ID

10326

Description

HEM Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FF1B0A30-0B37-31B9-E034-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FF1B0A30-0B37-31B9-E034-0003BA3F9857

Keywords

Versions (2)
  1. 9/19/12 9/19/12 -
  2. 5/28/15 5/28/15 -
Uploaded on

May 28, 2015

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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HEM

English

No Instruction available.

1 forms  
Header Module
Description

Header Module

Segment
Description

Segment

Data type

text

Visit number
Description

HospitalAdmissionOrdinalNumber

Data type

float

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C16696
UMLS 2011AA ObjectClass
C0019994
NCI Thesaurus Property
C25385
UMLS 2011AA Property
C0809949
Record Neutrophil Count And Specimen Collection Dates
Description

Record Neutrophil Count And Specimen Collection Dates

Did the patient achieve ANC recovery =>500/mm3 on three consecutive
Description

DidthepatientachieveANCrecovery=>500/mm3onthreeconsecutive

Data type

text

Day 3
Description

LaboratoryProcedureNeutrophilResultTotalValue

Data type

float

Alias
NCI Thesaurus ObjectClass
C25294
UMLS 2011AA ObjectClass
C0022885
NCI Thesaurus Property
C12533
UMLS 2011AA Property
C0027950
NCI Thesaurus Property-2
C20200
UMLS 2011AA Property-2
C1274040
NCI Thesaurus ValueDomain
C25304
UMLS 2011AA ValueDomain
C0439810
NCI Thesaurus ValueDomain-2
C25712
UMLS 2011AA ValueDomain-2
C1522609
Date specimen collected
Description

SpecimenCollectedDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C19157
UMLS 2011AA ObjectClass
C0370003
NCI Thesaurus Property
C25452
NCI Thesaurus Property-2
C25275
UMLS 2011AA Property
C2745955
Record Chimerism Assay Data For Marrow And/or Blood
Description

Record Chimerism Assay Data For Marrow And/or Blood

Marrow
Description

Marrow

Was a chimerism performed on a marrow sample
Description

Wasachimerismperformedonamarrowsample

Data type

boolean

Method of evaluation
Description

AssessmentMethodType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C16847
UMLS 2011AA Property
C0449851
Specify other
Description

AssessmentMethodSpecify

Data type

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C16847
UMLS 2011AA Property
C0449851
Cell type
Description

CellSpecimenCollectionType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C12508
UMLS 2011AA ObjectClass
C0007634
NCI Thesaurus Property
C25453
UMLS 2011AA Property
C1516698
NCI Thesaurus ObjectClass-2
C19157
UMLS 2011AA ObjectClass-2
C0370003
Marrow assay results
Description

Marrowassayresults

Data type

text

% donor
Description

%donor

Data type

text

T Cell Chimerism
Description

T Cell Chimerism

Was a chimerism performed on a T cell sample
Description

WasachimerismperformedonaTcellsample

Data type

boolean

Type of sample
Description

TissueSpecimenType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C12801
UMLS 2011AA ObjectClass
C0040300
NCI Thesaurus ObjectClass-2
C19157
UMLS 2011AA ObjectClass-2
C0370003
NCI Thesaurus Property
C25365
UMLS 2011AA Property
C0678257
T cell assay results
Description

Tcellassayresults

Data type

text

% donor
Description

%donor

Data type

text

Did the patient achieve a stem cell re-infusion due to inadequate hematopoietic function
Description

Didthepatientachieveastemcellre-infusionduetoinadequatehematopoieticfunction

Data type

boolean

Record date of infusion
Description

PeripheralBloodStemCellTransplantInfusionDate

Data type

date

Alias
NCI Thesaurus ObjectClass
C12981
UMLS 2011AA ObjectClass
C0332835
NCI Thesaurus ObjectClass-2
C12946
UMLS 2011AA ObjectClass-2
C1518999
NCI Thesaurus Property
C15388
UMLS 2011AA Property
C0574032
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ValueDomain-2
C25367
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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Similar models

