ID

10025

Beschrijving

Comparison of Combination Chemotherapy Regimens in Treating Older Women Who Have Undergone Surgery for Breast Cancer NCT00024102 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A50CFEAE-D13B-3952-E034-080020C9C0E0

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A50CFEAE-D13B-3952-E034-080020C9C0E0

Trefwoorden

  1. 26-08-12 26-08-12 -
  2. 18-03-15 18-03-15 - Martin Dugas
Geüploaded op

18 maart 2015

DOI

Voor een aanvraag inloggen.

Licentie

Creative Commons BY-NC 3.0 Legacy

Model Commentaren :

Hier kunt u commentaar leveren op het model. U kunt de tekstballonnen bij de itemgroepen en items gebruiken om er specifiek commentaar op te geven.

Itemgroep Commentaren voor :

Item Commentaren voor :

U moet ingelogd zijn om formulieren te downloaden. AUB inloggen of schrijf u gratis in.

Breast Cancer combination chemotherapies (NCT00024102)

PATIENT INSTRUCTIONS: Use this calendar as a reminder to take your medication. Be sure to mark an "x" in each box for each day that you take your pills, record the time you took them, and circle AM or PM.

Header
Beschrijving

Header

CALGB Form
Beschrijving

CALGBForm

Datatype

text

CALGB Study No
Beschrijving

CALGBStudyNo

Datatype

text

CALGB Patient ID
Beschrijving

CALGBPatientID

Datatype

text

Amended data?
Beschrijving

Amended data?

Datatype

boolean

Patient's Name
Beschrijving

Patient'sName

Datatype

text

Cycle number
Beschrijving

CycleNumber

Datatype

text

Day 1 of cycle (M)
Beschrijving

Day1ofcycle

Datatype

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
Completed By (Print or Type Name)
Beschrijving

CompletedBy

Datatype

text

Date Completed (M)
Beschrijving

DateCompleted

Datatype

date

Medication calendar
Beschrijving

Medication calendar

DAY OF WEEK
Beschrijving

DAYOFWEEK

Datatype

text

Day of cycle
Beschrijving

Dayofcycle

Datatype

text

TOOK PILLS
Beschrijving

TOOKPILLS

Datatype

text

Took pills time
Beschrijving

Tookpillstime

Datatype

text

AM or PM (CRA use only)
Beschrijving

AMorPM

Datatype

text

TOTAL NUMBER OF DAYS PILLS TAKEN THIS CYCLE
Beschrijving

TOTAL NUMBER OF DAYS PILLS TAKEN THIS CYCLE

Datatype

integer

Similar models

PATIENT INSTRUCTIONS: Use this calendar as a reminder to take your medication. Be sure to mark an "x" in each box for each day that you take your pills, record the time you took them, and circle AM or PM.

Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
CALGBForm
Item
CALGB Form
text
CALGBStudyNo
Item
CALGB Study No
text
CALGBPatientID
Item
CALGB Patient ID
text
Amended data
Item
Amended data?
boolean
Patient'sName
Item
Patient's Name
text
CycleNumber
Item
Cycle number
text
Day1ofcycle
Item
Day 1 of cycle (M)
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
CompletedBy
Item
Completed By (Print or Type Name)
text
DateCompleted
Item
Date Completed (M)
date
DAYOFWEEK
Item
DAY OF WEEK
text
Item
Day of cycle
text
Code List
Day of cycle
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10 (10)
CL Item
11 (11)
CL Item
12 (12)
CL Item
13 (13)
CL Item
14 (14)
TOOKPILLS
Item
TOOK PILLS
text
Tookpillstime
Item
Took pills time
text
Item
AM or PM (CRA use only)
text
Code List
AM or PM (CRA use only)
CL Item
Am (AM)
CL Item
Pm (PM)
total number of pills
Item
TOTAL NUMBER OF DAYS PILLS TAKEN THIS CYCLE
integer

Gebruik dit formulier voor feedback, vragen en verbeteringsvoorstellen.

Velden gemarkeerd met een * zijn verplicht.

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial