-2
C1513882
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C19202
Institution Code
Description

NationalCancerInstituteInstituteCode

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25162
UMLS 2011AA ValueDomain
C0805701
NCI Thesaurus ObjectClass
C21541
UMLS 2011AA ObjectClass
C0018704
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Participant ID
Description

ParticipantIdentifier

Type de données

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ValueDomain
C25364
UMLS 2011AA ValueDomain
C0600091
Visit Type
Description

VisitTypeText

Type de données

text

Alias
NCI Thesaurus Property
C25284
UMLS 2011AA Property
C0332307
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ObjectClass
C25716
UMLS 2011AA ObjectClass
C0545082
Visit Date
Description

VisitDate

Type de données

date

Alias
NCI Thesaurus Property
C25164
UMLS 2011AA Property
C0011008
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ValueDomain-2
C25367
NCI Thesaurus ObjectClass
C25716
UMLS 2011AA ObjectClass
C0545082
Physical Examination
Description

Physical Examination

Alias
UMLS CUI-1
C0031809
Physical Examination Date
Description

Physical Examination Date

Type de données

date

Alias
NCI Thesaurus Property
C25164
NCI Thesaurus ValueDomain
C25164
NCI Metathesaurus ObjectClass
C0031809
UMLS CUI-1-1
C2826643
Height
Description

Height

Type de données

float

Unités de mesure
  • cm
Alias
NCI Thesaurus ObjectClass
C25190
NCI Thesaurus ValueDomain
C25712
NCI Thesaurus Property
C25347
NCI Thesaurus ValueDomain-2
C25347
UMLS CUI-1-1
C0005890
cm
Not Obtained
Description

Not Obtained

Type de données

boolean

Alias
NCI Thesaurus Property
C25180
NCI Metathesaurus ObjectClass
CL310460
NCI Metathesaurus ObjectClass-2
CL052458
NCI Metathesaurus ValueDomain
C0021212
UMLS CUI-1-1
C1882120
Not Obtained
Description

Not Obtained

Type de données

boolean

Alias
NCI Thesaurus Property
C25180
NCI Metathesaurus ObjectClass
CL310460
NCI Metathesaurus ObjectClass-2
CL052458
NCI Metathesaurus ValueDomain
C0021212
UMLS CUI-1-1
C1882120
Not Obtained
Description

Not Obtained

Type de données

boolean

Alias
NCI Thesaurus Property
C25180
NCI Metathesaurus ObjectClass
CL310460
NCI Metathesaurus ObjectClass-2
CL052458
NCI Metathesaurus ValueDomain
C0021212
UMLS CUI-1-1
C1882120
Not Obtained
Description

Not Obtained

Type de données

boolean

Alias
NCI Thesaurus Property
C25180
NCI Metathesaurus ObjectClass
CL310460
NCI Metathesaurus ObjectClass-2
CL052458
NCI Metathesaurus ValueDomain
C0021212
UMLS CUI-1-1
C1882120
Not Obtained
Description

Not Obtained

Type de données

boolean

Alias
NCI Thesaurus Property
C25180
NCI Metathesaurus ObjectClass
CL310460
NCI Metathesaurus ObjectClass-2
CL052458
NCI Metathesaurus ValueDomain
C0021212
UMLS CUI-1-1
C1882120
Body weight
Description

Body weight

Type de données

float

Unités de mesure
  • kg
Alias
NCI Thesaurus ObjectClass
C25190
NCI Thesaurus Property
C25208
NCI Thesaurus ValueDomain
C25208
NCI Thesaurus ValueDomain-2
C25712
UMLS CUI-1-1
C0005910
kg
Temperature
Description

Temperature

Type de données

float

Unités de mesure
  • °C
Alias
NCI Thesaurus ValueDomain
C25337
NCI Thesaurus Property
C25209
NCI Metathesaurus ObjectClass
C0886414
UMLS CUI-1-1
C0039476
°C
Pulse
Description

