ID

10378

Beskrivning

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

Länk

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A16F5E81-8438-5E56-E034-080020C9C0E0

Nyckelord

Versioner (2)
  1. 2012-09-19 2012-09-19 -
  2. 2015-05-28 2015-05-28 -
Uppladdad den

28 maj 2015

DOI

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Licens

Creative Commons BY-NC 3.0 Legacy
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ECOG 4599 Registration Form

Engelsk

No Instruction available.

1 Formulär  
  1. StudyEvent: ECOG 4599 Registration Form
    1. No Instruction available.
ECOG clinical trial administrative data
Beskrivning

ECOG clinical trial administrative data

Cooperative Group Name
Beskrivning

CooperativeGroupName

Datatyp

text

Coordinating Group Protocol Number
Beskrivning

CoordinatingGroupProtocolNumber

Datatyp

text

Person Completing Form, First Name
Beskrivning

PersonCompletingForm,FirstName

Datatyp

text

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

PersonCompletingForm,LastName

Datatyp

text

Person Completing Form, Phone
Beskrivning

PersonCompletingForm,Phone

Datatyp

text

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

PersonCompletingForm,Fax

Datatyp

double

Institution Name
Beskrivning

InstitutionName

Datatyp

text

Institution City
Beskrivning

InstitutionCity

Datatyp

text

Institution State
Beskrivning

InstitutionState

Datatyp

text

Institution NCI Code
Beskrivning

InstitutionNCICode

Datatyp

text

Investigator Name
Beskrivning

InvestigatorName

Datatyp

text

Affiliate Name
Beskrivning

AffiliateName

Datatyp

text

IRB Approval Date
Beskrivning

IRBApprovalDate

Datatyp

date

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

InformedConsentDateSigned

Datatyp

date

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

PatientenrolledonanyotherCGtrial

Datatyp

text

Other Cooperative Group Trial-Group Name
Beskrivning

OtherCooperativeGroupTrial-GroupName

Datatyp

text

Other Cooperative Group Trial-Protocol #
Beskrivning

OtherCooperativeGroupTrial-Protocol#

Datatyp

text

Other Cooperative Group Trial-Specify
Beskrivning

OtherCooperativeGroupTrial-Specify

Datatyp

text

Patient Identifier
Beskrivning

PatientIdentifier

Datatyp

text

NCI Investigator Number
Beskrivning

NCIInvestigatorNumber

Datatyp

text

Investigator Status
Beskrivning

InvestigatorStatus

Datatyp

text

Patient Study ID, Coordinating Group
Beskrivning

PatientStudyID,CoordinatingGroup

Datatyp

text

Treatment Arm Number
Beskrivning

TreatmentArmNumber

Datatyp

text

Registration Date
Beskrivning

RegistrationDate

Datatyp

date

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

CTSUPatientRegistrar

Datatyp

text

Is Treating Institution a CCOP of a Coop
Beskrivning

IsTreatingInstitutionaCCOPofaCoop

Datatyp

text

U10
Beskrivning

U10

Datatyp

text

Patient Gender
Beskrivning

PatientGender

Datatyp

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
Beskrivning

PatientRace

Datatyp

text

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

Comments1

Datatyp

text

Comments2
Beskrivning

Comments2

Datatyp

text

Investigator Code
Beskrivning

InvestigatorCode

Datatyp

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
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Similar models

No Instruction available.

1 Formulär
  1. StudyEvent: ECOG 4599 Registration Form
    1. No Instruction available.
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
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)
Tillbaka till toppen 

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