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

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License

Creative Commons BY-NC 3.0 Legacy
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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

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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
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