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ID

10516

Description

AMC-051 Complete Physical Exam Form (F21)NCT00450320 Sirolimus in Treating Patients With HIV-Related Kaposi's Sarcoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=2FF95103-FC9E-6437-E044-0003BA3F9857

Lien

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=2FF95103-FC9E-6437-E044-0003BA3F9857

Mots-clés

Versions (3)
  1. 19/09/2012 19/09/2012 -
  2. 01/06/2015 01/06/2015 -
  3. 03/06/2015 03/06/2015 -
Téléchargé le

3 juin 2015

DOI

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Licence

Creative Commons BY-NC 3.0 Legacy
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    AMC-051 Complete Physical Exam Form (F21) NCT00450320

    Anglais

    No Instruction available.

    1 Formulaires  
    1. StudyEvent: AMC-051 Complete Physical Exam Form (F21)
      1. No Instruction available.
    Header Module
    Description

    Header Module

    Visit number
    Description

    HospitalAdmissionOrdinalNumber

    Type de données

    double

    Alias
    NCI Thesaurus ValueDomain
    C25337 (undefined)
    UMLS 2011AA ValueDomain
    C0237753 (Numbers)
    SNOMED
    260299005
    LOINC
    LP6841-3
    NCI Thesaurus ObjectClass
    C16696 (undefined)
    UMLS 2011AA ObjectClass
    C0019994 (Hospitals)
    NCI Thesaurus Property
    C25385 (undefined)
    UMLS 2011AA Property
    C0809949 (Admission activity)
    LOINC
    LA14106-1
    Date of evaluation
    Description

    AssessmentPerformedDate

    Type de données

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164 (undefined)
    UMLS 2011AA ValueDomain
    C0011008 (Date in time)
    SNOMED
    410671006
    NCI Thesaurus ObjectClass
    C25367 (undefined)
    NCI Thesaurus ValueDomain
    C25367 (undefined)
    NCI Thesaurus Property
    C38000 (undefined)
    UMLS 2011AA Property
    C0884358 (Performed)
    SNOMED
    398166005
    LOINC
    LA19974-7
    Physical examination
    Description

    Physical examination

    Primary site
    Description

    PatientCompletePhysicalExaminationAnatomicSite

    Type de données

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960 (undefined)
    UMLS 2011AA ObjectClass
    C0030705 (Patients)
    SNOMED
    116154003
    NCI Thesaurus Property
    C20989 (undefined)
    UMLS 2011AA Property
    C0031809 (Physical Examination)
    SNOMED
    5880005
    LOINC
    MTHU028014
    NCI Thesaurus Property
    C25250 (undefined)
    UMLS 2011AA Property
    C0205197 (Complete)
    SNOMED
    255594003
    LOINC
    LA13937-0
    NCI Thesaurus Property
    C25341 (undefined)
    UMLS 2011AA Property
    C0450429 (Location)
    SNOMED
    246267002
    LOINC
    LP149876-7
    NCI Thesaurus Property
    C25421 (undefined)
    UMLS 2011AA Property
    C0002808 (Science of Anatomy)
    LOINC
    LP6777-9
    NCI Thesaurus ValueDomain
    C37901 (undefined)
    UMLS 2011AA ValueDomain
    C0205145 (Site)
    SNOMED
    10546003
    LOINC
    MTHU014632
    Other, specify
    Description

    PatientCompletePhysicalExaminationAnatomicLocationSpecify

    Type de données

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960 (undefined)
    UMLS 2011AA ObjectClass
    C0030705 (Patients)
    SNOMED
    116154003
    NCI Thesaurus Property
    C20989 (undefined)
    UMLS 2011AA Property
    C0031809 (Physical Examination)
    SNOMED
    5880005
    LOINC
    MTHU028014
    NCI Thesaurus Property
    C25250 (undefined)
    UMLS 2011AA Property
    C0205197 (Complete)
    SNOMED
    255594003
    LOINC
    LA13937-0
    NCI Thesaurus Property
    C25341 (undefined)
    UMLS 2011AA Property
    C0450429 (Location)
    SNOMED
    246267002
    LOINC
    LP149876-7
    NCI Thesaurus Property
    C25421 (undefined)
    UMLS 2011AA Property
    C0002808 (Science of Anatomy)
    LOINC
    LP6777-9
    NCI Thesaurus ValueDomain
    C25685 (undefined)
    UMLS 2011AA ValueDomain
    C1521902 (To specify)
    Assessment
    Description

