ID
10492
Description
Radiation Therapy Oncology Group Demographic Data Form - Version 2 NCT00048997 Radiation Therapy in Preventing CNS Metastases in Patients With Non-Small Cell Lung Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9EC372A6-6D13-05D5-E034-080020C9C0E0
Link
Keywords
Versions (4)
- 9/19/12 9/19/12 -
- 8/11/14 8/11/14 - Martin Dugas
- 6/2/15 6/2/15 -
- 6/3/15 6/3/15 -
Uploaded on
June 3, 2015
DOI
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License
Creative Commons BY-NC 3.0 Legacy
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Radiation Therapy Oncology Group Demographic Data Form - Version 2 NCT00048997
No Instruction available.
- StudyEvent: Radiation Therapy Oncology Group Demographic Data Form - Version 2
Description
Patient administration
Description
Patient demographics
Description
Whocompletedthisform?
Data type
text
Description
PatientRace/Ethnicity
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C17049
- UMLS 2011AA Property
- C0034510
Description
RaceOther,specify
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
Description
AdditionalRace/Ethnicity
Data type
text
Description
Highestschoolgradecompleted
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C16529
- UMLS 2011AA Property
- C0013622
- NCI Thesaurus Property-2
- C25525
- UMLS 2011AA Property-2
- C1522410
Description
HighestschoolgradecompletedOther,specify
Data type
text
Description
PersonPediatricReligionName
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C39299
- UMLS 2011AA Property
- C0231335
- NCI Thesaurus ValueDomain
- C42614
- UMLS 2011AA ValueDomain
- C0027365
- NCI Thesaurus Property-2
- C17085
- UMLS 2011AA Property-2
- C0035039
Description
ReligionduringchildhoodOther,specify
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
Description
Maritalstatus
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
Description
Wherewereyouborn?
Data type
text
Description
USA,specifythe2letterStatecode,egNY
Data type
text
Description
PatientAddress,Country
Data type
text
Description
Wheredidyoulivethelongest
Data type
text
Description
USA,specifythe2letterStatecode,egNY
Data type
text
Description
Wheredidyoulivethelongest,othercountry,specify
Data type
text
Description
Smoking history
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25180
- UMLS CUI-1
- C1519384
- NCI Thesaurus Property
- C20989
- NCI Thesaurus ObjectClass
- C29719
Description
PatientInitialCigaretteSmokingAgeYearCount
Data type
float
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C25536
- UMLS 2011AA Property
- C1555582
- NCI Thesaurus Property-2
- C18270
- UMLS 2011AA Property-2
- C0700219
- NCI Thesaurus ValueDomain
- C29848
- UMLS 2011AA ValueDomain
- C0439234
- NCI Thesaurus ValueDomain-2
- C25463
- UMLS 2011AA ValueDomain-2
- C0750480
Description
Numberofyearssmokedcigarettes
Data type
text
Description
Averagenumberofcigarettessmokedperday
Data type
float
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
Description
PatientSmokingCessationAgeYear
Data type
float
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus ValueDomain
- C29848
- UMLS 2011AA ValueDomain
- C0439234
- NCI Thesaurus ValueDomain-2
- C25463
- UMLS 2011AA ValueDomain-2
- C0750480
- NCI Metathesaurus Property
- C0085134
Description
Ifyouhavehadanyoftheillnesslistedbelow,pleasecheckyesforthosethatapply.
Data type
text
Description
Illness,specifyother
Data type
text
Description
Howmanyofthefollowingfamilymembers(livinganddead)doyouhave?
Data type
text
Description
Brothers
Data type
text
Description
Sisters
Data type
text
Description
Sons
Data type
text
Description
Daughters
Data type
text
Description
Areyouadopted?
Data type
boolean
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C25290
- UMLS 2011AA Property
- C0425382
Description
Bloodrelativewithcancer
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
Description
PersonFirstCancerDiagnosisAgeYearCount
Data type
float
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C9305
- UMLS 2011AA Property
- C0006826
- NCI Thesaurus Property-2
- C25509
- UMLS 2011AA Property-2
- C1279901
- NCI Thesaurus Property-3
- C15220
- UMLS 2011AA Property-3
- C0011900
- NCI Thesaurus Property-4
- C25150
- UMLS 2011AA Property-4
- C0001779
- NCI Thesaurus ValueDomain
- C29848
- UMLS 2011AA ValueDomain
- C0439234
- NCI Thesaurus ValueDomain-2
- C25463
- UMLS 2011AA ValueDomain-2
- C0750480
Description
TypeofCancer
Data type
text
Description
CancerPreventionTrialKnowledgeDocumentedInd-2
Data type
boolean
Alias
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
- NCI Thesaurus ObjectClass
- C15790
- UMLS 2011AA ObjectClass
- C1516220
- NCI Thesaurus Property
- C25356
- UMLS 2011AA Property
- C1301725
- NCI Metathesaurus Property
- C0376554
Description
CancerPreventionTrialParticipationScale
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25664
- UMLS 2011AA ValueDomain
- C0349674
- NCI Thesaurus Property
- C25608
- UMLS 2011AA Property
- C0679823
- NCI Thesaurus ObjectClass
- C15790
- UMLS 2011AA ObjectClass
- C1516220
Similar models
No Instruction available.
