ID

10378

Description

ECOG 4599 Registration Form (RECIST) Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A16F5E81-8438-5E56-E034-080020C9C0E0

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A16F5E81-8438-5E56-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 :

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

ECOG 4599 Registration Form

English

No Instruction available.

1 forms  
  1. StudyEvent: ECOG 4599 Registration Form
    1. No Instruction available.
ECOG clinical trial administrative data
Description

ECOG clinical trial administrative data

Cooperative Group Name
Description

CooperativeGroupName

Data type

text

Coordinating Group Protocol Number
Description

CoordinatingGroupProtocolNumber

Data type

text

Person Completing Form, First Name
Description

PersonCompletingForm,FirstName

Data type

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Person Completing Form, Last Name
Description

PersonCompletingForm,LastName

Data type

text

Person Completing Form, Phone
Description

PersonCompletingForm,Phone

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
Person Completing Form, Fax
Description

PersonCompletingForm,Fax

Data type

double

Institution Name
Description

InstitutionName

Data type

text

Institution City
Description

InstitutionCity

Data type

text

Institution State
Description

InstitutionState

Data type

text

Institution NCI Code
Description

InstitutionNCICode

Data type

text

Investigator Name
Description

InvestigatorName

Data type

text

Affiliate Name
Description

AffiliateName

Data type

text

IRB Approval Date
Description

IRBApprovalDate

Data type

date

Alias
NCI Thesaurus ObjectClass
C25320
UMLS 2011AA ObjectClass
C1507394
NCI Thesaurus Property
C25425
UMLS 2011AA Property
C0205540
Informed Consent Date Signed
Description

InformedConsentDateSigned

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
Patient enrolled on any other CG trial
Description

PatientenrolledonanyotherCGtrial

Data type

text

Other Cooperative Group Trial-Group Name
Description

OtherCooperativeGroupTrial-GroupName

Data type

text

Other Cooperative Group Trial-Protocol #
Description

OtherCooperativeGroupTrial-Protocol#

Data type

text

Other Cooperative Group Trial-Specify
Description

OtherCooperativeGroupTrial-Specify

Data type

text

Patient Identifier
Description

PatientIdentifier

Data type

text

NCI Investigator Number
Description

NCIInvestigatorNumber

Data type

text

Investigator Status
Description

InvestigatorStatus

Data type

text

Patient Study ID, Coordinating Group
Description

PatientStudyID,CoordinatingGroup

Data type

text

Treatment Arm Number
Description

TreatmentArmNumber

Data type

text

Registration Date
Description

RegistrationDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
CTSU Patient Registrar
Description

CTSUPatientRegistrar

Data type

text

Is Treating Institution a CCOP of a Coop
Description

IsTreatingInstitutionaCCOPofaCoop

Data type

text

U10
Description

U10

Data type

text

Patient Gender
Description

PatientGender

Data type

text

Alias
NCI Thesaurus ValueDomain
C25372
UMLS 2011AA ValueDomain
C0683312
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C17357
UMLS 2011AA Property
C0079399
Patient Race/Ethnicity
Description

PatientRace

Data type

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C17049
UMLS 2011AA Property
C0034510
Comments1
Description

Comments1

Data type

text

Comments2
Description

Comments2

Data type

text

Investigator Code
Description

InvestigatorCode

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
Back to the top of the page

Similar models

No Instruction available.

1 forms
  1. StudyEvent: ECOG 4599 Registration Form
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
ECOG clinical trial administrative data
CooperativeGroupName
Item
Cooperative Group Name
text
CoordinatingGroupProtocolNumber
Item
Coordinating Group Protocol Number
text
PersonCompletingForm,FirstName
Item
Person Completing Form, First Name
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
PersonCompletingForm,LastName
Item
Person Completing Form, Last Name
text
PersonCompletingForm,Phone
Item
Person Completing Form, Phone
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
PersonCompletingForm,Fax
Item
Person Completing Form, Fax
double
InstitutionName
Item
Institution Name
text
InstitutionCity
Item
Institution City
text
InstitutionState
Item
Institution State
text
InstitutionNCICode
Item
Institution NCI Code
text
InvestigatorName
Item
Investigator Name
text
AffiliateName
Item
Affiliate Name
text
IRBApprovalDate
Item
IRB Approval Date
date
C25320 (NCI Thesaurus ObjectClass)
C1507394 (UMLS 2011AA ObjectClass)
C25425 (NCI Thesaurus Property)
C0205540 (UMLS 2011AA Property)
InformedConsentDateSigned
Item
Informed Consent Date Signed
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
PatientenrolledonanyotherCGtrial
Item
Patient enrolled on any other CG trial
text
OtherCooperativeGroupTrial-GroupName
Item
Other Cooperative Group Trial-Group Name
text
OtherCooperativeGroupTrial-Protocol#
Item
Other Cooperative Group Trial-Protocol #
text
OtherCooperativeGroupTrial-Specify
Item
Other Cooperative Group Trial-Specify
text
PatientIdentifier
Item
Patient Identifier
text
NCIInvestigatorNumber
Item
NCI Investigator Number
text
InvestigatorStatus
Item
Investigator Status
text
PatientStudyID,CoordinatingGroup
Item
Patient Study ID, Coordinating Group
text
TreatmentArmNumber
Item
Treatment Arm Number
text
RegistrationDate
Item
Registration Date
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
CTSUPatientRegistrar
Item
CTSU Patient Registrar
text
IsTreatingInstitutionaCCOPofaCoop
Item
Is Treating Institution a CCOP of a Coop
text
U10
Item
U10
text
PatientGender
Item
Patient Gender
text
C25372 (NCI Thesaurus ValueDomain)
C0683312 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C17357 (NCI Thesaurus Property)
C0079399 (UMLS 2011AA Property)
PatientRace
Item
Patient Race/Ethnicity
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C17049 (NCI Thesaurus Property)
C0034510 (UMLS 2011AA Property)
Comments1
Item
Comments1
text
Comments2
Item
Comments2
text
InvestigatorCode
Item
Investigator Code
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
Back to the top of the page 

Contact

Please use this form for feedback, questions and suggestions for improvements.

Fields marked with * are required.

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