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Demographics and Medical History Chronic Lymphocytic Leukemia NCT00090051

1 Formulários  
Personal data
Descrição

Personal data

Alias
UMLS CUI-1
C1704791
Date of visit
Descrição

Date of visit

Tipo de dados

date

Unidades de medida
  • ddmmyy
Alias
UMLS CUI-1
C1320303
ddmmyy
Patient initials
Descrição

Patient initials

Tipo de dados

text

Unidades de medida
  • FML
Alias
UMLS CUI-1
C2986440
FML
Birth Date
Descrição

Birth Date

Tipo de dados

date

Unidades de medida
  • ddmmyy
Alias
UMLS CUI-1
C0421451
ddmmyy
Sex
Descrição

Sex

Tipo de dados

text

Alias
UMLS CUI-1
C0079399
Female reproductive status
Descrição

Female reproductive status

Tipo de dados

integer

Alias
UMLS CUI-1
C1831019
contraceptive protection, specify
Descrição

contraceptive protection, specify

Tipo de dados

text

Race
Descrição

Race

Tipo de dados

integer

Alias
UMLS CUI-1
C0034510
Specify race
Descrição

Specify race

Tipo de dados

text

Serum pregnancy test (only females of childbearing potential)
Descrição

Serum pregnancy test (only females of childbearing potential)

Alias
UMLS CUI-1
C0032976
Date of pregnancy test
Descrição

Date of pregnancy test

Tipo de dados

date

Unidades de medida
  • ddmmyy
Alias
UMLS CUI-1
C0032976
UMLS CUI-2
C0011008
ddmmyy
Pregnancy Test
Descrição

Pregnancy Test

Tipo de dados

integer

Alias
UMLS CUI-1
C0032976
Previous or current diseases other than CLL
Descrição

Previous or current diseases other than CLL

Alias
UMLS CUI-1
C0262926
Are there any diseases (including allergies) that are clinically significant or for which the patient is under treatment (list treatments on treatment form) other than CLL?
Descrição

Are there any diseases (including allergies) that are clinically significant or for which the patient is under treatment (list treatments on treatment form) other than CLL?

Tipo de dados

integer

Alias
UMLS CUI-1
C0012634
UMLS CUI-2
C2985739
Disease
Descrição

Disease

Tipo de dados

text

Alias
UMLS CUI-1
C0012634
active
Descrição

active

Tipo de dados

boolean

Alias
UMLS CUI-1
C0205177
Previous treatments not associated with CLL
Descrição

Previous treatments not associated with CLL

Alias
UMLS CUI-1
C0814462
Have there been any previous drug treatments (or medical procedures) not associated with CLL completed in the last month?
Descrição

Have there been any previous drug treatments (or medical procedures) not associated with CLL completed in the last month?

Tipo de dados

integer

Alias
UMLS CUI-1
C0814462
Name of treatment (or medical procedure)
Descrição

Name of treatment (or medical procedure)

Tipo de dados

text

Alias
UMLS CUI-1
C0087111
Previous treatments/medical procedures/chemotherapy related to CLL
Descrição

Previous treatments/medical procedures/chemotherapy related to CLL

Alias
UMLS CUI-1
C0814462
Name of treatment
Descrição

Name of treatment

Tipo de dados

text

Alias
UMLS CUI-1
C2826702
Start date
Descrição

Start date

Tipo de dados

date

Unidades de medida
  • dd/mm/yy
Alias
UMLS CUI-1
C0808070
dd/mm/yy
End date
Descrição

