ID

6330

Beskrivning

Southwest Oncology Group S0201 Adjuvant Melanoma Prestudy Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A8B98176-F2DC-123A-E034-0003BA12F5E7

Länk

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A8B98176-F2DC-123A-E034-0003BA12F5E7

Nyckelord

Versioner (4)
  1. 2014-12-18 2014-12-18 - Martin Dugas
  2. 2015-01-09 2015-01-09 - Martin Dugas
  3. 2015-07-05 2015-07-05 -
  4. 2015-07-25 2015-07-25 - Martin Dugas
Uppladdad den

18 december 2014

DOI

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Licens

Creative Commons BY-NC 3.0 Legacy
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Melanoma (Skin) null On-Study - Southwest Oncology Group S0201 Adjuvant Melanoma Prestudy Form - 2055815v3.0

Engelsk

No Instruction available.

1 Formulär  
  1. StudyEvent: Southwest Oncology Group S0201 Adjuvant Melanoma Prestudy Form
    1. No Instruction available.
Unnamed 1
Beskrivning

Unnamed 1

SWOG Patient ID
Beskrivning

SWOGPatientID

Datatyp

text

Patient Initials (L, F M)
Beskrivning

PatientInitialsName

Datatyp

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25536
UMLS 2011AA Property
C1555582
Institution/Affiliate
Beskrivning

MainMemberInstitution/Affiliate

Datatyp

text

Physician (Groups other than SWOG)
Beskrivning

TreatingPhysician

Datatyp

text

Alias
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ObjectClass
C25741
UMLS 2011AA ObjectClass
C0031831
NCI Thesaurus ObjectClass
C25705
UMLS 2011AA ObjectClass
C1522326
Group Name
Beskrivning

ParticipatingGroupName

Datatyp

text

Study No.
Beskrivning

StudyNo.

Datatyp

text

Pt. ID
Beskrivning

Pt.ID

Datatyp

text

Patient Characteristics
Beskrivning

Patient Characteristics

Height
Beskrivning

PatientHeight

Datatyp

double

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25347
UMLS 2011AA Property
C0489786
Weight
Beskrivning

PatientWeight

Datatyp

double

BSA
Beskrivning

BodySurfaceArea

Datatyp

double

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25157
UMLS 2011AA Property
C0005902
Performance Status
Beskrivning

PerformanceStatus

Datatyp

text

Hla Status
Beskrivning

Hla Status

HLA Type
Beskrivning

HLAType

Datatyp

text

Date of HLA typing
Beskrivning

DateofHLAtyping

Datatyp

text

Specify HLA tissue typing kit used
Beskrivning

SpecifyHLAtissuetypingkitused

Datatyp

text

Primary Tumor
Beskrivning

Primary Tumor

Date of initial pathologic diagnosis
Beskrivning

InitialDiagnosisDate,Pathologic

Datatyp

date

Site
Beskrivning

PrimarySite

Datatyp

text

Ulceration present?
Beskrivning

UlcerationInd

Datatyp

text

Breslow thickness
Beskrivning

BreslowDepth

Datatyp

double

Clark level of invasion
Beskrivning

ClarkLevel

Datatyp

text

Regional Lymph Node Metastases
Beskrivning

RegionalLymphNodeMetastases

Datatyp

text

If yes, date of first diagnosis
Beskrivning

InitialDiagnosisDate,Metastatic

Datatyp

date

Total number of nodes examined
Beskrivning

LymphNode(s)ExaminedNumber

Datatyp

double

Alias
NCI Thesaurus Property
C25500
UMLS 2011AA Property
C0332128
NCI Thesaurus ObjectClass
C12745
UMLS 2011AA ObjectClass
C0024204
Number of positive nodes
Beskrivning

LymphNode(s)PositiveNumber

Datatyp

double

Alias
NCI Thesaurus Property
C25246
UMLS 2011AA Property
C1446409
NCI Thesaurus ObjectClass
C12745
UMLS 2011AA ObjectClass
C0024204
Comments
Beskrivning

Comments

Datatyp

text

Ccrr Module For Southwest Oncology Group S0201 Adjuvant Melanoma Prestudy Form
Beskrivning

Ccrr Module For Southwest Oncology Group S0201 Adjuvant Melanoma Prestudy Form

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Similar models

No Instruction available.

