ID

10588

Beschreibung

AMC-052 Oral Mucosal Tissue Examination For Oral Warts Form (OHA)NCT00513526 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=395233F2-905B-4E17-E044-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=395233F2-905B-4E17-E044-0003BA3F9857

Stichworte

Versionen (3)
  1. 19.09.12 19.09.12 -
  2. 28.05.15 28.05.15 -
  3. 03.06.15 03.06.15 -
Hochgeladen am

3. Juni 2015

DOI

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AMC-052 Oral Mucosal Tissue Examination For Oral Warts Form (OHA) NCT00513526

Englisch

No Instruction available.

1 Formulare  
  1. StudyEvent: AMC-052 Oral Mucosal Tissue Examination For Oral Warts Form (OHA)
    1. No Instruction available.
Header Module
Beschreibung

Header Module

Visit number
Beschreibung

HospitalAdmissionOrdinalNumber

Datentyp

double

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C16696
UMLS 2011AA ObjectClass
C0019994
NCI Thesaurus Property
C25385
UMLS 2011AA Property
C0809949
Sequence number
Beschreibung

SequentialFormSubmissionCount

Datentyp

double

Alias
NCI Thesaurus ObjectClass
C19464
UMLS 2011AA ObjectClass
C0376315
NCI Thesaurus ValueDomain
C25463
UMLS 2011AA ValueDomain
C0750480
NCI Thesaurus ObjectClass
C49153
UMLS 2011AA ObjectClass
C1705294
NCI Thesaurus Property
C25694
UMLS 2011AA Property
C1515022
ORAL WARTS LOCATION AND EXTENT OF ORAL WART DISEASE
Beschreibung

ORAL WARTS LOCATION AND EXTENT OF ORAL WART DISEASE

Oral exam performed (at this visit)
Beschreibung

OralCavityAssessmentPerformedInd-2

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C25367
NCI Thesaurus ObjectClass
C12421
UMLS 2011AA ObjectClass
C0226896
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
Specify (If no)
Beschreibung

OralCavityAssessmentNotPerformedSpecify

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C25367
NCI Thesaurus ObjectClass
C12421
UMLS 2011AA ObjectClass
C0226896
NCI Thesaurus Property
C25594
UMLS 2011AA Property
C1518422
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
Oral warts present (at this visit)
Beschreibung

OralVerrucousLesionDiseasePresentInd-2

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus ObjectClass
C25311
UMLS 2011AA ObjectClass
C0442027
NCI Thesaurus ObjectClass
C5028
UMLS 2011AA ObjectClass
C0043037
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Oral warts location
Beschreibung

OralVerrucousLesionDiseaseAnatomicSite

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus ObjectClass
C25311
UMLS 2011AA ObjectClass
C0442027
NCI Thesaurus ObjectClass
C5028
UMLS 2011AA ObjectClass
C0043037
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus Property
C25421
UMLS 2011AA Property
C0002808
NCI Thesaurus ValueDomain
C37901
UMLS 2011AA ValueDomain
C0205145
Extent of oral wart disease
Beschreibung

OralVerrucousLesionDiseaseExtentType

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus ObjectClass
C25311
UMLS 2011AA ObjectClass
C0442027
NCI Thesaurus ObjectClass
C5028
UMLS 2011AA ObjectClass
C0043037
NCI Thesaurus Property
C25332
UMLS 2011AA Property
C0439792
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Oral wart color
Beschreibung

OralVerrucousLesionDiseaseColorPresentType

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus ObjectClass
C25311
UMLS 2011AA ObjectClass
C0442027
NCI Thesaurus ObjectClass
C5028
UMLS 2011AA ObjectClass
C0043037
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus Property
C64546
UMLS 2011AA Property
C1880121
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Oral wart characteristics
Beschreibung

OralVerrucousLesionDiseaseCharacteristicsPresentType

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus ObjectClass
C25311
UMLS 2011AA ObjectClass
C0442027
NCI Thesaurus ObjectClass
C5028
UMLS 2011AA ObjectClass
C0043037
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus Property
C25447
UMLS 2011AA Property
C1521970
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Prior History And Treatment
Beschreibung

Prior History And Treatment

Oral warts previously detected (at the last oral examination visit for this study)
Beschreibung

OralVerrucousLesionDiseasePriorPresentInd-2

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus ObjectClass
C25311
UMLS 2011AA ObjectClass
C0442027
NCI Thesaurus ObjectClass
C5028
UMLS 2011AA ObjectClass
C0043037
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus Property
C25629
UMLS 2011AA Property
C0332152
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Prior Biopsy for Oral Warts (since the last oral examination visit for this study)
Beschreibung

