ID

18972

Description

AMC-051 Physical Exam Form (RK2) Sirolimus in Treating Patients With HIV-Related Kaposi's Sarcoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=2FF95103-FCC6-6437-E044-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=2FF95103-FCC6-6437-E044-0003BA3F9857

Keywords

Versions (2)
  1. 9/19/12 9/19/12 -
  2. 11/27/16 11/27/16 - Martin Dugas
Uploaded on

November 27, 2016

DOI

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Creative Commons BY-NC 3.0
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AMC-051 Physical Exam Form (RK2)

English

No Instruction available.

1 forms  
  1. StudyEvent: AMC-051 Physical Exam Form (RK2)
    1. No Instruction available.
Header Module
Description

Header Module

Alias
UMLS CUI-1
C1320722
Visit number
Description

Hospital Admission Number

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
NCI Thesaurus ObjectClass
C16696
NCI Thesaurus Property
C25385
UMLS CUI [1]
C1549755
EVALUATION OF CUTANEOUS LESIONS
Description

EVALUATION OF CUTANEOUS LESIONS

At entry, does the participant have >=50 lesions
Description

Kaposi Sarcoma malignant cutaneous Neoplasms

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C9305
NCI Thesaurus ObjectClass-2
C9087
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C13316
NCI Thesaurus ValueDomain
C38147
UMLS CUI [1,1]
C0036220
UMLS CUI [1,2]
C0221912
Kaposi Sarcoma Anatomic Site
Description

Kaposi Sarcoma Anatomic Site

Data type

text

Alias
NCI Thesaurus ObjectClass
C9305
NCI Thesaurus ObjectClass-2
C9087
NCI Thesaurus Property
C25341
NCI Thesaurus Property-2
C13316
NCI Thesaurus Property-3
C25421
NCI Thesaurus ValueDomain
C37901
UMLS CUI [1,1]
C0036220
UMLS CUI [1,2]
C0450429
UMLS CUI [1,3]
C0221912
Total Number Raised Lesions
Description

KaposiSarcomaMalignantNeoplasmElevatedCount

Data type

integer

Alias
NCI Thesaurus ObjectClass
C9305
NCI Thesaurus ObjectClass-2
C9087
NCI Thesaurus Property
C25493
NCI Thesaurus Property-2
C25256
NCI Thesaurus ValueDomain
C25463
UMLS CUI [1,1]
C0006826
UMLS CUI [1,2]
C0036220
UMLS CUI [1,3]
C0205250
UMLS CUI [1,4]
C1265611
UMLS CUI [1,5]
C0750480
Total Number Flat Lesions
Description

KaposiSarcomaMalignantNeoplasmFlatCount

Data type

integer

Alias
NCI Thesaurus ObjectClass
C9305
NCI Thesaurus ObjectClass-2
C9087
NCI Thesaurus Property
C25256
NCI Metathesaurus Property
C0205324
NCI Thesaurus ValueDomain
C25463
UMLS CUI [1,1]
C0006826
UMLS CUI [1,2]
C0036220
UMLS CUI [1,3]
C1265611
UMLS CUI [1,4]
C0750480
Total Number New Lesions
Description

KaposiSarcomaMalignantNeoplasmNewCount

Data type

integer

Alias
NCI Thesaurus ObjectClass
C9305
NCI Thesaurus ObjectClass-2
C9087
NCI Thesaurus Property
C25586
NCI Thesaurus Property-2
C25256
NCI Thesaurus ValueDomain
C25463
UMLS CUI [1,1]
C0006826
UMLS CUI [1,2]
C0036220
UMLS CUI [1,3]
C0205314
UMLS CUI [1,4]
C1265611
UMLS CUI [1,5]
C0750480
Number of cutaneous lesions
Description

