ID
10192
Descripción
Southwest Oncology Group S0925 Registration Worksheet Form (Step 1) Bicalutamide and Goserelin or Leuprolide Acetate With or Without Cixutumumab in Treating Patients With Newly Diagnosed Metastatic Prostate Cancer NCT01120236 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=94470DE4-29D5-D339-E040-BB89AD4306AB
Link
Palabras clave
Versiones (3)
- 19/9/12 19/9/12 -
- 9/1/15 9/1/15 - Martin Dugas
- 25/4/15 25/4/15 - Martin Dugas
Subido en
25 de abril de 2015
DOI
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Licencia
Creative Commons BY-NC 3.0 Legacy
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Prostate Cancer Registration SWOG S0925 NCT01120236
INSTRUCTIONS: All of the information on this Registration Worksheet and the Protocol Eligibility Section must be answered appropriately for a patient to be considered eligible for registration. This Registration Worksheet must be entirely filled out and referred to during the registration. Do NOT submit this worksheet as part of the patient data.
- StudyEvent: Southwest Oncology Group S0925 Registration Worksheet Form (Step 1)
Descripción
Swog Patient Id
Descripción
PatientSouthwestOncologyGroupIdentifierStatus
Tipo de datos
integer
Alias
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25364
- NCI Thesaurus Property-2
- C25699
- NCI Thesaurus ValueDomain
- C25688
- UMLS CUI-1
- C1519429
- UMLS CUI-2
- C0600091
Descripción
Trial subject ID SWOG
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS CUI-1
- C2348585
- NCI Thesaurus ObjectClass
- C16960
- UMLS CUI-2
- C1519429
- NCI Thesaurus Property
- C25364
- NCI Thesaurus Property-2
- C25699
Descripción
Demography
Descripción
First Name
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS CUI-1
- C1443235
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25364
- NCI Thesaurus Property-2
- C25509
Descripción
PatientMiddleName
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS 2011AA ValueDomain
- C1547383
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
- NCI Thesaurus Property-2
- C25569
- UMLS 2011AA Property-2
- C0444598
Descripción
Last Name
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS CUI-1
- C1301584
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25364
- NCI Thesaurus Property-2
- C25551
Descripción
FOR SWOG INSTITUTIONS
Descripción
RegistrarSouthwestOncologyGroupIdentifierNumber
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- NCI Thesaurus Property
- C25364
- NCI Thesaurus Property-2
- C25699
- NCI Thesaurus ObjectClass
- C25357
- UMLS CUI-1
- C0557514
Descripción
SouthwestOncologyGroupInvestigatorIdentifierNumber
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- NCI Thesaurus Property
- C25364
- NCI Thesaurus ObjectClass
- C25699
- NCI Thesaurus ObjectClass-2
- C17089
- UMLS CUI-1
- C0237753
- UMLS CUI-2
- C1519429
Descripción
SouthwestOncologyGroupTreatingInstitutionIdentifierNumber
Tipo de datos
text
Alias
- NCI Thesaurus ObjectClass
- C25699
- NCI Thesaurus ObjectClass-2
- C25705
- NCI Thesaurus ObjectClass-3
- C41206
- NCI Thesaurus Property
- C25364
- NCI Thesaurus ValueDomain
- C25337
- UMLS CUI-1
- C1519429
- UMLS CUI-2
- C1272753
- UMLS CUI-3
- C0600091
Descripción
PATIENT INFORMATION
Alias
- UMLS CUI-1
- C1955348
Descripción
InformedConsentFormSignedDate
Tipo de datos
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ValueDomain-2
- C25367
- NCI Thesaurus ObjectClass
- C16468
- UMLS 2011AA ObjectClass
- C0009797
- NCI Thesaurus Property
- C25679
Descripción
HIPAA Approval Date
Tipo de datos
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C0600593
- NCI Thesaurus ObjectClass
- C25320
- UMLS CUI-2
- C2346844
- NCI Thesaurus Property
- C25425
Descripción
Treatment Begin Date
Tipo de datos
date
Alias
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus ObjectClass-2
- C25631
- NCI Thesaurus Property
- C25431
- UMLS CUI-1
- C3173309
- NCI Thesaurus Property-2
- C25275
- NCI Thesaurus ValueDomain
- C25164
- NCI Thesaurus ValueDomain-2
- C25431
Descripción
Auxiliary Question
Descripción
PatientLateInductionRegistrationInd-2
Tipo de datos
boolean
Alias
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25646
- NCI Thesaurus Property-2
- C61367
- NCI Thesaurus Property-3
- C64998
- NCI Thesaurus ValueDomain
- C38147
- UMLS CUI-1
- C1514821
- UMLS CUI-2
- C0205087
Descripción
Stratification Question
Descripción
PatientPSAStratificationCode
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C25162
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C17525
- NCI Thesaurus Property-2
- C25689
- UMLS CUI-1
- C0138741
Descripción
PerformanceStatusAssessmentPerformanceStatusStratificationCode
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C25162
- NCI Thesaurus Property
- C25367
- NCI Thesaurus ObjectClass
- C20641
- NCI Thesaurus ValueDomain-2
- C25689
- UMLS CUI-1
- C1518965
Descripción
Indicate how the patient answered the following questions on the consent form
Descripción
SouthwestOncologyGroupPatientSpecimenSpecialConsentIndicator
Tipo de datos
text
Alias
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus ObjectClass-2
- C25699
- NCI Thesaurus Property
- C19157
- NCI Thesaurus Property-2
- C25460
- NCI Thesaurus Property-3
- C25684
- NCI Thesaurus ValueDomain
- C25180
- UMLS CUI-1
- C1511481
- UMLS CUI-2
- C1292533
Descripción
SouthwestOncologyGroupPatientResearchConsentIndicator
Tipo de datos
text
Alias
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus ObjectClass-2
- C25699
- NCI Thesaurus Property
- C15319
- NCI Thesaurus Property-2
- C25460
- NCI Thesaurus ValueDomain
- C25180
Descripción
Patient Eligibility
Alias
- UMLS CUI-1
- C1302261
Descripción
SouthwestOncologyGroupPatientRegistrationEligibilityDeterminationInd-2
Tipo de datos
boolean
Alias
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus ObjectClass-2
- C25699
- NCI Thesaurus Property
- C25646
- NCI Thesaurus Property-2
- C25171
- NCI Thesaurus ValueDomain
- C38147
- UMLS CUI-1
- C1302261
Similar models
INSTRUCTIONS: All of the information on this Registration Worksheet and the Protocol Eligibility Section must be answered appropriately for a patient to be considered eligible for registration. This Registration Worksheet must be entirely filled out and referred to during the registration. Do NOT submit this worksheet as part of the patient data.