- StudyEvent: Radiation Therapy Oncology Group Demographic Data Form - Version 2
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
C0036588 (UMLS 2011AA)
C0030705 (UMLS 2011AA ObjectClass)
C17049 (NCI Thesaurus Property)
C0034510 (UMLS 2011AA Property)
C1521902 (UMLS 2011AA ValueDomain)
C0086409 (UMLS 2011AA)
C0027361 (UMLS 2011AA ObjectClass)
C16529 (NCI Thesaurus Property)
C0013622 (UMLS 2011AA Property)
C25525 (NCI Thesaurus Property-2)
C1522410 (UMLS 2011AA Property-2)
C1511035 (UMLS 2011AA)
C0027361 (UMLS 2011AA ObjectClass)
C39299 (NCI Thesaurus Property)
C0231335 (UMLS 2011AA Property)
C42614 (NCI Thesaurus ValueDomain)
C0027365 (UMLS 2011AA ValueDomain)
C17085 (NCI Thesaurus Property-2)
C0035039 (UMLS 2011AA Property-2)
C0549184 (UMLS 2011AA)
C1521902 (UMLS 2011AA ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C0206275 (UMLS 2011AA)
C1519384 (UMLS CUI-1)
C20989 (NCI Thesaurus Property)
C29719 (NCI Thesaurus ObjectClass)
C1298908 (UMLS 2011AA)
C0030705 (UMLS 2011AA ObjectClass)
C25536 (NCI Thesaurus Property)
C1555582 (UMLS 2011AA Property)
C18270 (NCI Thesaurus Property-2)
C0700219 (UMLS 2011AA Property-2)
C29848 (NCI Thesaurus ValueDomain)
C0439234 (UMLS 2011AA ValueDomain)
C25463 (NCI Thesaurus ValueDomain-2)
C0750480 (UMLS 2011AA ValueDomain-2)
C0237753 (UMLS 2011AA ValueDomain)
C0030705 (UMLS 2011AA ObjectClass)
C29848 (NCI Thesaurus ValueDomain)
C0439234 (UMLS 2011AA ValueDomain)
C25463 (NCI Thesaurus ValueDomain-2)
C0750480 (UMLS 2011AA ValueDomain-2)
C0085134 (NCI Metathesaurus Property)
C0036572 (UMLS 2011AA)
C0205394 (UMLS 2011AA)
C0030705 (UMLS 2011AA ObjectClass)
C25290 (NCI Thesaurus Property)
C0425382 (UMLS 2011AA Property)
C0332307 (UMLS 2011AA ValueDomain)
C0015671 (UMLS 2011AA)
C0026591 (UMLS 2011AA)
C0027361 (UMLS 2011AA ObjectClass)
C9305 (NCI Thesaurus Property)
C0006826 (UMLS 2011AA Property)
C25509 (NCI Thesaurus Property-2)
C1279901 (UMLS 2011AA Property-2)
C15220 (NCI Thesaurus Property-3)
C0011900 (UMLS 2011AA Property-3)
C25150 (NCI Thesaurus Property-4)
C0001779 (UMLS 2011AA Property-4)
C29848 (NCI Thesaurus ValueDomain)
C0439234 (UMLS 2011AA ValueDomain)
C25463 (NCI Thesaurus ValueDomain-2)
C0750480 (UMLS 2011AA ValueDomain-2)
C0024109 (UMLS 2011AA)
C0006141 (UMLS 2011AA)
C0009368 (UMLS 2011AA)
C0033572 (UMLS 2011AA)
C0205394 (UMLS 2011AA)
C1512698 (UMLS 2011AA ValueDomain)
C15790 (NCI Thesaurus ObjectClass)
C1516220 (UMLS 2011AA ObjectClass)
C25356 (NCI Thesaurus Property)
C1301725 (UMLS 2011AA Property)
C0376554 (NCI Metathesaurus Property)
C0349674 (UMLS 2011AA ValueDomain)
C25608 (NCI Thesaurus Property)
C0679823 (UMLS 2011AA Property)
C15790 (NCI Thesaurus ObjectClass)
C1516220 (UMLS 2011AA ObjectClass)
C0205448 (UMLS 2011AA)