ID
10750
Descrição
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
Link
Palavras-chave
Versões (3)
- 29/12/2014 29/12/2014 - Martin Dugas
- 08/01/2015 08/01/2015 - Martin Dugas
- 08/06/2015 08/06/2015 -
Transferido a
8 de junho de 2015
DOI
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Licença
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
Descrição
Patient demographics
Descrição
Patient Initials
Tipo de dados
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS CUI-1
- C2986440
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25536
Descrição
Medical Record Number
Tipo de dados
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS CUI-1
- C1301894
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25261
- NCI Thesaurus Property-2
- C25198
Descrição
Institution Name
Tipo de dados
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
Descrição
Participating Group
Tipo de dados
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS CUI-1
- C2347449
- NCI Thesaurus ObjectClass
- C25608
- NCI Thesaurus ObjectClass-2
- C17005
- NCI Thesaurus Property
- C25364
Descrição
Study Number Participating Group
Tipo de dados
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
Descrição
Trial subject ID Participating Group
Tipo de dados
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
Descrição
Medication
Descrição
Additional Form Page Number
Tipo de dados
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
Descrição
Concomitant Medication
Tipo de dados
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS CUI-1
- C2347852
- NCI Thesaurus ObjectClass
- C459
- NCI Thesaurus Property
- C25639
- NCI Thesaurus ObjectClass-2
- C25730
Descrição
Concomitant Medication Category
Tipo de dados
text
Alias
- NCI Thesaurus ValueDomain
- C25372
- UMLS CUI-1
- C2826808
- NCI Thesaurus ObjectClass
- C459
- NCI Thesaurus ObjectClass-2
- C25730
- NCI Thesaurus Property
- C25382
Descrição
CYP3A4 inhibitor or inducer
Tipo de dados
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
Descrição
Concomitant Medication Daily Dose
Tipo de dados
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
Descrição
Units
Tipo de dados
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS CUI-1
- C1519795
- NCI Thesaurus ValueDomain-2
- C44278
- NCI Thesaurus ObjectClass
- C1708
- NCI Thesaurus Property
- C25256
Descrição
Concomitant Medication Start Date
Tipo de dados
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C2826734
- NCI Thesaurus ValueDomain-2
- C25431
- NCI Thesaurus ObjectClass
- C1708
- NCI Thesaurus Property
- C25275
Descrição
Concomitant Medication End Date
Tipo de dados
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C2826744
- NCI Thesaurus ObjectClass
- C1708
- NCI Thesaurus Property
- C25275
Descrição
Concomitant Medication Ongoing
Tipo de dados
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)