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1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Header Module
Segment
Item
Segment
text
HospitalAdmissionOrdinalNumber
Item
Visit number
float
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16696 (NCI Thesaurus ObjectClass)
C0019994 (UMLS 2011AA ObjectClass)
C25385 (NCI Thesaurus Property)
C0809949 (UMLS 2011AA Property)
Item Group
Record Neutrophil Count And Specimen Collection Dates
Item
Did the patient achieve ANC recovery =>500/mm3 on three consecutive
text
CL.1
Code List
Did the patient achieve ANC recovery =>500/mm3 on three consecutive
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Previously reported (Previously reported)
LaboratoryProcedureNeutrophilResultTotalValue
Item
Day 3
float
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
C12533 (NCI Thesaurus Property)
C0027950 (UMLS 2011AA Property)
C20200 (NCI Thesaurus Property-2)
C1274040 (UMLS 2011AA Property-2)
C25304 (NCI Thesaurus ValueDomain)
C0439810 (UMLS 2011AA ValueDomain)
C25712 (NCI Thesaurus ValueDomain-2)
C1522609 (UMLS 2011AA ValueDomain-2)
SpecimenCollectedDate
Item
Date specimen collected
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C25452 (NCI Thesaurus Property)
C25275 (NCI Thesaurus Property-2)
C2745955 (UMLS 2011AA Property)
Item Group
Record Chimerism Assay Data For Marrow And/or Blood
Item Group
Marrow
Wasachimerismperformedonamarrowsample
Item
Was a chimerism performed on a marrow sample
boolean
Item
Method of evaluation
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C16847 (NCI Thesaurus Property)
C0449851 (UMLS 2011AA Property)
CL.8
Code List
Method of evaluation
CL Item
Standard cytogenetics (Standard cytogenetics)
CL Item
Fluorescent in situ hyrbidization (FISH) (Fluorescent in situ hyrbidization (FISH))
CL Item
Restriction fragment-length polymorphisms (RFLP) (Restriction fragment-length polymorphisms (RFLP))
CL Item
Polymerase chain reaction (Polymerase chain reaction)
CL Item
HLA serotyping (HLA serotyping)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
AssessmentMethodSpecify
Item
Specify other
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C16847 (NCI Thesaurus Property)
C0449851 (UMLS 2011AA Property)
Item
Cell type
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C12508 (NCI Thesaurus ObjectClass)
C0007634 (UMLS 2011AA ObjectClass)
C25453 (NCI Thesaurus Property)
C1516698 (UMLS 2011AA Property)
C19157 (NCI Thesaurus ObjectClass-2)
C0370003 (UMLS 2011AA ObjectClass-2)
CL.4
Code List
Cell type
CL Item
Unmanipulated (Unmanipulated)
CL Item
Granulocytes (Granulocytes)
Item
Marrow assay results
text
CL.5
Code List
Marrow assay results
CL Item
All host cells (All host cells)
CL Item
All donor cells (All donor cells)
CL Item
Host and donor (Host and donor)
%donor
Item
% donor
text
Item Group
T Cell Chimerism
WasachimerismperformedonaTcellsample
Item
Was a chimerism performed on a T cell sample
boolean
Item
Type of sample
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C12801 (NCI Thesaurus ObjectClass)
C0040300 (UMLS 2011AA ObjectClass)
C19157 (NCI Thesaurus ObjectClass-2)
C0370003 (UMLS 2011AA ObjectClass-2)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
CL.7
Code List
Type of sample
CL Item
Blood (Blood)
CL Item
Marrow (Marrow)
Item
T cell assay results
text
CL.9
Code List
T cell assay results
CL Item
All host cells (All host cells)
CL Item
All donor cells (All donor cells)
CL Item
Host and donor (Host and donor)
%donor
Item
% donor
text
Didthepatientachieveastemcellre-infusionduetoinadequatehematopoieticfunction
Item
Did the patient achieve a stem cell re-infusion due to inadequate hematopoietic function
boolean
PeripheralBloodStemCellTransplantInfusionDate
Item
Record date of infusion
date
C12981 (NCI Thesaurus ObjectClass)
C0332835 (UMLS 2011AA ObjectClass)
C12946 (NCI Thesaurus ObjectClass-2)
C1518999 (UMLS 2011AA ObjectClass-2)
C15388 (NCI Thesaurus Property)
C0574032 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
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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