0 Ratings
ID

10370

Description

ECOG 4599 Toxicity Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A16E9DCC-CE6C-6087-E034-080020C9C0E0

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A16E9DCC-CE6C-6087-E034-080020C9C0E0

Keywords

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

May 28, 2015

DOI

To request one please log in.

License

Creative Commons BY-NC 3.0 Legacy
Model comments :

You can comment on the data model here. Via the speech bubbles at the itemgroups and items you can add comments to those specificially.

Back to model comments
Itemgroup comments for :

Item comments for :

  • Newest
  • Oldest
  • Popular
  • Newest
    • Newest
    • Oldest
    • Popular

    No comments

    In order to download data models you must be logged in. Please log in or register for free.

    ECOG 4599 Treatment Form

    English

    No Instruction available.

    1 forms  
    1. StudyEvent: ECOG 4599 Treatment Form
      1. No Instruction available.
    ECOG treatment data
    Description

    ECOG treatment data

    Date of data transfer
    Description

    Dateofdatatransfer

    Data type

    text

    Transfer Method
    Description

    TransferMethod

    Data type

    text

    Specify other transfer method
    Description

    Specifyothertransfermethod

    Data type

    text

    Amended Data Ind
    Description

    AmendedDataInd

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C25474
    UMLS 2011AA ObjectClass
    C1511726
    NCI Thesaurus Property
    C25416
    UMLS 2011AA Property
    C1691222
    Patient Name
    Description

    PatientName

    Data type

    text

    Particip. Group Protocol Number
    Description

    Particip.GroupProtocolNumber

    Data type

    double

    Patient Study ID, Participating Group
    Description

    PatientStudyID,ParticipatingGroup

    Data type

    text

    Step Number
    Description

    StepNumber

    Data type

    text

    Institution Name
    Description

    InstitutionName

    Data type

    text

    Affiliate Name
    Description

    AffiliateName

    Data type

    text

    Patient's Vital Status
    Description

    Patient'sVitalStatus

    Data type

    text

    Death Date/Last Contact Date
    Description

    DeathDate/LastContactDate

    Data type

    date

    Death Reason
    Description

    DeathReason

    Data type

    text

    Death Reason, Specify
    Description

    DeathReason,Specify

    Data type

    text

    Course Identification
    Description

    CourseIdentification

    Data type

    text

    Treatment Begin Date
    Description

    TreatmentBeginDate

    Data type

    date

    Treatment Last Dose End Date
    Description

    TreatmentLastDoseEndDate

    Data type

    date

    Blood Pressure, Systolic
    Description

    BloodPressure,Systolic

    Data type

    double

    Alias
    NCI Thesaurus ValueDomain
    C25209
    UMLS 2011AA ValueDomain
    C0242485
    Blood pressure, Diastolic
    Description

    Bloodpressure,Diastolic

    Data type

    text

    Alias
    NCI Thesaurus Property
    C25214
    UMLS 2011AA Property
    C0220825
    NCI Thesaurus ObjectClass
    C25299
    UMLS 2011AA ObjectClass
    C0428883
    Patient Weight(kg)
    Description

    PatientWeight

    Data type

    double

    Urine dipstick result
    Description

    Urinedipstickresult

    Data type

    text

    Date of urine dipstick
    Description

    Dateofurinedipstick

    Data type

    text

    Date Bevacizumab given
    Description

    DateBevacizumabgiven

    Data type

    text

    Bevacizumab dose (mg)
    Description

    BevacizumabAgentQuantityDose

    Data type

    double

    Alias
    NCI Thesaurus ObjectClass
    C2039
    UMLS 2011AA ObjectClass
    C0796392
    NCI Thesaurus ObjectClass
    C1708
    UMLS 2011AA ObjectClass
    C0450442
    NCI Thesaurus Property
    C25256
    UMLS 2011AA Property
    C1265611
    NCI Thesaurus ValueDomain
    C25488
    UMLS 2011AA ValueDomain
    C0178602
    NCI Thesaurus ValueDomain
    C1708
    UMLS 2011AA ValueDomain
    C0450442
    Dose Modification (Change)
    Description

    DoseModification(Change)

    Data type

    text

    Treatment End Date
    Description

    TreatmentEndDate

    Data type

    date

    Off Treatment Reason
    Description

    OffTreatmentReason

    Data type

    text

    Off Treatment Reason, Complicating Disease
    Description

    OffTreatmentReason,ComplicatingDisease

    Data type

    text

    Comments
    Description

    Comments

    Data type

    text

    Comments2
    Description

    Comments2

    Data type

    text

    Back to the top of the page

    Similar models

    No Instruction available.

