ID

6908

Beschreibung

Melanoma-Treatment By Cycle Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=99CD59C5-A99E-3FA4-E034-080020C9C0E0

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=99CD59C5-A99E-3FA4-E034-080020C9C0E0

Stichworte

Versionen (2)
  1. 19.09.12 19.09.12 -
  2. 08.01.15 08.01.15 - Martin Dugas
Hochgeladen am

8. Januar 2015

DOI

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Lizenz

Creative Commons BY-NC 3.0 Legacy
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Treatment - Melanoma-Treatment By Cycle Form - 2020199v2.31

Englisch

No Instruction available.

1 Formulare  
  1. StudyEvent: Melanoma-Treatment By Cycle Form
    1. No Instruction available.
Crf Header
Beschreibung

Crf Header

Coordinating Group Protocol Number
Beschreibung

CoordinatingGroupProtocolNumber

Datentyp

text

Coordinating Group Code
Beschreibung

CoordinatingGroupCode

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25162
UMLS 2011AA ValueDomain
C0805701
Protocol Title
Beschreibung

Protocol Title

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C25320
UMLS CUI-1
C2986303
NCI Thesaurus Property
C42774
Patient Study ID, Coordinating Group
Beschreibung

PatientStudyID,CoordinatingGroup

Datentyp

text

Patient Study ID, Participating Group
Beschreibung

PatientStudyID,ParticipatingGroup

Datentyp

text

Participating Group Code
Beschreibung

ParticipatingGroupCode

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25162
UMLS 2011AA ValueDomain
C0805701
Institution Name
Beschreibung

InstitutionName

Datentyp

text

Affiliate Name
Beschreibung

AffiliateName

Datentyp

text

Patient Name, Last
Beschreibung

PatientName,Last

Datentyp

text

Patient Name, First
Beschreibung

PatientName,First

Datentyp

text

Patient Name, Middle
Beschreibung

PatientName,Middle

Datentyp

text

Melanoma: Treatment Cycle Information-systemic Therapy
Beschreibung

Melanoma: Treatment Cycle Information-systemic Therapy

Agent Name
Beschreibung

AgentName

Datentyp

text

Melanoma: Treatment Cycle-systemic Therapy
Beschreibung

Melanoma: Treatment Cycle-systemic Therapy

Course Begin Date
Beschreibung

Chemotherapy Cycle Start Date

Datentyp

date

Alias
UMLS CUI-1
C1302181
UMLS CUI-2
C3173309
Course Identification
Beschreibung

CourseIdentification

Datentyp

text

Agent Total Dose (per course)
Beschreibung

AgentTotalDose(percourse)

Datentyp

float

Agent Dose Units
Beschreibung

AgentDoseUnits

Datentyp

text

Agent Name
Beschreibung

AgentName

Datentyp

text

Melanoma: Treatment Cycle-vaccine Therapy
Beschreibung

Melanoma: Treatment Cycle-vaccine Therapy

Vaccine Date
Beschreibung

VaccineDate

Datentyp

date

Course Identification
Beschreibung

CourseIdentification

Datentyp

text

Vaccine Site
Beschreibung

VaccineSite

Datentyp

text

Agent Total Dose (per course)
Beschreibung

AgentTotalDose(percourse)

Datentyp

float

Vaccine Site, Other
Beschreibung

VaccineSite,Other

Datentyp

text

Agent Dose Units
Beschreibung

AgentDoseUnits

Datentyp

text

Agent Name
Beschreibung

AgentName

Datentyp

text

Melanoma: Treatment Modifications
Beschreibung

Melanoma: Treatment Modifications

Dose Modification (Change)
Beschreibung

DoseModification(Change)

Datentyp

text

Dose Modification Reason
Beschreibung

DoseModificationReason

Datentyp

text

Melanoma: Treatment Schedule-radiation Therapy
Beschreibung

Melanoma: Treatment Schedule-radiation Therapy

RT Begin Date
Beschreibung

RTBeginDate

Datentyp

date

Course Identification
Beschreibung

CourseIdentification

Datentyp

text

RT End Date
Beschreibung

RTEndDate

Datentyp

date

RT Site
Beschreibung

RTSite

Datentyp

text

RT Site, Other
Beschreibung

RTSite,Other

Datentyp

text

RT Total Dose
Beschreibung

RTTotalDose

Datentyp

float

RT Interruptions Ind
Beschreibung

RTInterruptionsInd

Datentyp

text

RT Interruptions Reason
Beschreibung

RTInterruptionsReason

Datentyp

text

Allows Documentation Of Any Additional Cooments
Beschreibung

Allows Documentation Of Any Additional Cooments

Comments
Beschreibung

Comments

Datentyp

text

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Ähnliche Modelle

No Instruction available.