OralVerrucousLesionDiseasePriorBiopsyPerformedInd-2

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus ObjectClass
C25311
UMLS 2011AA ObjectClass
C0442027
NCI Thesaurus ObjectClass
C5028
UMLS 2011AA ObjectClass
C0043037
NCI Thesaurus Property
C15189
UMLS 2011AA Property
C0005558
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus Property
C25629
UMLS 2011AA Property
C0332152
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Prior Treatment for Oral Warts (since the last oral examination visit for this study)
Beschreibung

OralVerrucousLesionDiseasePriorTreatmentPresentInd-2

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus ObjectClass
C25311
UMLS 2011AA ObjectClass
C0442027
NCI Thesaurus ObjectClass
C5028
UMLS 2011AA ObjectClass
C0043037
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus Property
C25629
UMLS 2011AA Property
C0332152
NCI Thesaurus Property
C15697
UMLS 2011AA Property
C0040808
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Oral Warts Treatment Result (per participant report)
Beschreibung

OralVerrucousLesionDiseasePriorTreatmentPresentStatus

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus ObjectClass
C25311
UMLS 2011AA ObjectClass
C0442027
NCI Thesaurus ObjectClass
C5028
UMLS 2011AA ObjectClass
C0043037
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus Property
C25629
UMLS 2011AA Property
C0332152
NCI Thesaurus Property
C15697
UMLS 2011AA Property
C0040808
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
Further information concerning oral warts (If "Yes" specify in comments)
Beschreibung

OralVerrucousLesionDiseaseAdditionalCommentInd-2

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus ObjectClass
C25311
UMLS 2011AA ObjectClass
C0442027
NCI Thesaurus ObjectClass
C5028
UMLS 2011AA ObjectClass
C0043037
NCI Thesaurus Property
C25393
UMLS 2011AA Property
C0282411
NCI Thesaurus Property
C25406
UMLS 2011AA Property
C1524062
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Comments Module
Beschreibung

Comments Module

Comments
Beschreibung

ResearchCommentsText

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
UMLS 2011AA Property
C0282411
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Ähnliche Modelle

No Instruction available.

