ID

10483

Beskrivning

CALGB: 80101 BLOOD SAMPLE TRACKING FORM Chemotherapy and Radiation Therapy After Surgery in Treating Patients With Stomach or Esophageal Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9DA6CD3D-FA7B-5976-E034-080020C9C0E0 NCT00052910

Länk

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9DA6CD3D-FA7B-5976-E034-080020C9C0E0

Nyckelord

Versioner (3)
  1. 2014-12-18 2014-12-18 - Martin Dugas
  2. 2015-06-02 2015-06-02 -
  3. 2015-06-03 2015-06-03 -
Uppladdad den

3 juni 2015

DOI

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Licens

Creative Commons BY-NC 3.0 Legacy
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CALGB: 80101 BLOOD SAMPLE TRACKING FORM NCT00052910

Engelsk

No Instruction available.

1 Formulär  
  1. StudyEvent: CALGB: 80101 BLOOD SAMPLE TRACKING FORM
    1. No Instruction available.
CALGB clinical trial administrative data
Beskrivning

CALGB clinical trial administrative data

CALGB Form
Beskrivning

CALGBForm

Datatyp

text

CALGB Study No
Beskrivning

CALGBProtocolNumber

Datatyp

text

CALGB Patient ID
Beskrivning

CALGBPatientID

Datatyp

text

Patient's Name
Beskrivning

PatientName,Last

Datatyp

text

Participating Group
Beskrivning

ParticipatingGroupCode

Datatyp

text

Patient Hospital Number
Beskrivning

PatientMedicalRecordNumber

Datatyp

text

Participating Group Protocol No.
Beskrivning

Particip.GroupProtocolNumber

Datatyp

float

Main Member Institution/Adjunct
Beskrivning

InstitutionName

Datatyp

text

Participating Group Patient No.
Beskrivning

PatientStudyID,ParticipatingGroup

Datatyp

text

Date form submitted
Beskrivning

Dateformsubmitted

Datatyp

text

Amended data?
Beskrivning

AmendedDataInd

Datatyp

text

Alias
NCI Thesaurus ObjectClass
C25474
UMLS 2011AA ObjectClass
C1511726
NCI Thesaurus Property
C25416
UMLS 2011AA Property
C1691222
To Be Completed By Submitting Institution
Beskrivning

To Be Completed By Submitting Institution

Does specimen accompany this form?
Beskrivning

Specimenw/FormInd

Datatyp

text

Specify reason
Beskrivning

Specifyreason

Datatyp

text

Date sample collected
Beskrivning

SpecimenCollectionDate

Datatyp

date

Number of tubes of whole blood submitted with this form
Beskrivning

WholeBloodTubesSubmittedCount

Datatyp

float

Alias
NCI Thesaurus ValueDomain
C25463
UMLS 2011AA ValueDomain
C0750480
NCI Thesaurus ObjectClass
C41067
UMLS 2011AA ObjectClass
C1608383
NCI Thesaurus Property
C25695
UMLS 2011AA Property
C1515023
NCI Metathesaurus Property
C0175730
Sample time Point
Beskrivning

SpecimenCollectionTime

Datatyp

text

Submitted by
Beskrivning

PersonSpecimenSubmittedName

Datatyp

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C19157
UMLS 2011AA Property
C0370003
NCI Thesaurus Property-2
C25695
UMLS 2011AA Property-2
C1515023
Phone #
Beskrivning

PhoneNumber

Datatyp

float

To Be Completed By Receiving Institution/laboratory
Beskrivning

To Be Completed By Receiving Institution/laboratory

Date sample received
Beskrivning

SpecimenReceivedDate

Datatyp

date

Sample condition
Beskrivning

Samplecondition

Datatyp

text

Sample ID no.
Beskrivning

SpecimenID

Datatyp

float

Received by
Beskrivning

PersonSpecimenReceivedName

Datatyp

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C25639
UMLS 2011AA Property
C1514756
NCI Thesaurus Property-2
C19157
UMLS 2011AA Property-2
C0370003
Is sample evaluable for analysis?
Beskrivning

SpecimenEvaluableInd

Datatyp

text

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Similar models

No Instruction available.

1 Formulär
  1. StudyEvent: CALGB: 80101 BLOOD SAMPLE TRACKING FORM
    1. No Instruction available.
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
CALGB clinical trial administrative data
CALGBForm
Item
CALGB Form
text
CALGBProtocolNumber
Item
CALGB Study No
text
CALGBPatientID
Item
CALGB Patient ID
text
PatientName,Last
Item
Patient's Name
text
ParticipatingGroupCode
Item
Participating Group
text
PatientMedicalRecordNumber
Item
Patient Hospital Number
text
Particip.GroupProtocolNumber
Item
Participating Group Protocol No.
float
InstitutionName
Item
Main Member Institution/Adjunct
text
PatientStudyID,ParticipatingGroup
Item
Participating Group Patient No.
text
Dateformsubmitted
Item
Date form submitted
text
Item
Amended data?
text
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
CL.1
Code List
Amended data?
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item Group
To Be Completed By Submitting Institution
Item
Does specimen accompany this form?
text
CL.2
Code List
Does specimen accompany this form?
CL Item
No, Specify Reason (No, specify reason)
CL Item
Yes, Complete The Remainder Of Form (Yes, complete the remainder of form)
Specifyreason
Item
Specify reason
text
SpecimenCollectionDate
Item
Date sample collected
date
WholeBloodTubesSubmittedCount
Item
Number of tubes of whole blood submitted with this form
float
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C41067 (NCI Thesaurus ObjectClass)
C1608383 (UMLS 2011AA ObjectClass)
C25695 (NCI Thesaurus Property)
C1515023 (UMLS 2011AA Property)
C0175730 (NCI Metathesaurus Property)
Item
Sample time Point
text
CL.3
Code List
Sample time Point
CL Item
1-pre-study (1-pre-study)
PersonSpecimenSubmittedName
Item
Submitted by
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C19157 (NCI Thesaurus Property)
C0370003 (UMLS 2011AA Property)
C25695 (NCI Thesaurus Property-2)
C1515023 (UMLS 2011AA Property-2)
PhoneNumber
Item
Phone #
float
Item Group
To Be Completed By Receiving Institution/laboratory
SpecimenReceivedDate
Item
Date sample received
date
Item
Sample condition
text
CL.4
Code List
Sample condition
CL Item
Okay (Okay)
CL Item
Damaged (Damaged)
CL Item
Missing (Missing)
CL Item
Thawed (Thawed)
CL Item
Insufficient Amount (Insufficient amount)
CL Item
Clotted (Clotted)
SpecimenID
Item
Sample ID no.
float
PersonSpecimenReceivedName
Item
Received by
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25639 (NCI Thesaurus Property)
C1514756 (UMLS 2011AA Property)
C19157 (NCI Thesaurus Property-2)
C0370003 (UMLS 2011AA Property-2)
Item
Is sample evaluable for analysis?
text
CL.5
Code List
Is sample evaluable for analysis?
CL Item
No, Procedural Deviations Definitely Affect Analysis (No, procedural deviations definitely affect analysis)
CL Item
Yes, Sample Is Evaluable (Yes, sample is evaluable)
CL Item
Unsure, Procedural Deviations May Affect Analysis (Unsure, procedural deviations may affect analysis)
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