    1 forms
    1. StudyEvent: ECOG 4599 Treatment Form
      1. No Instruction available.
    Name
    Type
    Description | Question | Decode (Coded Value)
    Data type
    Alias
    Item Group
    ECOG treatment data
    Dateofdatatransfer
    Item
    Date of data transfer
    text
    TransferMethod
    Item
    Transfer Method
    text
    Specifyothertransfermethod
    Item
    Specify other transfer method
    text
    AmendedDataInd
    Item
    Amended Data Ind
    text
    C25474 (NCI Thesaurus ObjectClass)
    C1511726 (UMLS 2011AA ObjectClass)
    C25416 (NCI Thesaurus Property)
    C1691222 (UMLS 2011AA Property)
    PatientName
    Item
    Patient Name
    text
    Particip.GroupProtocolNumber
    Item
    Particip. Group Protocol Number
    double
    PatientStudyID,ParticipatingGroup
    Item
    Patient Study ID, Participating Group
    text
    StepNumber
    Item
    Step Number
    text
    InstitutionName
    Item
    Institution Name
    text
    AffiliateName
    Item
    Affiliate Name
    text
    Patient'sVitalStatus
    Item
    Patient's Vital Status
    text
    DeathDate/LastContactDate
    Item
    Death Date/Last Contact Date
    date
    DeathReason
    Item
    Death Reason
    text
    DeathReason,Specify
    Item
    Death Reason, Specify
    text
    CourseIdentification
    Item
    Course Identification
    text
    TreatmentBeginDate
    Item
    Treatment Begin Date
    date
    TreatmentLastDoseEndDate
    Item
    Treatment Last Dose End Date
    date
    BloodPressure,Systolic
    Item
    Blood Pressure, Systolic
    double
    C25209 (NCI Thesaurus ValueDomain)
    C0242485 (UMLS 2011AA ValueDomain)
    Bloodpressure,Diastolic
    Item
    Blood pressure, Diastolic
    text
    C25214 (NCI Thesaurus Property)
    C0220825 (UMLS 2011AA Property)
    C25299 (NCI Thesaurus ObjectClass)
    C0428883 (UMLS 2011AA ObjectClass)
    PatientWeight
    Item
    Patient Weight(kg)
    double
    Urinedipstickresult
    Item
    Urine dipstick result
    text
    Dateofurinedipstick
    Item
    Date of urine dipstick
    text
    DateBevacizumabgiven
    Item
    Date Bevacizumab given
    text
    BevacizumabAgentQuantityDose
    Item
    Bevacizumab dose (mg)
    double
    C2039 (NCI Thesaurus ObjectClass)
    C0796392 (UMLS 2011AA ObjectClass)
    C1708 (NCI Thesaurus ObjectClass)
    C0450442 (UMLS 2011AA ObjectClass)
    C25256 (NCI Thesaurus Property)
    C1265611 (UMLS 2011AA Property)
    C25488 (NCI Thesaurus ValueDomain)
    C0178602 (UMLS 2011AA ValueDomain)
    C1708 (NCI Thesaurus ValueDomain)
    C0450442 (UMLS 2011AA ValueDomain)
    DoseModification(Change)
    Item
    Dose Modification (Change)
    text
    TreatmentEndDate
    Item
    Treatment End Date
    date
    OffTreatmentReason
    Item
    Off Treatment Reason
    text
    OffTreatmentReason,ComplicatingDisease
    Item
    Off Treatment Reason, Complicating Disease
    text
    Comments
    Item
    Comments
    text
    Comments2
    Item
    Comments2
    text
    Back to the top of the page 

    Help

    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