KaposiSarcomaNumberMalignantNeoplasmCutaneousAssessmentStatus

Data type

text

Alias
NCI Thesaurus ObjectClass
C25337
UMLS 2011AA ObjectClass
C0237753
NCI Thesaurus ObjectClass-2
C9305
UMLS 2011AA ObjectClass-2
C0006826
NCI Thesaurus ObjectClass-3
C9087
UMLS 2011AA ObjectClass-3
C0036220
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C13316
UMLS 2011AA Property
C0221912
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
Character of cutaneous lesions
Description

KaposiSarcomaMalignantNeoplasmCutaneousAssessmentStatus

Data type

text

Alias
NCI Thesaurus ObjectClass
C9305
UMLS 2011AA ObjectClass
C0006826
NCI Thesaurus ObjectClass-2
C9087
UMLS 2011AA ObjectClass-2
C0036220
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C13316
UMLS 2011AA Property
C0221912
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
EVALUATION OF MARKER LESIONS
Description

EVALUATION OF MARKER LESIONS

Representative Area
Description

KaposiSarcomaMalignantNeoplasmDiseaseMarkerAnatomicSite

Data type

text

Alias
NCI Thesaurus ObjectClass
C9305
UMLS 2011AA ObjectClass
C0006826
NCI Thesaurus ObjectClass-2
C9087
UMLS 2011AA ObjectClass-2
C0036220
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus Property-2
C18329
UMLS 2011AA Property-2
C1511983
NCI Thesaurus Property-3
C25421
UMLS 2011AA Property-3
C0002808
NCI Thesaurus ValueDomain
C37901
UMLS 2011AA ValueDomain
C0205145
Specify
Description

KaposiSarcomaMalignantNeoplasmDiseaseMarkerAnatomicLocationSpecify

Data type

text

Alias
NCI Thesaurus ObjectClass
C9305
UMLS 2011AA ObjectClass
C0006826
NCI Thesaurus ObjectClass-2
C9087
UMLS 2011AA ObjectClass-2
C0036220
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus Property-2
C18329
UMLS 2011AA Property-2
C1511983
NCI Thesaurus Property-3
C25421
UMLS 2011AA Property-3
C0002808
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
Dimension 1
Description

Tumor Largest Dimension Measurement

Data type

float

Measurement units
  • cm
Alias
NCI Thesaurus ValueDomain
C25209
NCI Thesaurus ObjectClass
C3262
NCI Thesaurus Property
C25550
NCI Thesaurus Property-2
C25483
UMLS CUI [1,1]
C0242485
UMLS CUI [1,2]
C0027651
UMLS CUI [1,3]
C0443228
UMLS CUI [1,4]
C0439534
cm
Dimension 2
Description

TumorSecondDimensionMeasurement

Data type

float

Measurement units
  • cm
Alias
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
NCI Thesaurus ObjectClass
C3262
UMLS 2011AA ObjectClass
C0027651
NCI Thesaurus Property
C25666
UMLS 2011AA Property
C0205436
NCI Thesaurus Property-2
C25483
UMLS 2011AA Property-2
C0439534
cm
Product of Diameters
Description

MalignantNeoplasmProductDimensionMeasurement

Data type

float

Alias
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
NCI Thesaurus ObjectClass
C9305
UMLS 2011AA ObjectClass
C0006826
NCI Thesaurus Property
C25483
UMLS 2011AA Property
C0439534
NCI Thesaurus Property-2
C40352
UMLS 2011AA Property-2
C1704444
Photos Taken
Description

Patient Photograph Malignant Neoplasm Assessment

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C9305
NCI Thesaurus Property-3
C86035
NCI Thesaurus ValueDomain
C38147
UMLS CUI [1,1]
C0030705
UMLS CUI [1,2]
C0006826
UMLS CUI [1,3]
C0441468
Sum of Products of Greatest Diameters
Description

SumLesionDiameterProductMeasurement

Data type

float

Alias
NCI Thesaurus ObjectClass
C3824
UMLS 2011AA ObjectClass
C0221198
NCI Thesaurus ObjectClass-2
C25697
UMLS 2011AA ObjectClass-2
C1515051
NCI Thesaurus Property
C25285
UMLS 2011AA Property
C1301886
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
NCI Thesaurus ValueDomain-2
C40352
UMLS 2011AA ValueDomain-2
C1704444
Evaluation of Marker Lesions
Description