1 Formulare
  1. StudyEvent: AMC-052 Oral Mucosal Tissue Examination For Oral Warts Form (OHA)
    1. No Instruction available.
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
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)
SequentialFormSubmissionCount
Item
Sequence number
double
C19464 (NCI Thesaurus ObjectClass)
C0376315 (UMLS 2011AA ObjectClass)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C49153 (NCI Thesaurus ObjectClass)
C1705294 (UMLS 2011AA ObjectClass)
C25694 (NCI Thesaurus Property)
C1515022 (UMLS 2011AA Property)
Item Group
ORAL WARTS LOCATION AND EXTENT OF ORAL WART DISEASE
Item
Oral exam performed (at this visit)
text
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ObjectClass)
C12421 (NCI Thesaurus ObjectClass)
C0226896 (UMLS 2011AA ObjectClass)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
CL.1
Code List
Oral exam performed (at this visit)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
OralCavityAssessmentNotPerformedSpecify
Item
Specify (If no)
text
C25367 (NCI Thesaurus ObjectClass)
C12421 (NCI Thesaurus ObjectClass)
C0226896 (UMLS 2011AA ObjectClass)
C25594 (NCI Thesaurus Property)
C1518422 (UMLS 2011AA Property)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
Item
Oral warts present (at this visit)
text
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C25311 (NCI Thesaurus ObjectClass)
C0442027 (UMLS 2011AA ObjectClass)
C5028 (NCI Thesaurus ObjectClass)
C0043037 (UMLS 2011AA ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
CL.2
Code List
Oral warts present (at this visit)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Oral warts location
text
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C25311 (NCI Thesaurus ObjectClass)
C0442027 (UMLS 2011AA ObjectClass)
C5028 (NCI Thesaurus ObjectClass)
C0043037 (UMLS 2011AA ObjectClass)
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.3
Code List
Oral warts location
CL Item
Lower Lip (Lower lip)
CL Item
Upper Lip (Upper lip)
CL Item
Lower Labial Mucosa (Lower labial mucosa)
CL Item
Upper Labial Mucosa (Upper labial mucosa)
CL Item
Right Buccal Mucosa (Right buccal mucosa)
CL Item
Left Buccal Mucosa (Left buccal mucosa)
CL Item
Hard Palate (Hard palate)
C12230 (NCI Thesaurus)
C0226901 (UMLS 2011AA)
CL Item
Soft Palate (Soft palate)
C12231 (NCI Thesaurus)
C0030219 (UMLS 2011AA)
CL Item
Dorsum Of Tongue (Dorsum of tongue)
CL Item
Ventral And Lateral Tongue (Ventral and lateral tongue)
CL Item
Floor Of Mouth (Floor of mouth)
C0026638 (NCI Metathesaurus)
CL Item
Upper Right Gingiva (Upper right gingiva)
CL Item
Upper Left Gingiva (Upper left gingiva)
CL Item
Lower Right Gingiva (Lower right gingiva)
CL Item
Lower Left Gingiva (Lower left gingiva)
Item
Extent of oral wart disease
text
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C25311 (NCI Thesaurus ObjectClass)
C0442027 (UMLS 2011AA ObjectClass)
C5028 (NCI Thesaurus ObjectClass)
C0043037 (UMLS 2011AA ObjectClass)
C25332 (NCI Thesaurus Property)
C0439792 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.4
Code List
Extent of oral wart disease
CL Item
No Wart Seen (No wart seen)
CL Item
Wart(s) Covering Less Than 25% Of Area (Wart(s) covering less than 25% of area)
CL Item
Warts Covering 25% To 50% Of Area (Warts covering 25% to 50% of area)
CL Item
Warts Covering More Than 50% Of Area (Warts covering more than 50% of area)
CL Item
Not Evaluated (Not evaluated)
Item
Oral wart color
text
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C25311 (NCI Thesaurus ObjectClass)
C0442027 (UMLS 2011AA ObjectClass)
C5028 (NCI Thesaurus ObjectClass)
C0043037 (UMLS 2011AA ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C64546 (NCI Thesaurus Property)
C1880121 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.5
Code List
Oral wart color
CL Item
White (White)
CL107068 (NCI Metathesaurus)
CL Item
Pink (mucosa Color) (Pink (mucosa color))
Item
Oral wart characteristics
text
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C25311 (NCI Thesaurus ObjectClass)
C0442027 (UMLS 2011AA ObjectClass)
C5028 (NCI Thesaurus ObjectClass)
C0043037 (UMLS 2011AA ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C25447 (NCI Thesaurus Property)
C1521970 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.6
Code List
Oral wart characteristics
CL Item
Smooth (Smooth)
CL Item
Spiky (Spiky)
CL Item
Cauliflower-like (Cauliflower-like)
CL Item
Any Combination (Any combination)
Item Group
Prior History And Treatment
Item
Oral warts previously detected (at the last oral examination visit for this study)
text
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C25311 (NCI Thesaurus ObjectClass)
C0442027 (UMLS 2011AA ObjectClass)
C5028 (NCI Thesaurus ObjectClass)
C0043037 (UMLS 2011AA ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C25629 (NCI Thesaurus Property)
C0332152 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
CL.7
Code List
Oral warts previously detected (at the last oral examination visit for this study)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Prior Biopsy for Oral Warts (since the last oral examination visit for this study)
text
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C25311 (NCI Thesaurus ObjectClass)
C0442027 (UMLS 2011AA ObjectClass)
C5028 (NCI Thesaurus ObjectClass)
C0043037 (UMLS 2011AA ObjectClass)
C15189 (NCI Thesaurus Property)
C0005558 (UMLS 2011AA Property)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C25629 (NCI Thesaurus Property)
C0332152 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
CL.8
Code List
Prior Biopsy for Oral Warts (since the last oral examination visit for this study)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Prior Treatment for Oral Warts (since the last oral examination visit for this study)
text
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C25311 (NCI Thesaurus ObjectClass)
C0442027 (UMLS 2011AA ObjectClass)
C5028 (NCI Thesaurus ObjectClass)
C0043037 (UMLS 2011AA ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C25629 (NCI Thesaurus Property)
C0332152 (UMLS 2011AA Property)
C15697 (NCI Thesaurus Property)
C0040808 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
CL.9
Code List
Prior Treatment for Oral Warts (since the last oral examination visit for this study)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Oral Warts Treatment Result (per participant report)
text
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C25311 (NCI Thesaurus ObjectClass)
C0442027 (UMLS 2011AA ObjectClass)
C5028 (NCI Thesaurus ObjectClass)
C0043037 (UMLS 2011AA ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C25629 (NCI Thesaurus Property)
C0332152 (UMLS 2011AA Property)
C15697 (NCI Thesaurus Property)
C0040808 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.10
Code List
Oral Warts Treatment Result (per participant report)
CL Item
No Resolution (No resolution)
CL Item
Partial Resolution (Partial resolution)
CL Item
Total Resolution (Total resolution)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Further information concerning oral warts (If "Yes" specify in comments)
text
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C25311 (NCI Thesaurus ObjectClass)
C0442027 (UMLS 2011AA ObjectClass)
C5028 (NCI Thesaurus ObjectClass)
C0043037 (UMLS 2011AA ObjectClass)
C25393 (NCI Thesaurus Property)
C0282411 (UMLS 2011AA Property)
C25406 (NCI Thesaurus Property)
C1524062 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
CL.11
Code List
Further information concerning oral warts (If "Yes" specify in comments)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item Group
Comments 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)
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