    PatientCompletePhysicalExaminationStatus

    Type de données

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960 (undefined)
    UMLS 2011AA ObjectClass
    C0030705 (Patients)
    SNOMED
    116154003
    NCI Thesaurus Property
    C20989 (undefined)
    UMLS 2011AA Property
    C0031809 (Physical Examination)
    SNOMED
    5880005
    LOINC
    MTHU028014
    NCI Thesaurus Property
    C25250 (undefined)
    UMLS 2011AA Property
    C0205197 (Complete)
    SNOMED
    255594003
    LOINC
    LA13937-0
    NCI Thesaurus ValueDomain
    C25688 (undefined)
    UMLS 2011AA ValueDomain
    C0449438 (Status)
    SNOMED
    263490005
    LOINC
    LP73412-6
    Describe abnormal findings
    Description

    PatientCompletePhysicalExaminationSpecify

    Type de données

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960 (undefined)
    UMLS 2011AA ObjectClass
    C0030705 (Patients)
    SNOMED
    116154003
    NCI Thesaurus Property
    C20989 (undefined)
    UMLS 2011AA Property
    C0031809 (Physical Examination)
    SNOMED
    5880005
    LOINC
    MTHU028014
    NCI Thesaurus Property
    C25250 (undefined)
    UMLS 2011AA Property
    C0205197 (Complete)
    SNOMED
    255594003
    LOINC
    LA13937-0
    NCI Thesaurus ValueDomain
    C25685 (undefined)
    UMLS 2011AA ValueDomain
    C1521902 (To specify)
    NCI Thesaurus ValueDomain
    C25401 (undefined)
    UMLS 2011AA ValueDomain
    C0205161 (Abnormal)
    SNOMED
    263654008
    LOINC
    LP28764-6
    Footer Module
    Description

    Footer Module

    Comments
    Description

    ResearchCommentsText

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704 (undefined)
    UMLS 2011AA ValueDomain
    C1527021 (Text)
    LOINC
    LP6885-0
    NCI Thesaurus ObjectClass
    C15319 (undefined)
    NCI Thesaurus Property
    C25393 (undefined)
    UMLS 2011AA Property
    C0282411 (Published Comment)
    LOINC
    MTHU018874
    Retour au début de la page

    Similar models

    No Instruction available.