KaposiSarcomaMalignantNeoplasmDiseaseMarkerAssessmentStatus

Data type

text

Alias
NCI Thesaurus ObjectClass
C9305
UMLS 2011AA ObjectClass
C0006826
NCI Thesaurus ObjectClass-2
C9087
UMLS 2011AA ObjectClass-2
C0036220
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C18329
UMLS 2011AA Property
C1511983
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
Footer Module
Description

Footer Module

Comments
Description

ResearchCommentsText

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
UMLS 2011AA Property
C0282411
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1 forms
  1. StudyEvent: AMC-051 Physical Exam Form (RK2)
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Header Module
C1320722 (UMLS CUI-1)
Hospital Admission Number
Item
Visit number
text
C25337 (NCI Thesaurus ValueDomain)
C16696 (NCI Thesaurus ObjectClass)
C25385 (NCI Thesaurus Property)
C1549755 (UMLS CUI [1])
Item Group
EVALUATION OF CUTANEOUS LESIONS
Kaposi Sarcoma malignant cutaneous Neoplasms
Item
At entry, does the participant have >=50 lesions
boolean
C9305 (NCI Thesaurus ObjectClass)
C9087 (NCI Thesaurus ObjectClass-2)
C25367 (NCI Thesaurus Property)
C13316 (NCI Thesaurus Property-2)
C38147 (NCI Thesaurus ValueDomain)
C0036220 (UMLS CUI [1,1])
C0221912 (UMLS CUI [1,2])
Item
Kaposi Sarcoma Anatomic Site
text
C9305 (NCI Thesaurus ObjectClass)
C9087 (NCI Thesaurus ObjectClass-2)
C25341 (NCI Thesaurus Property)
C13316 (NCI Thesaurus Property-2)
C25421 (NCI Thesaurus Property-3)
C37901 (NCI Thesaurus ValueDomain)
C0036220 (UMLS CUI [1,1])
C0450429 (UMLS CUI [1,2])
C0221912 (UMLS CUI [1,3])
CL.2
Code List
Kaposi Sarcoma Anatomic Site
CL Item
Abdomen (Abdomen)
C12664 (NCI Thesaurus)
C0000726 (UMLS CUI-1)
CL Item
Back (Back)
C13062 (NCI Thesaurus)
C0205095 (UMLS CUI-1)
CL Item
Chest (Chest)
C25389 (NCI Thesaurus)
C0817096 (UMLS CUI-1)
CL Item
Genital Area (Genital)
C0437955 (UMLS CUI-1)
CL Item
Head (Head)
C12419 (NCI Thesaurus)
C0018670 (UMLS CUI-1)
CL Item
Left Arm (Left arm)
C0230347 (UMLS CUI-1)
CL Item
Left Foot (Left foot)
C0230461 (UMLS CUI-1)
CL Item
Left Hand (Left hand)
C0230371 (UMLS CUI-1)
CL Item
Left Leg (Left leg)
C0230443 (UMLS CUI-1)
CL Item
Neck (Neck)
C13063 (NCI Thesaurus)
C0027530 (UMLS CUI-1)
CL Item
Periorbital (Periorbital)
C0230064 (UMLS CUI-1)
CL Item
Right Arm (Right arm)
C0230346 (UMLS CUI-1)
CL Item
Right Foot (Right foot)
C0230460 (UMLS CUI-1)
CL Item
Right Hand (Right hand)
C0230370 (UMLS CUI-1)
CL Item
Right Leg (Right leg)
C0230442 (UMLS CUI-1)
CL Item
Total Body (Total body)
C0229960 (UMLS CUI-1)
KaposiSarcomaMalignantNeoplasmElevatedCount
Item
Total Number Raised Lesions
integer
C9305 (NCI Thesaurus ObjectClass)
C9087 (NCI Thesaurus ObjectClass-2)
C25493 (NCI Thesaurus Property)
C25256 (NCI Thesaurus Property-2)
C25463 (NCI Thesaurus ValueDomain)
C0006826 (UMLS CUI [1,1])
C0036220 (UMLS CUI [1,2])
C0205250 (UMLS CUI [1,3])
C1265611 (UMLS CUI [1,4])
C0750480 (UMLS CUI [1,5])
KaposiSarcomaMalignantNeoplasmFlatCount
Item
Total Number Flat Lesions
