ID

10482

Description

AMC-052 Histology Result Form 2676563v1.0 Human Papillomavirus Vaccine Therapy in Treating Men With HIV-1 Infection Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=3950D614-2D53-3AAB-E044-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=3950D614-2D53-3AAB-E044-0003BA3F9857

Keywords

Versions (3)
  1. 12/18/14 12/18/14 - Martin Dugas
  2. 6/2/15 6/2/15 -
  3. 6/3/15 6/3/15 -
Uploaded on

June 3, 2015

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License

Creative Commons BY-NC 3.0 Legacy
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AMC-052 Histology Result Form 2676563v1.0

English

No Instruction available.

1 forms  
  1. StudyEvent: AMC-052 Histology Result Form
    1. No Instruction available.
Header module
Description

Header module

Date anal biopsy obtained
Description

AnalHistologySpecimenCollectionDate

Data type

date

Alias
NCI Thesaurus ObjectClass
C16681
UMLS 2011AA ObjectClass
C0019638
NCI Thesaurus ObjectClass
C19157
UMLS 2011AA ObjectClass
C0370003
NCI Thesaurus ObjectClass
C28048
NCI Thesaurus Property
C25453
UMLS 2011AA Property
C1516698
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
Study week
Description

TreatmentReportingPeriodWeekNumber

Data type

double

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus Property
C25616
UMLS 2011AA Property
C1948053
NCI Thesaurus ObjectClass
C15368
NCI Thesaurus Property
C25651
UMLS 2011AA Property
C0700287
Anal histology results
Description

Anal histology results

Anal Biopsy Location
Description

AnalBiopsySpecimenAnatomicSite

Data type

text

Alias
NCI Thesaurus ObjectClass
C15189
UMLS 2011AA ObjectClass
C0005558
NCI Thesaurus ObjectClass
C28048
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus Property
C19157
UMLS 2011AA Property
C0370003
NCI Thesaurus Property
C25421
UMLS 2011AA Property
C0002808
NCI Thesaurus ValueDomain
C37901
UMLS 2011AA ValueDomain
C0205145
Proximity to squamocolumnar junction
Description

AnalCanalBiopsySpecimenAnatomicSite

Data type

text

Alias
NCI Thesaurus ObjectClass
C15189
UMLS 2011AA ObjectClass
C0005558
NCI Thesaurus ObjectClass
C12375
UMLS 2011AA ObjectClass
C0227411
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus Property
C19157
UMLS 2011AA Property
C0370003
NCI Thesaurus Property
C25421
UMLS 2011AA Property
C0002808
NCI Thesaurus ValueDomain
C37901
UMLS 2011AA ValueDomain
C0205145
Most severe anal biopsy result
Description

AnalBiopsyResultType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C15189
UMLS 2011AA ObjectClass
C0005558
NCI Thesaurus Property
C20200
UMLS 2011AA Property
C1274040
NCI Thesaurus ObjectClass
C28048
Modifying diagnosis
Description

AnalBiopsyAdditionalDiagnosisType

Data type

text

Alias
NCI Thesaurus ObjectClass
C15189
UMLS 2011AA ObjectClass
C0005558
NCI Thesaurus ObjectClass
C28048
NCI Thesaurus Property
C15220
UMLS 2011AA Property
C0011900
NCI Metathesaurus Property
CL051857
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Other, specify
Description

AnalBiopsyAdditionalDiagnosisSpecify

Data type

text

Alias
NCI Thesaurus ObjectClass
C15189
UMLS 2011AA ObjectClass
C0005558
NCI Thesaurus ObjectClass
C28048
NCI Thesaurus Property
C15220
UMLS 2011AA Property
C0011900
NCI Metathesaurus Property
CL051857
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
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Similar models

No Instruction available.

