ID
10192
Descrizione
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
collegamento
Keywords
versioni (3)
- 19/09/12 19/09/12 -
- 09/01/15 09/01/15 - Martin Dugas
- 25/04/15 25/04/15 - Martin Dugas
Caricato su
25 aprile 2015
DOI
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Licenza
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)
Descrizione
Swog Patient Id
Descrizione
PatientSouthwestOncologyGroupIdentifierStatus
Tipo di dati
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
Descrizione
Trial subject ID SWOG
Tipo di dati
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
Descrizione
Demography
Descrizione
First Name
Tipo di dati
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS CUI-1
- C1443235
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25364
- NCI Thesaurus Property-2
- C25509
Descrizione
PatientMiddleName
Tipo di dati
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
Descrizione
Last Name
Tipo di dati
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS CUI-1
- C1301584
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25364
- NCI Thesaurus Property-2
- C25551
Descrizione
FOR SWOG INSTITUTIONS
Descrizione
RegistrarSouthwestOncologyGroupIdentifierNumber
Tipo di dati
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- NCI Thesaurus Property
- C25364
- NCI Thesaurus Property-2
- C25699
- NCI Thesaurus ObjectClass
- C25357
- UMLS CUI-1
- C0557514
Descrizione
SouthwestOncologyGroupInvestigatorIdentifierNumber
Tipo di dati
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
Descrizione
SouthwestOncologyGroupTreatingInstitutionIdentifierNumber
Tipo di dati
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
Descrizione
PATIENT INFORMATION
Alias
- UMLS CUI-1
- C1955348
Descrizione
InformedConsentFormSignedDate
Tipo di dati
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
Descrizione
HIPAA Approval Date
Tipo di dati
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C0600593
- NCI Thesaurus ObjectClass
- C25320
- UMLS CUI-2
- C2346844
- NCI Thesaurus Property
- C25425
Descrizione
Treatment Begin Date
Tipo di dati
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
Descrizione
Auxiliary Question
Descrizione
PatientLateInductionRegistrationInd-2
Tipo di dati
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
Descrizione
Stratification Question
Descrizione
PatientPSAStratificationCode
Tipo di dati
text
Alias
- NCI Thesaurus ValueDomain
- C25162
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C17525
- NCI Thesaurus Property-2
- C25689
- UMLS CUI-1
- C0138741
Descrizione
PerformanceStatusAssessmentPerformanceStatusStratificationCode
Tipo di dati
text
Alias
- NCI Thesaurus ValueDomain
- C25162
- NCI Thesaurus Property
- C25367
- NCI Thesaurus ObjectClass
- C20641
- NCI Thesaurus ValueDomain-2
- C25689
- UMLS CUI-1
- C1518965
Descrizione
Indicate how the patient answered the following questions on the consent form
Descrizione
SouthwestOncologyGroupPatientSpecimenSpecialConsentIndicator
Tipo di dati
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
Descrizione
SouthwestOncologyGroupPatientResearchConsentIndicator
Tipo di dati
text
Alias
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus ObjectClass-2
- C25699
- NCI Thesaurus Property
- C15319
- NCI Thesaurus Property-2
- C25460
- NCI Thesaurus ValueDomain
- C25180
Descrizione
Patient Eligibility
Alias
- UMLS CUI-1
- C1302261
Descrizione
SouthwestOncologyGroupPatientRegistrationEligibilityDeterminationInd-2
Tipo di dati
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)