1 Formulare
  1. StudyEvent: Melanoma-Treatment By Cycle Form
    1. No Instruction available.
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Crf Header
CoordinatingGroupProtocolNumber
Item
Coordinating Group Protocol Number
text
CoordinatingGroupCode
Item
Coordinating Group Code
text
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
Protocol Title
Item
Protocol Title
text
C25320 (NCI Thesaurus ObjectClass)
C2986303 (UMLS CUI-1)
C42774 (NCI Thesaurus Property)
PatientStudyID,CoordinatingGroup
Item
Patient Study ID, Coordinating Group
text
PatientStudyID,ParticipatingGroup
Item
Patient Study ID, Participating Group
text
ParticipatingGroupCode
Item
Participating Group Code
text
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
InstitutionName
Item
Institution Name
text
AffiliateName
Item
Affiliate Name
text
PatientName,Last
Item
Patient Name, Last
text
PatientName,First
Item
Patient Name, First
text
PatientName,Middle
Item
Patient Name, Middle
text
Item Group
Melanoma: Treatment Cycle Information-systemic Therapy
AgentName
Item
Agent Name
text
Item Group
Melanoma: Treatment Cycle-systemic Therapy
Chemotherapy Cycle Start Date
Item
Course Begin Date
date
C1302181 (UMLS CUI-1)
C3173309 (UMLS CUI-2)
CourseIdentification
Item
Course Identification
text
AgentTotalDose(percourse)
Item
Agent Total Dose (per course)
float
Item
Agent Dose Units
text
CL.3
Code List
Agent Dose Units
CL Item
Curie (Ci)
C0700085 (NCI Metathesaurus)
CL Item
Unit (unit)
C44278 (NCI Thesaurus)
C0439148 (UMLS 2011AA)
CL Item
Hertz (Hz)
CL Item
International Unit (IU)
C28255 (NCI Thesaurus)
CL Item
Joules Per Centimeter Square (JCM2)
CL Item
Liter (L)
CL Item
Megahertz (MHz)
CL Item
Milligrams Per Milliliter Per Minute (MMM)
CL Item
Million Electron Volts (MeV)
CL Item
Megarad (Mrad)
CL Item
Not Applicable (N/A)
C48660 (NCI Thesaurus)
C1272460 (UMLS 2011AA)
CL Item
Osmole (Osmol)
CL Item
Pascal (Pa)
C42547 (NCI Thesaurus)
C0439473 (UMLS 2011AA)
CL Item
Viral Particles (VP)
CL Item
Centimeter (cm)
C49668 (NCI Thesaurus)
C0475210 (UMLS 2011AA)
CL Item
Deciliter (dL)
CL Item
Decimeter (dm)
CL Item
Gram (g)
C0439208 (NCI Metathesaurus)
CL Item
Gravity (in Centrifugation) (gravity)
CL Item
Kilohertz (kHz)
CL Item
Kilopascal (kPa)
CL Item
Kilo-electron Volt (keV)
CL Item
Kilogram (kg)
C28252 (NCI Thesaurus)
C0439209 (UMLS 2011AA)
CL Item
Meter (m)
C0475209 (NCI Metathesaurus)
CL Item
Millicurie (mCi)
CL Item
Milliequivalent (mEq)
CL Item
Milliliter (mL)
C28254 (NCI Thesaurus)
C0439242 (UMLS 2011AA)
CL Item
Milliosmole (mOsmol)
CL Item
Million Unit (mU)
CL Item
Millivolt (mV)
C0456691 (NCI Metathesaurus)
CL Item
Microcurie (mcCi)
CL Item
Microliter (mcL)
CL Item
Microgram (mcg)
CL Item
Micrometer (mcm)
CL Item
Milligram (mg)
C28253 (NCI Thesaurus)
C0439210 (UMLS 2011AA)
CL Item
Milliunit (milliunit)
CL Item
Millimeter (mm)
C28251 (NCI Thesaurus)
C0439200 (UMLS 2011AA)
CL Item
Millimole (mmol)
CL Item
Gram-molecular Weight (mole) (mol)
CL Item
Nanocurie (nCi)
C0560007 (NCI Metathesaurus)
CL Item
Nanogram (ng)
CL Item
Nanometer (nm)
C0439202 (NCI Metathesaurus)
CL Item
Nanometers Of Light (nm light)
CL Item
Plaque Forming Unit (pfu)
CL Item
Picogram (pg)
C0439213 (NCI Metathesaurus)
CL Item
Pounds Per Square Inch (psi)
C0439472 (NCI Metathesaurus)
CL Item
Gram-equivalent Weight (Eq)
AgentName
Item
Agent Name
text
Item Group
Melanoma: Treatment Cycle-vaccine Therapy
VaccineDate
Item
Vaccine Date
date
CourseIdentification
Item
Course Identification
text
Item
Vaccine Site
text
CL.2
Code List
Vaccine Site
CL Item
Left Lower Extremity (left lower extremity)
CL Item
Left Upper Extremity (left upper extremity)
CL Item
Trunk (trunk)
C33816 (NCI Thesaurus)
C0460005 (UMLS 2011AA)
CL Item
Right Lower Extremity (right lower extremity)
