ID

6908

Beschrijving

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

Trefwoorden

Versies (2)
  1. 19-09-12 19-09-12 -
  2. 08-01-15 08-01-15 - Martin Dugas
Geüploaded op

8 januari 2015

DOI

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Licentie

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

Engels

No Instruction available.

1 Formulieren  
  1. StudyEvent: Melanoma-Treatment By Cycle Form
    1. No Instruction available.
Crf Header
Beschrijving

Crf Header

Coordinating Group Protocol Number
Beschrijving

CoordinatingGroupProtocolNumber

Datatype

text

Coordinating Group Code
Beschrijving

CoordinatingGroupCode

Datatype

text

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

Protocol Title

Datatype

text

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

PatientStudyID,CoordinatingGroup

Datatype

text

Patient Study ID, Participating Group
Beschrijving

PatientStudyID,ParticipatingGroup

Datatype

text

Participating Group Code
Beschrijving

ParticipatingGroupCode

Datatype

text

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

InstitutionName

Datatype

text

Affiliate Name
Beschrijving

AffiliateName

Datatype

text

Patient Name, Last
Beschrijving

PatientName,Last

Datatype

text

Patient Name, First
Beschrijving

PatientName,First

Datatype

text

Patient Name, Middle
Beschrijving

PatientName,Middle

Datatype

text

Melanoma: Treatment Cycle Information-systemic Therapy
Beschrijving

Melanoma: Treatment Cycle Information-systemic Therapy

Agent Name
Beschrijving

AgentName

Datatype

text

Melanoma: Treatment Cycle-systemic Therapy
Beschrijving

Melanoma: Treatment Cycle-systemic Therapy

Course Begin Date
Beschrijving

Chemotherapy Cycle Start Date

Datatype

date

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

CourseIdentification

Datatype

text

Agent Total Dose (per course)
Beschrijving

AgentTotalDose(percourse)

Datatype

float

Agent Dose Units
Beschrijving

AgentDoseUnits

Datatype

text

Agent Name
Beschrijving

AgentName

Datatype

text

Melanoma: Treatment Cycle-vaccine Therapy
Beschrijving

Melanoma: Treatment Cycle-vaccine Therapy

Vaccine Date
Beschrijving

VaccineDate

Datatype

date

Course Identification
Beschrijving

CourseIdentification

Datatype

text

Vaccine Site
Beschrijving

VaccineSite

Datatype

text

Agent Total Dose (per course)
Beschrijving

AgentTotalDose(percourse)

Datatype

float

Vaccine Site, Other
Beschrijving

VaccineSite,Other

Datatype

text

Agent Dose Units
Beschrijving

AgentDoseUnits

Datatype

text

Agent Name
Beschrijving

AgentName

Datatype

text

Melanoma: Treatment Modifications
Beschrijving

Melanoma: Treatment Modifications

Dose Modification (Change)
Beschrijving

DoseModification(Change)

Datatype

text

Dose Modification Reason
Beschrijving

DoseModificationReason

Datatype

text

Melanoma: Treatment Schedule-radiation Therapy
Beschrijving

Melanoma: Treatment Schedule-radiation Therapy

RT Begin Date
Beschrijving

RTBeginDate

Datatype

date

Course Identification
Beschrijving

CourseIdentification

Datatype

text

RT End Date
Beschrijving

RTEndDate

Datatype

date

RT Site
Beschrijving

RTSite

Datatype

text

RT Site, Other
Beschrijving

RTSite,Other

Datatype

text

RT Total Dose
Beschrijving

RTTotalDose

Datatype

float

RT Interruptions Ind
Beschrijving

RTInterruptionsInd

Datatype

text

RT Interruptions Reason
Beschrijving

RTInterruptionsReason

Datatype

text

Allows Documentation Of Any Additional Cooments
Beschrijving

Allows Documentation Of Any Additional Cooments

Comments
Beschrijving

Comments

Datatype

text

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Similar models

No Instruction available.

1 Formulieren
  1. StudyEvent: Melanoma-Treatment By Cycle Form
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Datatype
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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