Pulse

Type de données

integer

Unités de mesure
  • beats/min
Alias
NCI Thesaurus ObjectClass
C25190
NCI Thesaurus ObjectClass-2
C25749
NCI Thesaurus Property
C25636
NCI Thesaurus ValueDomain
C25209
NCI Thesaurus ValueDomain-2
C25749
UMLS CUI-1-1
C0232117
beats/min
Respiratory Rate
Description

Respiratory Rate

Type de données

integer

Unités de mesure
  • /min
Alias
NCI Thesaurus ObjectClass
C25190
NCI Thesaurus Property
C20989
NCI Thesaurus Property-2
C49672
NCI Thesaurus Property-3
C49678
NCI Thesaurus ValueDomain
C25712
UMLS CUI-1-1
C0231832
/min
Systolic
Description

Systolic

Type de données

integer

Unités de mesure
  • mmHg
Alias
NCI Thesaurus ValueDomain
C25337
NCI Thesaurus ObjectClass
C25190
NCI Thesaurus Property
C25367
NCI Thesaurus ObjectClass-2
C54706
UMLS CUI-1-1
C0871470
mmHg
Diastolic
Description

Diastolic

Type de données

integer

Unités de mesure
  • mmHg
Alias
NCI Thesaurus ValueDomain
C25337
NCI Thesaurus ObjectClass
C25190
NCI Thesaurus Property
C25367
NCI Thesaurus ObjectClass-2
C54706
UMLS CUI-1-1
C0428883
mmHg
Check here if NO body systems were examined
Description

Check here if NO body systems were examined

Type de données

boolean

Alias
NCI Thesaurus ObjectClass
C19464
NCI Thesaurus Property
C25250
NCI Thesaurus Property-2
C25594
NCI Thesaurus Property-3
C25404
NCI Thesaurus ValueDomain
C25180
ECOG Performance Status
Description

ECOG Performance Status

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS CUI-1
C1520224
NCI Thesaurus Property
C25367
NCI Thesaurus ValueDomain-2
C25491
NCI Thesaurus ObjectClass
C20641
Body System/Site
Description

BodySystem/SiteName

Type de données

text

Alias
NCI Thesaurus ObjectClass
C13717
UMLS 2011AA ObjectClass
C1515974
NCI Thesaurus ValueDomain
C13717
UMLS 2011AA ValueDomain
C1515974
NCI Thesaurus Property
C25367
NCI Thesaurus ValueDomain-2
C42614
UMLS 2011AA ValueDomain-2
C0027365
Body System
Description

BodySystemIndicator

Type de données

text

Alias
NCI Thesaurus ObjectClass
C13041
UMLS 2011AA ObjectClass
C1268086
NCI Thesaurus Property
C25700
UMLS 2011AA Property
C0449913
NCI Metathesaurus ValueDomain
C0021212
Comment (Required if Abnormal)
Description

AbnormalCommentText

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ObjectClass
C25393
UMLS 2011AA ObjectClass
C0282411
NCI Thesaurus Property
C25365
UMLS 2011AA Property
C0678257
Dcp Template Footer
Description

Dcp Template Footer

Protocol Title
Description

Protocol Title

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986303
NCI Thesaurus ObjectClass
C25320
NCI Thesaurus Property
C42774
Protocol Version
Description

Protocol Version

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS CUI-1
C2985700
NCI Thesaurus ObjectClass
C25320
NCI Thesaurus Property
C25364
Protocol Date
Description

Protocol Version Date

Type de données

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS CUI-1
C2985700
NCI Thesaurus ObjectClass
C25320
UMLS CUI-2
C0011008
NCI Thesaurus Property
C25364
NCI Thesaurus ValueDomain-2
C25367
Page #
Description