1 forms
  1. StudyEvent: AMC-052 Histology Result Form
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Header module
AnalHistologySpecimenCollectionDate
Item
Date anal biopsy obtained
date
C16681 (NCI Thesaurus ObjectClass)
C0019638 (UMLS 2011AA ObjectClass)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C28048 (NCI Thesaurus ObjectClass)
C25453 (NCI Thesaurus Property)
C1516698 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
TreatmentReportingPeriodWeekNumber
Item
Study week
double
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25616 (NCI Thesaurus Property)
C1948053 (UMLS 2011AA Property)
C15368 (NCI Thesaurus ObjectClass)
C25651 (NCI Thesaurus Property)
C0700287 (UMLS 2011AA Property)
Item Group
Anal histology results
Item
Anal Biopsy Location
text
C15189 (NCI Thesaurus ObjectClass)
C0005558 (UMLS 2011AA ObjectClass)
C28048 (NCI Thesaurus ObjectClass)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C19157 (NCI Thesaurus Property)
C0370003 (UMLS 2011AA Property)
C25421 (NCI Thesaurus Property)
C0002808 (UMLS 2011AA Property)
C37901 (NCI Thesaurus ValueDomain)
C0205145 (UMLS 2011AA ValueDomain)
CL.1
Code List
Anal Biopsy Location
CL Item
Anterior (Anterior)
C25231 (NCI Thesaurus)
C0205094 (UMLS 2011AA)
CL Item
Left Anterior (Left anterior)
CL Item
Left Lateral (Left lateral)
CL Item
Left Posterior (Left posterior)
CL Item
Posterior (Posterior)
C25622 (NCI Thesaurus)
C0205095 (UMLS 2011AA)
CL Item
Right Anterior (Right anterior)
CL Item
Right Lateral (Right lateral)
CL Item
Right Posterior (Right posterior)
Item
Proximity to squamocolumnar junction
text
C15189 (NCI Thesaurus ObjectClass)
C0005558 (UMLS 2011AA ObjectClass)
C12375 (NCI Thesaurus ObjectClass)
C0227411 (UMLS 2011AA ObjectClass)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C19157 (NCI Thesaurus Property)
C0370003 (UMLS 2011AA Property)
C25421 (NCI Thesaurus Property)
C0002808 (UMLS 2011AA Property)
C37901 (NCI Thesaurus ValueDomain)
C0205145 (UMLS 2011AA ValueDomain)
CL.2
Code List
Proximity to squamocolumnar junction
CL Item
At Or Near Squamocolumnar Junction (At or near squamocolumnar junction)
CL Item
Distal Or Midcanal (Distal or midcanal)
CL Item
Perianal (Perianal)
Item
Most severe anal biopsy result
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C15189 (NCI Thesaurus ObjectClass)
C0005558 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C28048 (NCI Thesaurus ObjectClass)
CL.3
Code List
Most severe anal biopsy result
CL Item
Normal Squamous Epithelium (Normal squamous epithelium)
CL Item
Squamous Metaplasia (Squamous metaplasia)
C3237 (NCI Thesaurus)
C0025570 (UMLS 2011AA)
CL Item
Low-grade Ain (Low-grade AIN)
CL Item
Condyloma (Condyloma)
CL Item
Flat Condyloma (Flat condyloma)
CL Item
High-grade Ain (High-grade AIN)
CL Item
Invasive Cancer (Invasive cancer)
CL Item
Colonic Epithelium (Colonic epithelium)
CL Item
Unevaluable (Unevaluable)
C62222 (NCI Thesaurus)
C1883425 (UMLS 2011AA)
Item
Modifying diagnosis
text
C15189 (NCI Thesaurus ObjectClass)
C0005558 (UMLS 2011AA ObjectClass)
C28048 (NCI Thesaurus ObjectClass)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
CL051857 (NCI Metathesaurus Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.4
Code List
Modifying diagnosis
CL Item
Acanthosis (Acanthosis)
CL Item
Inflammation (Acute inflammation)
C3137 (NCI Thesaurus)
C0021368 (UMLS 2011AA)
CL Item
Evidence Of Hsv Infection (Evidence of HSV infection)
CL Item
Hyperkeratosis (Hyperkeratosis)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
CL Item
Papillomatosis (Papillomatosis)
CL Item
Parakeratosis (Parakeratosis)
CL Item
Subacute Or Chronic Inflammation (Subacute or chronic inflammation)
AnalBiopsyAdditionalDiagnosisSpecify
Item
Other, specify
text
C15189 (NCI Thesaurus ObjectClass)
C0005558 (UMLS 2011AA ObjectClass)
C28048 (NCI Thesaurus ObjectClass)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
CL051857 (NCI Metathesaurus Property)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
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