integer
C9305 (NCI Thesaurus ObjectClass)
C9087 (NCI Thesaurus ObjectClass-2)
C25256 (NCI Thesaurus Property)
C0205324 (NCI Metathesaurus Property)
C25463 (NCI Thesaurus ValueDomain)
C0006826 (UMLS CUI [1,1])
C0036220 (UMLS CUI [1,2])
C1265611 (UMLS CUI [1,3])
C0750480 (UMLS CUI [1,4])
KaposiSarcomaMalignantNeoplasmNewCount
Item
Total Number New Lesions
integer
C9305 (NCI Thesaurus ObjectClass)
C9087 (NCI Thesaurus ObjectClass-2)
C25586 (NCI Thesaurus Property)
C25256 (NCI Thesaurus Property-2)
C25463 (NCI Thesaurus ValueDomain)
C0006826 (UMLS CUI [1,1])
C0036220 (UMLS CUI [1,2])
C0205314 (UMLS CUI [1,3])
C1265611 (UMLS CUI [1,4])
C0750480 (UMLS CUI [1,5])
Item
Number of cutaneous lesions
text
C25337 (NCI Thesaurus ObjectClass)
C0237753 (UMLS 2011AA ObjectClass)
C9305 (NCI Thesaurus ObjectClass-2)
C0006826 (UMLS 2011AA ObjectClass-2)
C9087 (NCI Thesaurus ObjectClass-3)
C0036220 (UMLS 2011AA ObjectClass-3)
C25367 (NCI Thesaurus Property)
C13316 (NCI Thesaurus Property-2)
C0221912 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.3
Code List
Number of cutaneous lesions
CL Item
Complete Resolution (Complete resolution)
CL Item
None Of The Above (None of the above)
CL Item
at least 25% Increase In The Number Of Lesions Since Baseline Or Since Best Response (25 percent)
CL Item
at least 50% Decrease In The Number Of Lesions Since Baseline (50 percent)
Item
Character of cutaneous lesions
text
C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C9087 (NCI Thesaurus ObjectClass-2)
C0036220 (UMLS 2011AA ObjectClass-2)
C25367 (NCI Thesaurus Property)
C13316 (NCI Thesaurus Property-2)
C0221912 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.4
Code List
Character of cutaneous lesions
CL Item
Since Baseline, >=50% Of Raised Have Become Flat (Since baseline, >=50% of raised have become flat)
CL Item
>=25% Increase In The Number Of Raised Lesions (>=25% increase in the number of raised lesions)
CL Item
None Of The Above (None of the above)
Item Group
EVALUATION OF MARKER LESIONS
Item
Representative Area
text
C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C9087 (NCI Thesaurus ObjectClass-2)
C0036220 (UMLS 2011AA ObjectClass-2)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C18329 (NCI Thesaurus Property-2)
C1511983 (UMLS 2011AA Property-2)
C25421 (NCI Thesaurus Property-3)
C0002808 (UMLS 2011AA Property-3)
C37901 (NCI Thesaurus ValueDomain)
C0205145 (UMLS 2011AA ValueDomain)
CL.5
Code List
Representative Area
CL Item
Abdomen (Abdomen)
C12664 (NCI Thesaurus)
C0230168 (UMLS 2011AA)
CL Item
Back (Back)
C13062 (NCI Thesaurus)
C0205095 (UMLS 2011AA)
CL Item
Chest (Chest)
C25389 (NCI Thesaurus)
C0817096 (UMLS 2011AA)
CL Item
Genital Area (Genital)
CL Item
Head (Head)
C12419 (NCI Thesaurus)
C0018670 (UMLS 2011AA)
CL Item
Left Arm (Left arm)
CL Item
Left Foot (Left foot)
CL Item
Left Hand (Left hand)
CL Item
Left Leg (Left leg)
CL Item
Neck (Neck)
C13063 (NCI Thesaurus)
C0027530 (UMLS 2011AA)
CL Item
Periorbital (Periorbital)
CL Item
