ID
10750
Description
CALGB: 10603 Concomitant Medications Form NCT00651261 Daunorubicin, Cytarabine, and Midostaurin in Treating Patients With Newly Diagnosed Acute Myeloid Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=742F65D1-34F2-9883-E040-BB89AD437120
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Versions (3)
- 29/12/2014 29/12/2014 - Martin Dugas
- 08/01/2015 08/01/2015 - Martin Dugas
- 08/06/2015 08/06/2015 -
Téléchargé le
8 juin 2015
DOI
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Creative Commons BY-NC 3.0 Legacy
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CALGB: 10603 Concomitant Medications Form DRKS00003845 NCT00651261
INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice
- StudyEvent: CALGB: 10603 Concomitant Medications Form
Description
Patient demographics
Description
Patient Initials
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS CUI-1
- C2986440
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25536
Description
Medical Record Number
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS CUI-1
- C1301894
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25261
- NCI Thesaurus Property-2
- C25198
Description
Institution Name
Type de données
text
Alias
- NCI Thesaurus ObjectClass
- C25454
- UMLS CUI-1
- C1301943
- NCI Thesaurus ObjectClass-2
- C21541
- NCI Thesaurus Property
- C25364
- NCI Thesaurus ValueDomain
- C25191
- NCI Thesaurus ValueDomain-2
- C21541
Description
Participating Group
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS CUI-1
- C2347449
- NCI Thesaurus ObjectClass
- C25608
- NCI Thesaurus ObjectClass-2
- C17005
- NCI Thesaurus Property
- C25364
Description
Study Number Participating Group
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS CUI-1
- C3274381
- NCI Thesaurus ObjectClass
- C25320
- UMLS CUI-2
- C2347449
- NCI Thesaurus Property
- C25608
- NCI Thesaurus Property-2
- C25364
Description
Trial subject ID Participating Group
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS CUI-1
- C2348585
- NCI Thesaurus ObjectClass
- C16960
- UMLS CUI-2
- C2347449
- NCI Thesaurus Property
- C25608
- NCI Thesaurus Property-2
- C25364
Description
Medication
Description
Additional Form Page Number
Type de données
text
Alias
- NCI Thesaurus ObjectClass
- C19464
- UMLS CUI-1
- C1706499
- NCI Thesaurus ObjectClass-2
- C25406
- UMLS CUI-2
- C1704732
- NCI Thesaurus Property
- C25695
- UMLS CUI-3
- C0237753
- NCI Thesaurus ValueDomain
- C25337
- NCI Thesaurus ValueDomain-2
- C42783
Description
Concomitant Medication
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS CUI-1
- C2347852
- NCI Thesaurus ObjectClass
- C459
- NCI Thesaurus Property
- C25639
- NCI Thesaurus ObjectClass-2
- C25730
Description
Concomitant Medication Category
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25372
- UMLS CUI-1
- C2826808
- NCI Thesaurus ObjectClass
- C459
- NCI Thesaurus ObjectClass-2
- C25730
- NCI Thesaurus Property
- C25382
Description
CYP3A4 inhibitor or inducer
Type de données
boolean
Alias
- NCI Thesaurus ObjectClass
- C459
- UMLS CUI-1
- C3830624
- NCI Thesaurus ObjectClass-2
- C61367
- UMLS CUI-2
- C3830625
- NCI Thesaurus ObjectClass-3
- C17573
- NCI Thesaurus ObjectClass-4
- C42791
- NCI Thesaurus Property
- C25409
- NCI Thesaurus ValueDomain
- C38147
Description
Concomitant Medication Daily Dose
Type de données
float
Alias
- NCI Thesaurus ObjectClass
- C25473
- UMLS CUI-1
- C2826638
- NCI Thesaurus ObjectClass-2
- C1708
- NCI Thesaurus Property
- C25304
- NCI Thesaurus Property-2
- C25256
- NCI Thesaurus ValueDomain
- C25488
- NCI Thesaurus ValueDomain-2
- C1708