PageNumber

Type de données

float

Alias
NCI Thesaurus Property
C25337
UMLS 2011AA Property
C0237753
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Metathesaurus ObjectClass
C0439643
Total Page Number
Description

CaseReportFormTotalPageNumber

Type de données

text

Alias
NCI Thesaurus ObjectClass
C40988
UMLS 2011AA ObjectClass
C1516308
NCI Thesaurus Property
C25337
UMLS 2011AA Property
C0237753
NCI Thesaurus Property-2
C25304
UMLS 2011AA Property-2
C0439810
NCI Thesaurus Property-3
C42783
UMLS 2011AA Property-3
C1704732
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
DCP Template Version
Description

DCPTemplateVersionText

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Metathesaurus ObjectClass
C0728990
NCI Thesaurus Property
C25714
UMLS 2011AA Property
C0333052
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1 Formulaires
  1. StudyEvent: Physical Exam
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Type de données
Alias
Item Group
Header
C1320722 (UMLS CUI-1)
Protocol ID NCI
Item
DCP Protocol #
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1513882 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C19202 (NCI Thesaurus Property-2)
NationalCancerInstituteInstituteCode
Item
Institution Code
text
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
C21541 (NCI Thesaurus ObjectClass)
C0018704 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
ParticipantIdentifier
Item
Participant ID
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25364 (NCI Thesaurus ValueDomain)
C0600091 (UMLS 2011AA ValueDomain)
VisitTypeText
Item
Visit Type
text
C25284 (NCI Thesaurus Property)
C0332307 (UMLS 2011AA Property)
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25716 (NCI Thesaurus ObjectClass)
C0545082 (UMLS 2011AA ObjectClass)
VisitDate
Item
Visit Date
date
C25164 (NCI Thesaurus Property)
C0011008 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
C25716 (NCI Thesaurus ObjectClass)
C0545082 (UMLS 2011AA ObjectClass)
Item Group
Physical Examination
C0031809 (UMLS CUI-1)
Examination Date
Item
Physical Examination Date
date
C25164 (NCI Thesaurus Property)
C25164 (NCI Thesaurus ValueDomain)
C0031809 (NCI Metathesaurus ObjectClass)
C2826643 (UMLS CUI-1-1)
Height
Item
Height
float
C25190 (NCI Thesaurus ObjectClass)
C25712 (NCI Thesaurus ValueDomain)
C25347 (NCI Thesaurus Property)
C25347 (NCI Thesaurus ValueDomain-2)
C0005890 (UMLS CUI-1-1)
Not Obtained
Item
Not Obtained
boolean
C25180 (NCI Thesaurus Property)
CL310460 (NCI Metathesaurus ObjectClass)
CL052458 (NCI Metathesaurus ObjectClass-2)
C0021212 (NCI Metathesaurus ValueDomain)
C1882120 (UMLS CUI-1-1)
Not Obtained
Item
Not Obtained
boolean
C25180 (NCI Thesaurus Property)
CL310460 (NCI Metathesaurus ObjectClass)
CL052458 (NCI Metathesaurus ObjectClass-2)
C0021212 (NCI Metathesaurus ValueDomain)
C1882120 (UMLS CUI-1-1)
Not Obtained
Item
Not Obtained
boolean
C25180 (NCI Thesaurus Property)
CL310460 (NCI Metathesaurus ObjectClass)
CL052458 (NCI Metathesaurus ObjectClass-2)
C0021212 (NCI Metathesaurus ValueDomain)
C1882120 (UMLS CUI-1-1)
Not Obtained
Item
