ID

9373

Descripción

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

Link

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

Palabras clave

Versiones (4)
  1. 18/12/14 18/12/14 - Martin Dugas
  2. 9/1/15 9/1/15 - Martin Dugas
  3. 5/7/15 5/7/15 -
  4. 25/7/15 25/7/15 - Martin Dugas
Subido en

9 de enero de 2015

DOI

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Licencia

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

Inglés

No Instruction available.

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

Unnamed 1

SWOG Patient ID
Descripción

SWOGPatientID

Tipo de datos

text

Patient Initials (L, F M)
Descripción

Patient Initials

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986440
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25536
Institution/Affiliate
Descripción

MainMemberInstitution/Affiliate

Tipo de datos

text

Physician (Groups other than SWOG)
Descripción

TreatingPhysician

Tipo de datos

text

Alias
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ObjectClass
C25741
UMLS 2011AA ObjectClass
C0031831
NCI Thesaurus ObjectClass-2
C25705
UMLS 2011AA ObjectClass-2
C1522326
Group Name
Descripción

ParticipatingGroupName

Tipo de datos

text

Study No.
Descripción

StudyNo.

Tipo de datos

text

Pt. ID
Descripción

Pt.ID

Tipo de datos

text

Patient Characteristics
Descripción

Patient Characteristics

Height
Descripción

PatientHeight

Tipo de datos

float

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

PatientWeight

Tipo de datos

float

BSA
Descripción

BodySurfaceArea

Tipo de datos

float

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

PerformanceStatus

Tipo de datos

text

Hla Status
Descripción

Hla Status

HLA Type
Descripción

HLAType

Tipo de datos

text

Date of HLA typing
Descripción

DateofHLAtyping

Tipo de datos

text

Specify HLA tissue typing kit used
Descripción

SpecifyHLAtissuetypingkitused

Tipo de datos

text

Primary Tumor
Descripción

Primary Tumor

Date of initial pathologic diagnosis
Descripción

InitialDiagnosisDate,Pathologic

Tipo de datos

date

Site
Descripción

PrimarySite

Tipo de datos

text

Ulceration present?
Descripción

UlcerationInd

Tipo de datos

text

Breslow thickness
Descripción

BreslowDepth

Tipo de datos

float

Clark level of invasion
Descripción

ClarkLevel

Tipo de datos

text

Regional Lymph Node Metastases
Descripción

RegionalLymphNodeMetastases

Tipo de datos

text

If yes, date of first diagnosis
Descripción

InitialDiagnosisDate,Metastatic

Tipo de datos

date

Total number of nodes examined
Descripción

LymphNode(s)ExaminedNumber

Tipo de datos

float

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

LymphNode(s)PositiveNumber

Tipo de datos

float

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

Comments

Tipo de datos

text

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

Ccrr Module For Southwest Oncology Group S0201 Adjuvant Melanoma Prestudy Form

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Similar models

No Instruction available.

1 formularios
  1. StudyEvent: Southwest Oncology Group S0201 Adjuvant Melanoma Prestudy Form
    1. No Instruction available.
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
Unnamed 1
SWOGPatientID
Item
SWOG Patient ID
text
Patient Initials
Item
Patient Initials (L, F M)
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus 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-2)
C1522326 (UMLS 2011AA ObjectClass-2)
ParticipatingGroupName
Item
Group Name
text
StudyNo.
Item
Study No.
text
Pt.ID
Item
Pt. ID
text
Item Group
Patient Characteristics
PatientHeight
Item
Height
float
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25347 (NCI Thesaurus Property)
C0489786 (UMLS 2011AA Property)
PatientWeight
Item
Weight
float
BodySurfaceArea
Item
BSA
float
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
float
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
float
C25500 (NCI Thesaurus Property)
C0332128 (UMLS 2011AA Property)
C12745 (NCI Thesaurus ObjectClass)
C0024204 (UMLS 2011AA ObjectClass)
LymphNode(s)PositiveNumber
Item
Number of positive nodes
float
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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