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ID
10370
Beschrijving
ECOG 4599 Toxicity Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A16E9DCC-CE6C-6087-E034-080020C9C0E0
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Versies (2)
- 19-09-12 19-09-12 -
- 28-05-15 28-05-15 -
Geüploaded op
28 mei 2015
DOI
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Licentie
Creative Commons BY-NC 3.0 Legacy
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ECOG 4599 Treatment Form
No Instruction available.
- StudyEvent: ECOG 4599 Treatment Form
Similar models
No Instruction available.
- StudyEvent: ECOG 4599 Treatment Form
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
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)
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)
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)
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)
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