Description
Units
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS CUI-1
- C1519795
- NCI Thesaurus ValueDomain-2
- C44278
- NCI Thesaurus ObjectClass
- C1708
- NCI Thesaurus Property
- C25256
Description
Concomitant Medication Start Date
Type de données
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C2826734
- NCI Thesaurus ValueDomain-2
- C25431
- NCI Thesaurus ObjectClass
- C1708
- NCI Thesaurus Property
- C25275
Description
Concomitant Medication End Date
Type de données
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C2826744
- NCI Thesaurus ObjectClass
- C1708
- NCI Thesaurus Property
- C25275
Description
Concomitant Medication Ongoing
Type de données
text
Alias
- NCI Thesaurus ObjectClass
- C459
- UMLS CUI-1
- C2826666
- NCI Thesaurus ObjectClass-2
- C25730
- NCI Thesaurus Property
- C25471
- NCI Thesaurus Property-2
- C25409
- NCI Thesaurus ValueDomain
- C25704
Similar models
INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice
- StudyEvent: CALGB: 10603 Concomitant Medications Form
C3262252 (UMLS CUI-1)
C19464 (NCI Thesaurus ObjectClass)
C1516238 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25442 (NCI Thesaurus ObjectClass-2)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1516238 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25442 (NCI Thesaurus Property-2)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1516238 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25442 (NCI Thesaurus Property-2)
C25616 (NCI Thesaurus Property)
C2361257 (UMLS CUI-1)
C25651 (NCI Thesaurus Property-2)
C25164 (NCI Thesaurus ValueDomain)
C25431 (NCI Thesaurus ValueDomain-2)
C2361259 (UMLS CUI-1)
C25616 (NCI Thesaurus Property)
C15368 (NCI Thesaurus ObjectClass)
C25651 (NCI Thesaurus Property-2)
C0680532 (UMLS CUI-1)
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
C1301894 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25261 (NCI Thesaurus Property)
C25198 (NCI Thesaurus Property-2)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
C25191 (NCI Thesaurus ValueDomain)
C21541 (NCI Thesaurus ValueDomain-2)
C2347449 (UMLS CUI-1)
C25608 (NCI Thesaurus ObjectClass)
C17005 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
C1706499 (UMLS CUI-1)
C25406 (NCI Thesaurus ObjectClass-2)
C1704732 (UMLS CUI-2)
C25695 (NCI Thesaurus Property)
C0237753 (UMLS CUI-3)
C25337 (NCI Thesaurus ValueDomain)
C42783 (NCI Thesaurus ValueDomain-2)
C2347852 (UMLS CUI-1)
C459 (NCI Thesaurus ObjectClass)
C25639 (NCI Thesaurus Property)
C25730 (NCI Thesaurus ObjectClass-2)
C2826808 (UMLS CUI-1)
C459 (NCI Thesaurus ObjectClass)
C25730 (NCI Thesaurus ObjectClass-2)
C25382 (NCI Thesaurus Property)
C0001617 (UMLS 2011AA)
C0018284 (UMLS 2011AA)
C3830624 (UMLS CUI-1)
C61367 (NCI Thesaurus ObjectClass-2)
C3830625 (UMLS CUI-2)
C17573 (NCI Thesaurus ObjectClass-3)
C42791 (NCI Thesaurus ObjectClass-4)
C25409 (NCI Thesaurus Property)
C38147 (NCI Thesaurus ValueDomain)
C2826638 (UMLS CUI-1)
C1708 (NCI Thesaurus ObjectClass-2)
C25304 (NCI Thesaurus Property)
C25256 (NCI Thesaurus Property-2)
C25488 (NCI Thesaurus ValueDomain)
C1708 (NCI Thesaurus ValueDomain-2)
C1519795 (UMLS CUI-1)
C44278 (NCI Thesaurus ValueDomain-2)
C1708 (NCI Thesaurus ObjectClass)
C25256 (NCI Thesaurus Property)
C2826734 (UMLS CUI-1)
C25431 (NCI Thesaurus ValueDomain-2)
C1708 (NCI Thesaurus ObjectClass)
C25275 (NCI Thesaurus Property)
C2826744 (UMLS CUI-1)
C1708 (NCI Thesaurus ObjectClass)
C25275 (NCI Thesaurus Property)
C2826666 (UMLS CUI-1)
C25730 (NCI Thesaurus ObjectClass-2)
C25471 (NCI Thesaurus Property)
C25409 (NCI Thesaurus Property-2)
C25704 (NCI Thesaurus ValueDomain)