ID

15964

Description

informed consent discussion Melanoma NCT00000000 To be conducted during the first inpatient stay or on the first outpatient visit. Not in the presence oof other patients independent from visit, if possible with reference person.

Keywords

Versions (4)
  1. 6/21/16 6/21/16 -
  2. 6/22/16 6/22/16 -
  3. 6/27/16 6/27/16 -
  4. 7/16/16 7/16/16 -
Uploaded on

June 21, 2016

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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informed consent discussion Melanoma NCT00000000

English

informed consent discussion Melanoma NCT00000000

1 forms  
Meta Information
Description

Meta Information

Informed Consent discussion conducted with
Description

Patient Name

Data type

text

Alias
UMLS CUI [1]
C1299487
Consulting Physician
Description

if Other, please specify

Data type

integer

Alias
UMLS CUI [1]
C1441532
Other Consulting physician
Description

Consulting Physician

Data type

text

Alias
UMLS CUI [1]
C1441532
Date of Informed Consent Discussion
Description

Date of Informed Consent Discussion

Data type

date

Alias
UMLS CUI [1,1]
C0557061
UMLS CUI [1,2]
C0021430
UMLS CUI [1,3]
C0011008
Results of investigations complete on the first discussion
Description

In case of missing results please specify. In that case an additional postponed Discussion will be necessary.

Data type

boolean

Alias
UMLS CUI [1,1]
C0582103
UMLS CUI [1,2]
C0205197
Missing Examination results
Description

Missing Examination results

Data type

text

Alias
UMLS CUI [1,1]
C0582103
UMLS CUI [1,2]
C1705492
Discussion participant
Description

In case of Participation of none but the patient themselves: Another discusssion with trusted people participating was suggested and offered.

Data type

integer

Alias
UMLS CUI [1,1]
C0679646
UMLS CUI [1,2]
C0557061
Other Participant
Description

Other Informed Consent Discussion participant

Data type

text

Alias
UMLS CUI [1,1]
C0557061
UMLS CUI [1,2]
C0021430
UMLS CUI [1,3]
C0679646
Complete education desired
Description

Complete education desired

Data type

boolean

Alias
UMLS CUI [1,1]
C0030688
UMLS CUI [1,2]
C0205197
UMLS CUI [1,3]
C0871633
Diagnosis and Extent discussed with patient
Description

Diagnosis and Extent discussed

Data type

boolean

Alias
UMLS CUI [1,1]
C0011900
UMLS CUI [1,2]
C0439792
UMLS CUI [1,3]
C0557061
Comment
Description

Comment

Data type

text

Alias
UMLS CUI [1]
C0947611
Other items discussed with the patient
Description

Other items discussed with the patient

Data type

text

Alias
UMLS CUI [1]
C0205394
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Similar models

informed consent discussion Melanoma NCT00000000

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Meta Information
Patient Name
Item
Informed Consent discussion conducted with
text
C1299487 (UMLS CUI [1])
Item
Consulting Physician
integer
C1441532 (UMLS CUI [1])
Consulting Physician
Code List
Consulting Physician
CL Item
Prof Sunderkötter (1)
CL Item
Dr. Weishaupt (2)
CL Item
Prof. Metze (3)
CL Item
Dr. Seller (4)
CL Item
Other (5)
Consulting Physician
Item
Other Consulting physician
text
C1441532 (UMLS CUI [1])
Date of Informed Consent Discussion
Item
Date of Informed Consent Discussion
date
C0557061 (UMLS CUI [1,1])
C0021430 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
Results of investigations complete
Item
Results of investigations complete on the first discussion
boolean
C0582103 (UMLS CUI [1,1])
C0205197 (UMLS CUI [1,2])
Missing Examination results
Item
Missing Examination results
text
C0582103 (UMLS CUI [1,1])
C1705492 (UMLS CUI [1,2])
Item
Discussion participant
integer
C0679646 (UMLS CUI [1,1])
C0557061 (UMLS CUI [1,2])
Discussion participant
Code List
Discussion participant
CL Item
Spouse (1)
CL Item
Children (2)
CL Item
Other (3)
CL Item
Only Patient (4)
Other Informed Consent Discussion participant
Item
Other Participant
text
C0557061 (UMLS CUI [1,1])
C0021430 (UMLS CUI [1,2])
C0679646 (UMLS CUI [1,3])
Complete education desired
Item
Complete education desired
boolean
C0030688 (UMLS CUI [1,1])
C0205197 (UMLS CUI [1,2])
C0871633 (UMLS CUI [1,3])
Diagnosis and Extent discussed
Item
Diagnosis and Extent discussed with patient
boolean
C0011900 (UMLS CUI [1,1])
C0439792 (UMLS CUI [1,2])
C0557061 (UMLS CUI [1,3])
Comment
Item
Comment
text
C0947611 (UMLS CUI [1])
Other items discussed with the patient
Item
Other items discussed with the patient
text
C0205394 (UMLS CUI [1])
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