- StudyEvent: Southwest Oncology Group S0925 Registration Worksheet Form (Step 1)
C25320 (NCI Thesaurus ObjectClass)
C64382 (NCI Thesaurus Property)
C41200 (NCI Thesaurus Property-2)
C1879547 (UMLS CUI-1)
C0011008 (UMLS CUI-2)
C0011008 (UMLS 2011AA ValueDomain)
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
C25551 (NCI Thesaurus ValueDomain-2)
C1517741 (UMLS 2011AA ValueDomain-2)
C1514821 (UMLS CUI-1)
C25646 (NCI Thesaurus ObjectClass)
C0237753 (UMLS CUI-2)
C16154 (NCI Thesaurus Property)
C16154 (NCI Thesaurus ValueDomain-2)
C25364 (NCI Thesaurus Property)
C25699 (NCI Thesaurus Property-2)
C25688 (NCI Thesaurus ValueDomain)
C1519429 (UMLS CUI-1)
C0600091 (UMLS CUI-2)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1519429 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25699 (NCI Thesaurus Property-2)
C1443235 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25364 (NCI Thesaurus Property)
C25509 (NCI Thesaurus Property-2)
C1547383 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25569 (NCI Thesaurus Property-2)
C0444598 (UMLS 2011AA Property-2)
C1301584 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25364 (NCI Thesaurus Property)
C25551 (NCI Thesaurus Property-2)
C25364 (NCI Thesaurus Property)
C25699 (NCI Thesaurus Property-2)
C25357 (NCI Thesaurus ObjectClass)
C0557514 (UMLS CUI-1)
C25364 (NCI Thesaurus Property)
C25699 (NCI Thesaurus ObjectClass)
C17089 (NCI Thesaurus ObjectClass-2)
C0237753 (UMLS CUI-1)
C1519429 (UMLS CUI-2)
C25705 (NCI Thesaurus ObjectClass-2)
C41206 (NCI Thesaurus ObjectClass-3)
C25364 (NCI Thesaurus Property)
C25337 (NCI Thesaurus ValueDomain)
C1519429 (UMLS CUI-1)
C1272753 (UMLS CUI-2)
C0600091 (UMLS CUI-3)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
C16468 (NCI Thesaurus ObjectClass)
C0009797 (UMLS 2011AA ObjectClass)
C25679 (NCI Thesaurus Property)
C0600593 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C2346844 (UMLS CUI-2)
C25425 (NCI Thesaurus Property)
C25631 (NCI Thesaurus ObjectClass-2)
C25431 (NCI Thesaurus Property)
C3173309 (UMLS CUI-1)
C25275 (NCI Thesaurus Property-2)
C25164 (NCI Thesaurus ValueDomain)
C25431 (NCI Thesaurus ValueDomain-2)
C25646 (NCI Thesaurus Property)
C61367 (NCI Thesaurus Property-2)
C64998 (NCI Thesaurus Property-3)
C38147 (NCI Thesaurus ValueDomain)
C1514821 (UMLS CUI-1)
C0205087 (UMLS CUI-2)
C16960 (NCI Thesaurus ObjectClass)
C17525 (NCI Thesaurus Property)
C25689 (NCI Thesaurus Property-2)
C0138741 (UMLS CUI-1)
C25367 (NCI Thesaurus Property)
C20641 (NCI Thesaurus ObjectClass)
C25689 (NCI Thesaurus ValueDomain-2)
C1518965 (UMLS CUI-1)
C25699 (NCI Thesaurus ObjectClass-2)
C19157 (NCI Thesaurus Property)
C25460 (NCI Thesaurus Property-2)
C25684 (NCI Thesaurus Property-3)
C25180 (NCI Thesaurus ValueDomain)
C1511481 (UMLS CUI-1)
C1292533 (UMLS CUI-2)
C25699 (NCI Thesaurus ObjectClass-2)
C15319 (NCI Thesaurus Property)
C25460 (NCI Thesaurus Property-2)
C25180 (NCI Thesaurus ValueDomain)
C25699 (NCI Thesaurus ObjectClass-2)
C25646 (NCI Thesaurus Property)
C25171 (NCI Thesaurus Property-2)
C38147 (NCI Thesaurus ValueDomain)
C1302261 (UMLS CUI-1)