Right Arm (Right arm)
CL Item
Right Foot (Right foot)
CL Item
Right Hand (Right hand)
CL Item
Right Leg (Right leg)
CL Item
Total Body (Total body)
KaposiSarcomaMalignantNeoplasmDiseaseMarkerAnatomicLocationSpecify
Item
Specify
text
C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C9087 (NCI Thesaurus ObjectClass-2)
C0036220 (UMLS 2011AA ObjectClass-2)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C18329 (NCI Thesaurus Property-2)
C1511983 (UMLS 2011AA Property-2)
C25421 (NCI Thesaurus Property-3)
C0002808 (UMLS 2011AA Property-3)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
Tumor Largest Dimension Measurement
Item
Dimension 1
float
C25209 (NCI Thesaurus ValueDomain)
C3262 (NCI Thesaurus ObjectClass)
C25550 (NCI Thesaurus Property)
C25483 (NCI Thesaurus Property-2)
C0242485 (UMLS CUI [1,1])
C0027651 (UMLS CUI [1,2])
C0443228 (UMLS CUI [1,3])
C0439534 (UMLS CUI [1,4])
TumorSecondDimensionMeasurement
Item
Dimension 2
float
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C25666 (NCI Thesaurus Property)
C0205436 (UMLS 2011AA Property)
C25483 (NCI Thesaurus Property-2)
C0439534 (UMLS 2011AA Property-2)
MalignantNeoplasmProductDimensionMeasurement
Item
Product of Diameters
float
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C25483 (NCI Thesaurus Property)
C0439534 (UMLS 2011AA Property)
C40352 (NCI Thesaurus Property-2)
C1704444 (UMLS 2011AA Property-2)
Patient Photograph Malignant Neoplasm Assessment
Item
Photos Taken
boolean
C16960 (NCI Thesaurus ObjectClass)
C25367 (NCI Thesaurus Property)
C9305 (NCI Thesaurus Property-2)
C86035 (NCI Thesaurus Property-3)
C38147 (NCI Thesaurus ValueDomain)
C0030705 (UMLS CUI [1,1])
C0006826 (UMLS CUI [1,2])
C0441468 (UMLS CUI [1,3])
SumLesionDiameterProductMeasurement
Item
Sum of Products of Greatest Diameters
float
C3824 (NCI Thesaurus ObjectClass)
C0221198 (UMLS 2011AA ObjectClass)
C25697 (NCI Thesaurus ObjectClass-2)
C1515051 (UMLS 2011AA ObjectClass-2)
C25285 (NCI Thesaurus Property)
C1301886 (UMLS 2011AA Property)
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
C40352 (NCI Thesaurus ValueDomain-2)
C1704444 (UMLS 2011AA ValueDomain-2)
Item
Evaluation of Marker Lesions
text
C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C9087 (NCI Thesaurus ObjectClass-2)
C0036220 (UMLS 2011AA ObjectClass-2)
C25367 (NCI Thesaurus Property)
C18329 (NCI Thesaurus Property-2)
C1511983 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.7
Code List
Evaluation of Marker Lesions
CL Item
Complete Resolution (Complete resolution)
CL Item
None Of The Above (None of the above)
CL Item
at least 50% Decrease In The Sum Of The Products Of The Diameters Of All Marker Lesions Since Baseline (50 percent)
CL Item
at least 25% Inc In Sum Of The Products Of The Diam Of All Marker Lesions Since Baseline/best Response (25 percent)
Item Group
Footer Module
ResearchCommentsText
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0282411 (UMLS 2011AA Property)
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