Not Obtained
boolean
C25180 (NCI Thesaurus Property)
CL310460 (NCI Metathesaurus ObjectClass)
CL052458 (NCI Metathesaurus ObjectClass-2)
C0021212 (NCI Metathesaurus ValueDomain)
C1882120 (UMLS CUI-1-1)
Not Obtained
Item
Not Obtained
boolean
C25180 (NCI Thesaurus Property)
CL310460 (NCI Metathesaurus ObjectClass)
CL052458 (NCI Metathesaurus ObjectClass-2)
C0021212 (NCI Metathesaurus ValueDomain)
C1882120 (UMLS CUI-1-1)
Weight
Item
Body weight
float
C25190 (NCI Thesaurus ObjectClass)
C25208 (NCI Thesaurus Property)
C25208 (NCI Thesaurus ValueDomain)
C25712 (NCI Thesaurus ValueDomain-2)
C0005910 (UMLS CUI-1-1)
Temperature
Item
Temperature
float
C25337 (NCI Thesaurus ValueDomain)
C25209 (NCI Thesaurus Property)
C0886414 (NCI Metathesaurus ObjectClass)
C0039476 (UMLS CUI-1-1)
Pulse Rate
Item
Pulse
integer
C25190 (NCI Thesaurus ObjectClass)
C25749 (NCI Thesaurus ObjectClass-2)
C25636 (NCI Thesaurus Property)
C25209 (NCI Thesaurus ValueDomain)
C25749 (NCI Thesaurus ValueDomain-2)
C0232117 (UMLS CUI-1-1)
Respiratory Rate
Item
Respiratory Rate
integer
C25190 (NCI Thesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C49672 (NCI Thesaurus Property-2)
C49678 (NCI Thesaurus Property-3)
C25712 (NCI Thesaurus ValueDomain)
C0231832 (UMLS CUI-1-1)
Systolic blood pressure
Item
Systolic
integer
C25337 (NCI Thesaurus ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C25367 (NCI Thesaurus Property)
C54706 (NCI Thesaurus ObjectClass-2)
C0871470 (UMLS CUI-1-1)
Diastolic blood pressure
Item
Diastolic
integer
C25337 (NCI Thesaurus ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C25367 (NCI Thesaurus Property)
C54706 (NCI Thesaurus ObjectClass-2)
C0428883 (UMLS CUI-1-1)
FormNotCompletedBox
Item
Check here if NO body systems were examined
boolean
C19464 (NCI Thesaurus ObjectClass)
C25250 (NCI Thesaurus Property)
C25594 (NCI Thesaurus Property-2)
C25404 (NCI Thesaurus Property-3)
C25180 (NCI Thesaurus ValueDomain)
Item
ECOG Performance Status
text
C25664 (NCI Thesaurus ValueDomain)
C1520224 (UMLS CUI-1)
C25367 (NCI Thesaurus Property)
C25491 (NCI Thesaurus ValueDomain-2)
C20641 (NCI Thesaurus ObjectClass)
CL.10
Code List
ECOG Performance Status
CL Item
Fully Active, Able To Carry On All Pre-disease Performance Without Restriction. (0)
CL Item
Restricted In Physically Strenuous Activity But Ambulatory And Able To Carry Out Work Of A Light Or Sedentary Nature, E.g., Light Housework, Office Work. (1)
CL Item
Ambulatory And Capable Of All Selfcare But Unable To Carry Out Any Work Activities. Up And About More Than 50% Of Waking Hours. (2)
CL Item
Capable Of Only Limited Selfcare, Confined To Bed Or Chair More Than 50% Of Waking Hours. (3)
CL Item
Completely Disabled. Cannot Carry On Any Selfcare. Totally Confined To Bed Or Chair. (4)
Item
Body System/Site
text
C13717 (NCI Thesaurus ObjectClass)
C1515974 (UMLS 2011AA ObjectClass)
C13717 (NCI Thesaurus ValueDomain)
C1515974 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus Property)
C42614 (NCI Thesaurus ValueDomain-2)
C0027365 (UMLS 2011AA ValueDomain-2)
CL.11
Code List
Body System/Site
CL Item
