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Informações:
Falhas:
ID
2212
Descrição
Pathology Submission Report Gefitinib in Treating Patients With Non-Small Cell Lung Cancer That Has Been Surgically Removed Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A069EFF3-E6C4-50D8-E034-080020C9C0E0
Link
Palavras-chave
Versões (2)
- 19/09/2012 19/09/2012 -
- 09/01/2015 09/01/2015 - Martin Dugas
Transferido a
19 de setembro de 2012
DOI
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Licença
Creative Commons BY-NC 3.0 Legacy
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Lung Cancer NCT00049543 Pathology - Pathology Submission Report - 2034358v3.0
No Instruction available.
- StudyEvent: Pathology Submission Report
Similar models
No Instruction available.
- StudyEvent: Pathology Submission Report
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de dados
Alias
PatientStudyID,CoordinatingGroup
Item
NCIC CTG Patient Serial #
text
PatientMedicalRecordNumber
Item
Hospital #
text
PatientInitialsName
Item
Patient Initials (first-middle-last)
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25536 (NCI Thesaurus Property)
C1555582 (UMLS 2011AA Property)
C1547383 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25536 (NCI Thesaurus Property)
C1555582 (UMLS 2011AA Property)
PatientStudyID,ParticipatingGroup
Item
Intergroup Patient Serial #
text
NCIInstitutionNumber
Item
Site #
text
PatientSocialSecurityNumber
Item
Patient's Social Security # (USA only)
double
InstitutionName
Item
Institution
text
RegisteredInvestigator
Item
Investigator
text
SpecimenCollectionDate
Item
Date tissue obtained for diagnosis
date
AddressPathologyInstitutionName
Item
Name of Institution
text
Address
Item
Address
text
PathologistName,Reviewing
Item
Contact Pathologist Name
text
SpecimenID
Item
Pathology specimen number(s)
double
Comments
Item
3. COMMENTS
text
InvestigatorSignature
Item
Signature of Responsible Investigator
text
C25678 (NCI Thesaurus Property)
C1519316 (UMLS 2011AA Property)
C17089 (NCI Thesaurus ObjectClass)
C0035173 (UMLS 2011AA ObjectClass)
C1519316 (UMLS 2011AA Property)
C17089 (NCI Thesaurus ObjectClass)
C0035173 (UMLS 2011AA ObjectClass)
PersonCompletingForm,LastName
Item
Name of Clinical Research Associate
text
FormCompletionDate,Original
Item
Date
date
LoggedEntryInitials
Item
Logged
text
LoggedEntryDate
Item
Unnamed1
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
CoordinatorReviewInitials
Item
Study Coord
text
CoordinatorReviewDate
Item
Unnamed2
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
PhysicianReviewInitials
Item
Phy
text
DataEntryInitials
Item
Data Ent'd
text
DataVerificationInitials
Item
Verified
text
PersonCompletingForm,FirstName
Item
Person Completing Form, First Name
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C0027361 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
AddressPathologyDepartment
Item
Address, Department
text
AddressPathologyStreet
Item
Address, Street
text
AddressPathologyPostalCode
Item
Address Postal Code
text
AddressPathologyProvince
Item
Address Province
text
AddressPathologyCountry
Item
Address Country
text
AddressPathologyCity
Item
Address City
text
State
Item
State
text