ID
10527
Description
Assessment Compliance Form NCT00057876 Gemcitabine With or Without Radiation Therapy in Treating Patients With Pancreatic Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A624C73B-3251-3CE8-E034-0003BA0B1A09
Link
Keywords
Versions (3)
- 9/19/12 9/19/12 -
- 6/1/15 6/1/15 -
- 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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Assessment Compliance Form NCT00057876
No Instruction available.
- StudyEvent: Assessment Compliance Form
Description
data amendment
Description
AmendedDataInd
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C25474
- UMLS 2011AA ObjectClass
- C1511726
- NCI Thesaurus Property
- C25416
- UMLS 2011AA Property
- C1691222
Description
AssessmentFormNo.
Data type
text
Description
DateAssessmentScheduled
Data type
text
Description
AssessmentFormCompletedInd-2
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
- NCI Thesaurus ObjectClass
- C19464
- UMLS 2011AA ObjectClass
- C0376315
- NCI Thesaurus Property
- C25250
- UMLS 2011AA Property
- C0205197
- NCI Thesaurus ObjectClass
- C25367
Description
Timepoint
Data type
text
Description
Timepoint,otherspecify
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
Description
If Assessment Was Completed
Description
If Assessment Is Intended To Be Self-administered
Description
WasAssessmentself-administered?
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C25217
- UMLS 2011AA ObjectClass
- C1516048
- NCI Thesaurus Property
- C25670
- UMLS 2011AA Property
- C1519231
Description
IfNO,howwaspatientassisted?
Data type
text
Description
IfNO,whatwasthereason?
Data type
text
Description
Languagedifficulty,specifylanguage
Data type
text
Description
disability,pleasespecify
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
Description
other,pleasespecify(reason)
Data type
text
Description
IfNO,whoassistedorcompletedassessment?
Data type
text
Description
other,pleasespecify(whoassistedorcompletedassessment)
Data type
text
Description
If Assessment Was Not Completed
Description
Indicateprimaryreasonwhyformwasnotcompleted
Data type
text
Description
unabletoaccommodatedisabilityorlanguageneedspleasespecify
Data type
text
Description
patientdidnotshowupinclinic/officepleasespecify
Data type
text
Description
assessmentnotrequiredperprotocolpleasespecify
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
Description
other,specify(primaryreasonformwasnotcompleted)
Data type
text
Description
Comment
Description
Comments
Data type
text
Description
InvestigatorSignature
Data type
text
Alias
- NCI Thesaurus Property
- C25678
- UMLS 2011AA Property
- C1519316
- NCI Thesaurus ObjectClass
- C17089
- UMLS 2011AA ObjectClass
- C0035173
Description
InvestigatorSignatureDate
Data type
date
Description
Ccrr Module For Assessment Compliance Form
Similar models
No Instruction available.
- StudyEvent: Assessment Compliance Form
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C1512698 (UMLS 2011AA ValueDomain)
C19464 (NCI Thesaurus ObjectClass)
C0376315 (UMLS 2011AA ObjectClass)
C25250 (NCI Thesaurus Property)
C0205197 (UMLS 2011AA Property)
C25367 (NCI Thesaurus ObjectClass)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C1442488 (UMLS 2011AA)
C1521902 (UMLS 2011AA ValueDomain)
C1516048 (UMLS 2011AA ObjectClass)
C25670 (NCI Thesaurus Property)
C1519231 (UMLS 2011AA Property)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C1521902 (UMLS 2011AA ValueDomain)
C0015576 (UMLS 2011AA)
C1521902 (UMLS 2011AA ValueDomain)
C1519316 (UMLS 2011AA Property)
C17089 (NCI Thesaurus ObjectClass)
C0035173 (UMLS 2011AA ObjectClass)
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