Informatie:
Fout:
ID
10378
Beschrijving
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
Trefwoorden
Versies (2)
- 19-09-12 19-09-12 -
- 28-05-15 28-05-15 -
Geüploaded op
28 mei 2015
DOI
Voor een aanvraag inloggen.
Licentie
Creative Commons BY-NC 3.0 Legacy
Model Commentaren :
Hier kunt u commentaar leveren op het model. U kunt de tekstballonnen bij de itemgroepen en items gebruiken om er specifiek commentaar op te geven.
Itemgroep Commentaren voor :
Item Commentaren voor :
U moet ingelogd zijn om formulieren te downloaden. AUB inloggen of schrijf u gratis in.
ECOG 4599 Registration Form
No Instruction available.
- StudyEvent: ECOG 4599 Registration Form
Similar models
No Instruction available.
- StudyEvent: ECOG 4599 Registration Form
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
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)
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)
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)
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)
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)
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)
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)
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)
C0237753 (UMLS 2011AA ValueDomain)