End date

Tipo de dados

date

Alias
UMLS CUI-1
C0806020
Best response
Descrição

Best response

Tipo de dados

integer

Alias
UMLS CUI-1
C2986560
Previous treatments radiotherapy
Descrição

Previous treatments radiotherapy

site of radiotherapy
Descrição

site of radiotherapy

Tipo de dados

text

Total dose
Descrição

Total dose

Tipo de dados

float

Unidades de medida
  • Gy
Gy
Start date
Descrição

Start date

Tipo de dados

date

End date
Descrição

End date

Tipo de dados

date

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Similar models

Demographics and Medical History Chronic Lymphocytic Leukemia NCT00090051

1 Formulários
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de dados
Alias
Item Group
Personal data
C1704791 (UMLS CUI-1)
Visit date
Item
Date of visit
date
C1320303 (UMLS CUI-1)
Patient initials
Item
text
C2986440 (UMLS CUI-1)
Birth Date
Item
Birth Date
date
C0421451 (UMLS CUI-1)
Item
Sex
text
C0079399 (UMLS CUI-1)
Sex
Code List
Sex
CL Item
male (m)
CL Item
female (f)
Item
Female reproductive status
integer
C1831019 (UMLS CUI-1)
Female reproductive status
Code List
Female reproductive status
CL Item
childbearing potential without contraceptive protection (-> exclusion) (1)
C3831118 (UMLS CUI-1)
C0700589 (UMLS CUI-2)
CL Item
childbearing potential with contraceptive protection (-> specify) (2)
C3831118 (UMLS CUI-1)
C0742784 (UMLS CUI-2)
CL Item
surgically sterilized (3)
C0015787 (UMLS CUI-1)
CL Item
postmenopausal (4)
C0232970 (UMLS CUI-1)
contraceptive protection, specify
Item
text
Item
Race
integer
C0034510 (UMLS CUI-1)
Race
Code List
Race
CL Item
caucasian/white (1)
CL Item
black (2)
CL Item
oriental (3)
CL Item
other (specify) (4)
Other race
Item
Specify race
text
Item Group
Serum pregnancy test (only females of childbearing potential)
C0032976 (UMLS CUI-1)
pregnancy test date
Item
Date of pregnancy test
date
C0032976 (UMLS CUI-1)
C0011008 (UMLS CUI-2)
Item
Pregnancy Test
integer
C0032976 (UMLS CUI-1)
Pregnancy Test
Code List
Pregnancy Test
CL Item
negative (0)
CL Item
positive (-> patient must be excluded from study) (1)
Item Group
Previous or current diseases other than CLL
C0262926 (UMLS CUI-1)
Item
Are there any diseases (including allergies) that are clinically significant or for which the patient is under treatment (list treatments on treatment form) other than CLL?
integer
C0012634 (UMLS CUI-1)
C2985739 (UMLS CUI-2)
Disease, clinically significant
Code List
Are there any diseases (including allergies) that are clinically significant or for which the patient is under treatment (list treatments on treatment form) other than CLL?
CL Item
yes -> specify (1)
CL Item
no (0)
Disease
Item
Disease
text
C0012634 (UMLS CUI-1)
active
Item
boolean
C0205177 (UMLS CUI-1)
Item Group
Previous treatments not associated with CLL
C0814462 (UMLS CUI-1)
Item
Have there been any previous drug treatments (or medical procedures) not associated with CLL completed in the last month?
integer
C0814462 (UMLS CUI-1)
Previous treatments
Code List
Have there been any previous drug treatments (or medical procedures) not associated with CLL completed in the last month?
CL Item
yes (->specify) (1)
CL Item
no (0)
Treatment
Item
Name of treatment (or medical procedure)
text
C0087111 (UMLS CUI-1)
Item Group
Previous treatments/medical procedures/chemotherapy related to CLL
C0814462 (UMLS CUI-1)
treatment name
Item
Name of treatment
text
C2826702 (UMLS CUI-1)
Start date
Item
Start date
date
C0808070 (UMLS CUI-1)
End date
Item
End date
date
C0806020 (UMLS CUI-1)
Item
Best response
integer
C2986560 (UMLS CUI-1)
Best response
Code List
Best response
CL Item
CR (1)
C0677874 (UMLS CUI-1)
CL Item
PR (2)
C1521726 (UMLS CUI-1)
CL Item
SD (3)
C0677946 (UMLS CUI-1)
CL Item
PD (4)
C1335499 (UMLS CUI-1)
CL Item
NK/NA (5)
C0439673 (UMLS CUI-1)
Item Group
Previous treatments radiotherapy
site of radiotherapy
Item
site of radiotherapy
text
Total dose
Item
Total dose
float
Start date
Item
Start date
date
End date
Item
End date
date
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