Appearance (Appearance)
C25377 (NCI Thesaurus)
C0700364 (UMLS 2011AA)
CL Item
Skin (Skin)
C12470 (NCI Thesaurus)
C1123023 (UMLS 2011AA)
CL Item
Heent (H/E/E/N/T)
CL Item
Thyroid (Thyroid)
CL Item
Chest (Chest)
C25389 (NCI Thesaurus)
C0817096 (UMLS 2011AA)
CL Item
Lung(s) (Lung(s))
CL Item
Breast(s) (Breast(s))
CL Item
Heart (Heart)
C12727 (NCI Thesaurus)
C0018787 (UMLS 2011AA)
CL Item
Abdomen (Abdomen)
C12664 (NCI Thesaurus)
C0230168 (UMLS 2011AA)
CL Item
Musculoskeletal (Musculoskeletal)
C25348 (NCI Thesaurus)
C0497254 (UMLS 2011AA)
CL Item
Genitalia (Genitalia)
C25177 (NCI Thesaurus)
C0017420 (UMLS 2011AA)
CL Item
Pelvis (Pelvis)
C12767 (NCI Thesaurus)
C0030797 (UMLS 2011AA)
CL Item
Rectal (Rectal)
C25224 (NCI Thesaurus)
C0205052 (UMLS 2011AA)
CL Item
Prostate Gland (Prostate)
C12410 (NCI Thesaurus)
C0033572 (UMLS 2011AA)
CL Item
Vascular (Vascular)
C13311 (NCI Thesaurus)
C1801960 (UMLS 2011AA)
CL Item
Neurological (Neurological)
CL Item
Lymph Nodes (Lymph Nodes)
Item
Body System
text
C13041 (NCI Thesaurus ObjectClass)
C1268086 (UMLS 2011AA ObjectClass)
C25700 (NCI Thesaurus Property)
C0449913 (UMLS 2011AA Property)
C0021212 (NCI Metathesaurus ValueDomain)
CL.12
Code List
Body System
CL Item
Normal (Normal)
C14165 (NCI Thesaurus)
C0205307 (UMLS 2011AA)
CL Item
Abnormal (Abnormal)
C25401 (NCI Thesaurus)
C0205161 (UMLS 2011AA)
CL Item
Not Examined (Not Examined)
C25500 (NCI Thesaurus)
C0332128 (UMLS 2011AA)
C25594 (NCI Thesaurus-3)
C1518422 (UMLS 2011AA-4)
AbnormalCommentText
Item
Comment (Required if Abnormal)
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25393 (NCI Thesaurus ObjectClass)
C0282411 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
Item Group
Dcp Template Footer
Protocol Title
Item
Protocol Title
text
C25191 (NCI Thesaurus ValueDomain)
C2986303 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C42774 (NCI Thesaurus Property)
Protocol Version
Item
Protocol Version
text
C25704 (NCI Thesaurus ValueDomain)
C2985700 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C25364 (NCI Thesaurus Property)
Protocol Version Date
Item
Protocol Date
date
C25164 (NCI Thesaurus ValueDomain)
C2985700 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C0011008 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25367 (NCI Thesaurus ValueDomain-2)
PageNumber
Item
Page #
float
C25337 (NCI Thesaurus Property)
C0237753 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C0439643 (NCI Metathesaurus ObjectClass)
CaseReportFormTotalPageNumber
Item
Total Page Number
text
C40988 (NCI Thesaurus ObjectClass)
C1516308 (UMLS 2011AA ObjectClass)
C25337 (NCI Thesaurus Property)
C0237753 (UMLS 2011AA Property)
C25304 (NCI Thesaurus Property-2)
C0439810 (UMLS 2011AA Property-2)
C42783 (NCI Thesaurus Property-3)
C1704732 (UMLS 2011AA Property-3)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
DCPTemplateVersionText
Item
DCP Template Version
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C0728990 (NCI Metathesaurus ObjectClass)
C25714 (NCI Thesaurus Property)
C0333052 (UMLS 2011AA Property)
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