    1 Formulaires
    1. StudyEvent: AMC-051 Complete Physical Exam Form (F21)
      1. No Instruction available.
    Name
    Type
    Description | Question | Decode (Coded Value)
    Type de données
    Alias
    Item Group
    Header Module
    HospitalAdmissionOrdinalNumber
    Item
    Visit number
    double
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    C16696 (NCI Thesaurus ObjectClass)
    C0019994 (UMLS 2011AA ObjectClass)
    C25385 (NCI Thesaurus Property)
    C0809949 (UMLS 2011AA Property)
    AssessmentPerformedDate
    Item
    Date of evaluation
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C25367 (NCI Thesaurus ObjectClass)
    C25367 (NCI Thesaurus ValueDomain)
    C38000 (NCI Thesaurus Property)
    C0884358 (UMLS 2011AA Property)
    Item Group
    Physical examination
    Item
    Primary site
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C25250 (NCI Thesaurus Property)
    C0205197 (UMLS 2011AA Property)
    C25341 (NCI Thesaurus Property)
    C0450429 (UMLS 2011AA Property)
    C25421 (NCI Thesaurus Property)
    C0002808 (UMLS 2011AA Property)
    C37901 (NCI Thesaurus ValueDomain)
    C0205145 (UMLS 2011AA ValueDomain)
    CL.1
    Code List
    Primary site
    CL Item
    Abdomen (Abdomen)
    C12664 (NCI Thesaurus)
    C0230168 (UMLS 2011AA)
    CL Item
    Chest (Chest)
    C25389 (NCI Thesaurus)
    C0817096 (UMLS 2011AA)
    CL Item
    Ear (Ears)
    C12394 (NCI Thesaurus)
    C0013443 (UMLS 2011AA)
    CL Item
    Extremities (Extremities)
    C30140 (NCI Thesaurus)
    CL Item
    Eye (Eyes)
    C12401 (NCI Thesaurus)
    C0015392 (UMLS 2011AA)
    CL Item
    Genitalia (Genital)
    C25177 (NCI Thesaurus)
    C0017420 (UMLS 2011AA)
    CL Item
    Head (Head)
    C12419 (NCI Thesaurus)
    C0018670 (UMLS 2011AA)
    CL Item
    Heart (Heart)
    C12727 (NCI Thesaurus)
    C0018787 (UMLS 2011AA)
    CL Item
    Liver (Liver)
    C12392 (NCI Thesaurus)
    C0023884 (UMLS 2011AA)
    CL Item
    Lung (Lungs)
    C12468 (NCI Thesaurus)
    C0024109 (UMLS 2011AA)
    CL Item
    Lymph Node (Lymph Nodes)
    C12745 (NCI Thesaurus)
    C0024204 (UMLS 2011AA)
    CL Item
    Mouth (Mouth)
    C0922752 (NCI Metathesaurus)
    CL Item
    Neck (Neck)
    C13063 (NCI Thesaurus)
    C0027530 (UMLS 2011AA)
    CL Item
    Neurologic (Neurological)
    C25262 (NCI Thesaurus)
    C0205494 (UMLS 2011AA)
    CL Item
    Other (Other)
    C17649 (NCI Thesaurus)
    C0205394 (UMLS 2011AA)
    CL Item
    Rectal (Rectal)
    C25224 (NCI Thesaurus)
    C0205052 (UMLS 2011AA)
    CL Item
    Skin (Skin)
    C12470 (NCI Thesaurus)
    C1123023 (UMLS 2011AA)
    CL Item
    Spleen (Spleen)
    C12432 (NCI Thesaurus)
    C0037993 (UMLS 2011AA)
    PatientCompletePhysicalExaminationAnatomicLocationSpecify
    Item
    Other, specify
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C25250 (NCI Thesaurus Property)
    C0205197 (UMLS 2011AA Property)
    C25341 (NCI Thesaurus Property)
    C0450429 (UMLS 2011AA Property)
    C25421 (NCI Thesaurus Property)
    C0002808 (UMLS 2011AA Property)
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    Item
    Assessment
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C25250 (NCI Thesaurus Property)
    C0205197 (UMLS 2011AA Property)
    C25688 (NCI Thesaurus ValueDomain)
    C0449438 (UMLS 2011AA ValueDomain)
    CL.2
    Code List
    Assessment
    CL Item
    Abnormal (Abnormal)
    C25401 (NCI Thesaurus)
    C0205161 (UMLS 2011AA)
    CL Item
    Normal (Normal)
    C14165 (NCI Thesaurus)
    C0205307 (UMLS 2011AA)
    CL Item
    Not Evaluated (Not Evaluated)
    PatientCompletePhysicalExaminationSpecify
    Item
    Describe abnormal findings
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C25250 (NCI Thesaurus Property)
    C0205197 (UMLS 2011AA Property)
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    C25401 (NCI Thesaurus ValueDomain)
    C0205161 (UMLS 2011AA ValueDomain)
    Item Group
    Footer Module
    ResearchCommentsText
    Item
    Comments
    text
    C25704 (NCI Thesaurus ValueDomain)
    C1527021 (UMLS 2011AA ValueDomain)
    C15319 (NCI Thesaurus ObjectClass)
    C25393 (NCI Thesaurus Property)
    C0282411 (UMLS 2011AA Property)
    Retour au début de la page 

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