1 Formulär
  1. StudyEvent: Southwest Oncology Group S0201 Adjuvant Melanoma Prestudy Form
    1. No Instruction available.
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
Unnamed 1
SWOGPatientID
Item
SWOG Patient ID
text
PatientInitialsName
Item
Patient Initials (L, F M)
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)
MainMemberInstitution/Affiliate
Item
Institution/Affiliate
text
TreatingPhysician
Item
Physician (Groups other than SWOG)
text
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25741 (NCI Thesaurus ObjectClass)
C0031831 (UMLS 2011AA ObjectClass)
C25705 (NCI Thesaurus ObjectClass)
C1522326 (UMLS 2011AA ObjectClass)
ParticipatingGroupName
Item
Group Name
text
StudyNo.
Item
Study No.
text
Pt.ID
Item
Pt. ID
text
Item Group
Patient Characteristics
PatientHeight
Item
Height
double
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25347 (NCI Thesaurus Property)
C0489786 (UMLS 2011AA Property)
PatientWeight
Item
Weight
double
BodySurfaceArea
Item
BSA
double
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25157 (NCI Thesaurus Property)
C0005902 (UMLS 2011AA Property)
PerformanceStatus
Item
Performance Status
text
Item Group
Hla Status
Item
HLA Type
text
CL.1
Code List
HLA Type
CL Item
A2+ Only (A2+ only)
CL Item
C3+ Only (C3+ only)
CL Item
Both A2+ And C3+ (both A2+ and C3+)
DateofHLAtyping
Item
Date of HLA typing
text
SpecifyHLAtissuetypingkitused
Item
Specify HLA tissue typing kit used
text
Item Group
Primary Tumor
InitialDiagnosisDate,Pathologic
Item
Date of initial pathologic diagnosis
date
Item
Site
text
CL.2
Code List
Site
CL Item
Head (head or neck)
C12419 (NCI Thesaurus)
C0018670 (UMLS 2011AA)
CL Item
Upper Extremity (upper limb)
C12671 (NCI Thesaurus)
C1140618 (UMLS 2011AA)
CL Item
Trunk (trunk)
C33816 (NCI Thesaurus)
C0460005 (UMLS 2011AA)
CL Item
Ocular (eye)
C0521414 (NCI Metathesaurus)
CL Item
Lower Extremity (lower limb)
C12742 (NCI Thesaurus)
C0023216 (UMLS 2011AA)
CL Item
Unknown (unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Ulceration present?
text
CL.3
Code List
Ulceration present?
CL Item
Yes (yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (no)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Unknown (unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
BreslowDepth
Item
Breslow thickness
double
Item
Clark level of invasion
text
CL.4
Code List
Clark level of invasion
CL Item
I-above Basal Lamina (in Situ) (I)
CL Item
Ii- Extension Into Papillary Dermis (II)
CL Item
Iii-interface Papillary-reticular Dermis (III)
CL Item
Iv-reticular Dermis (IV)
CL Item
V-subcutaneous Fat (V)
CL Item
Unknown (Unknown)
Item
Regional Lymph Node Metastases
text
CL.5
Code List
Regional Lymph Node Metastases
CL Item
Yes (yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (no)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Unknown (unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
InitialDiagnosisDate,Metastatic
Item
If yes, date of first diagnosis
date
LymphNode(s)ExaminedNumber
Item
Total number of nodes examined
double
C25500 (NCI Thesaurus Property)
C0332128 (UMLS 2011AA Property)
C12745 (NCI Thesaurus ObjectClass)
C0024204 (UMLS 2011AA ObjectClass)
LymphNode(s)PositiveNumber
Item
Number of positive nodes
double
C25246 (NCI Thesaurus Property)
C1446409 (UMLS 2011AA Property)
C12745 (NCI Thesaurus ObjectClass)
C0024204 (UMLS 2011AA ObjectClass)
Comments
Item
Comments
text
Item Group
Ccrr Module For Southwest Oncology Group S0201 Adjuvant Melanoma Prestudy Form
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