CL Item
Right Upper Extremity (right upper extremity)
CL Item
Other, Specify (other, specify)
AgentTotalDose(percourse)
Item
Agent Total Dose (per course)
float
VaccineSite,Other
Item
Vaccine Site, Other
text
Item
Agent Dose Units
text
CL.3
Code List
Agent Dose Units
CL Item
Curie (Ci)
C0700085 (NCI Metathesaurus)
CL Item
Unit (unit)
C44278 (NCI Thesaurus)
C0439148 (UMLS 2011AA)
CL Item
Hertz (Hz)
CL Item
International Unit (IU)
C28255 (NCI Thesaurus)
CL Item
Joules Per Centimeter Square (JCM2)
CL Item
Liter (L)
CL Item
Megahertz (MHz)
CL Item
Milligrams Per Milliliter Per Minute (MMM)
CL Item
Million Electron Volts (MeV)
CL Item
Megarad (Mrad)
CL Item
Not Applicable (N/A)
C48660 (NCI Thesaurus)
C1272460 (UMLS 2011AA)
CL Item
Osmole (Osmol)
CL Item
Pascal (Pa)
C42547 (NCI Thesaurus)
C0439473 (UMLS 2011AA)
CL Item
Viral Particles (VP)
CL Item
Centimeter (cm)
C49668 (NCI Thesaurus)
C0475210 (UMLS 2011AA)
CL Item
Deciliter (dL)
CL Item
Decimeter (dm)
CL Item
Gram (g)
C0439208 (NCI Metathesaurus)
CL Item
Gravity (in Centrifugation) (gravity)
CL Item
Kilohertz (kHz)
CL Item
Kilopascal (kPa)
CL Item
Kilo-electron Volt (keV)
CL Item
Kilogram (kg)
C28252 (NCI Thesaurus)
C0439209 (UMLS 2011AA)
CL Item
Meter (m)
C0475209 (NCI Metathesaurus)
CL Item
Millicurie (mCi)
CL Item
Milliequivalent (mEq)
CL Item
Milliliter (mL)
C28254 (NCI Thesaurus)
C0439242 (UMLS 2011AA)
CL Item
Milliosmole (mOsmol)
CL Item
Million Unit (mU)
CL Item
Millivolt (mV)
C0456691 (NCI Metathesaurus)
CL Item
Microcurie (mcCi)
CL Item
Microliter (mcL)
CL Item
Microgram (mcg)
CL Item
Micrometer (mcm)
CL Item
Milligram (mg)
C28253 (NCI Thesaurus)
C0439210 (UMLS 2011AA)
CL Item
Milliunit (milliunit)
CL Item
Millimeter (mm)
C28251 (NCI Thesaurus)
C0439200 (UMLS 2011AA)
CL Item
Millimole (mmol)
CL Item
Gram-molecular Weight (mole) (mol)
CL Item
Nanocurie (nCi)
C0560007 (NCI Metathesaurus)
CL Item
Nanogram (ng)
CL Item
Nanometer (nm)
C0439202 (NCI Metathesaurus)
CL Item
Nanometers Of Light (nm light)
CL Item
Plaque Forming Unit (pfu)
CL Item
Picogram (pg)
C0439213 (NCI Metathesaurus)
CL Item
Pounds Per Square Inch (psi)
C0439472 (NCI Metathesaurus)
CL Item
Gram-equivalent Weight (Eq)
AgentName
Item
Agent Name
text
Item Group
Melanoma: Treatment Modifications
Item
Dose Modification (Change)
text
CL.4
Code List
Dose Modification (Change)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
(i.e., The Treatment Change Was Not Part Of Protocol Guidelines) (Yes, unplanned)
CL Item
(i.e., The Treatment Was Changed According To Protocol Guidelines) (Yes, planned)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
DoseModificationReason
Item
Dose Modification Reason
text
Item Group
Melanoma: Treatment Schedule-radiation Therapy
RTBeginDate
Item
RT Begin Date
date
CourseIdentification
Item
Course Identification
text
RTEndDate
Item
RT End Date
date
Item
RT Site
text
CL.5
Code List
RT Site
CL Item
Bone (Bone)
C12366 (NCI Thesaurus)
C0262950 (UMLS 2011AA)
CL Item
Brain (Brain)
C12439 (NCI Thesaurus)
C0006104 (UMLS 2011AA)
CL Item
Other, Specify (Other, specify)
CL Item
Lymph Nodes (soft Tissue) (Lymph nodes (soft tissue))
CL Item
Head And Neck (Head and Neck)
C12418 (NCI Thesaurus)
C0460004 (UMLS 2011AA)
RTSite,Other
Item
RT Site, Other
text
RTTotalDose
Item
RT Total Dose
float
Item
RT Interruptions Ind
text
CL.6
Code List
RT Interruptions Ind
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes, For Other Reasons, Specify (Yes, for other reasons, specify)
CL Item
Yes, Due To Toxicity (Yes, due to toxicity)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
RTInterruptionsReason
Item
RT Interruptions Reason
text
Item Group
Allows Documentation Of Any Additional Cooments
Comments
Item
Comments
text
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