ID
10848
Description
CALGB-10501 Two Month Post First Treatment Restaging Form NCT00513747 Early or Delayed Fludarabine and Rituximab in Treating Patients With Previously Untreated Chronic Lymphocytic Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=3410113C-154F-25BC-E044-0003BA3F9857
Link
Keywords
Versions (3)
- 9/19/12 9/19/12 -
- 1/9/15 1/9/15 - Martin Dugas
- 6/9/15 6/9/15 -
Uploaded on
June 9, 2015
DOI
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License
Creative Commons BY-NC 3.0 Legacy
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CALGB-10501 Two Month Post First Treatment Restaging Form NCT00513747
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-10501 Two Month Post First Treatment Restaging Form
Description
Patient demographics
Description
Patient Initials
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS CUI-1
- C2986440
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25536
Description
Medical Record Number
Data type
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
Data type
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
Data type
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
Data type
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
Data type
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
Blood test results
Description
Leukocytes (WBC)
Data type
float
Measurement units
- 1000/uL
Alias
- NCI Thesaurus ObjectClass
- C25294
- UMLS CUI-1
- C0023508
- NCI Thesaurus Property
- C12529
- NCI Thesaurus Property-2
- C20200
- NCI Thesaurus ValueDomain
- C25712
- NCI Thesaurus ValueDomain-2
- C38024
Description
Neutrophil count
Data type
float
Alias
- NCI Thesaurus ObjectClass
- C25294
- UMLS CUI-1
- C0200633
- NCI Thesaurus Property
- C12533
- NCI Thesaurus Property-2
- C20200
- NCI Thesaurus ValueDomain
- C25304
- NCI Thesaurus ValueDomain-2
- C25712
Description
LaboratoryProcedureHemoglobinResultSpecifiedValue
Data type
float
Measurement units
- g/dL
Alias
- NCI Thesaurus Property
- C16676
- UMLS 2011AA Property
- C0019046
- NCI Thesaurus Property-2
- C20200
- UMLS 2011AA Property-2
- C1274040
- NCI Thesaurus ObjectClass
- C25294
- UMLS 2011AA ObjectClass
- C0022885
- NCI Thesaurus ValueDomain
- C25712
- UMLS 2011AA ValueDomain
- C1522609
Description
LaboratoryProcedureSerumImmunologicIgGResultUnspecifiedValue
Data type
float
Alias
- NCI Thesaurus ObjectClass
- C25294
- UMLS 2011AA ObjectClass
- C0022885
- NCI Thesaurus Property
- C20200
- UMLS 2011AA Property
- C1274040
- NCI Thesaurus Property-2
- C568
- UMLS 2011AA Property-2
- C0020852
- NCI Thesaurus Property-3
- C25675
- UMLS 2011AA Property-3
- C1519267
- NCI Thesaurus ValueDomain
- C25712
- UMLS 2011AA ValueDomain
- C1522609
Description
LaboratoryProcedureSerumImmunologicIgAResultUnspecifiedValue
Data type
float
Alias
- NCI Thesaurus ObjectClass
- C25294
- UMLS 2011AA ObjectClass
- C0022885
- NCI Thesaurus Property
- C20200
- UMLS 2011AA Property
- C1274040
- NCI Thesaurus Property-2
- C565
- UMLS 2011AA Property-2
- C0020835
- NCI Thesaurus Property-3
- C25675
- UMLS 2011AA Property-3
- C1519267
- NCI Thesaurus ValueDomain
- C25712
- UMLS 2011AA ValueDomain
- C1522609
Description
LaboratoryProcedureSerumImmunologicIgMResultUnspecifiedValue
Data type
float
Alias
- NCI Thesaurus ObjectClass
- C25294
- UMLS 2011AA ObjectClass
- C0022885
- NCI Thesaurus Property
- C20200
- UMLS 2011AA Property
- C1274040
- NCI Thesaurus Property-2
- C569
- UMLS 2011AA Property-2
- C0020861
- NCI Thesaurus Property-3
- C25675
- UMLS 2011AA Property-3
- C1519267
- NCI Thesaurus ValueDomain
- C25712
- UMLS 2011AA ValueDomain
- C1522609
Description
Platelets
Data type
float
Measurement units
- 1000/uL
Alias
- NCI Thesaurus Property
- C20200
- UMLS CUI-1
- C0005821
- NCI Thesaurus Property-2
- C12520
- NCI Thesaurus ObjectClass
- C25294
- NCI Thesaurus ValueDomain
- C25712
Description
LaboratoryProcedureBeta-2-MicroglobulinProteinOutcomeSpecifiedValue
Data type
float
Alias
- NCI Thesaurus Property
- C20200
- UMLS 2011AA Property
- C1274040
- NCI Thesaurus ObjectClass
- C25294
- UMLS 2011AA ObjectClass
- C0022885
- NCI Thesaurus ValueDomain
- C25712
- UMLS 2011AA ValueDomain
- C1522609
- NCI Thesaurus Property-2
- C62657
- UMLS 2011AA Property-2
- C0005149
Description
LaboratoryProcedureBeta-2-MicroglobulinProteinOutcomeSpecifiedUpperLimitofNormalValue
Data type
float
Alias
- NCI Thesaurus ObjectClass
- C25294
- UMLS 2011AA ObjectClass
- C0022885
- NCI Thesaurus Property
- C20200
- UMLS 2011AA Property
- C1274040
- NCI Thesaurus Property-2
- C62657
- UMLS 2011AA Property-2
- C0005149
- NCI Thesaurus ValueDomain
- C25712
- UMLS 2011AA ValueDomain
- C1522609
- NCI Thesaurus ValueDomain-2
- C25706
- UMLS 2011AA ValueDomain-2
- C1519815
Description
assessment of splenomegaly/hepatomegaly
Description
SplenomegalyPalpationDocumentedInd
Data type
boolean
Alias
- NCI Thesaurus ValueDomain
- C25180
- UMLS 2011AA ValueDomain
- C1522602
- NCI Thesaurus Property
- C16950
- UMLS 2011AA Property
- C0030247
- NCI Thesaurus ObjectClass
- C3384
- UMLS 2011AA ObjectClass
- C0038002
- NCI Thesaurus ValueDomain-2
- C25356
- UMLS 2011AA ValueDomain-2
- C1301725
Description
HepatomegalyPalpationDocumentedInd
Data type
boolean
Alias
- NCI Thesaurus ValueDomain
- C25180
- UMLS 2011AA ValueDomain
- C1522602
- NCI Thesaurus Property
- C16950
- UMLS 2011AA Property
- C0030247
- NCI Thesaurus ObjectClass
- C3100
- UMLS 2011AA ObjectClass
- C0017924
- NCI Thesaurus ValueDomain-2
- C25356
- UMLS 2011AA ValueDomain-2
- C1301725
Description
Coomb's Data
Description
CoombsTestResultType
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus Property
- C20200
- UMLS 2011AA Property
- C1274040
- NCI Thesaurus ObjectClass
- C25163
- UMLS 2011AA ObjectClass
- C0009961
- NCI Metathesaurus ObjectClass
- C0488535
Description
IndirectCoombsTestResultType
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus Property
- C20200
- UMLS 2011AA Property
- C1274040
- NCI Thesaurus ObjectClass
- C25163
- UMLS 2011AA ObjectClass
- C0009961
- NCI Thesaurus ObjectClass-2
- C62255
- UMLS 2011AA ObjectClass-2
- C0439852
Description
CoombsTestPerformedDate
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus Property
- C38000
- UMLS 2011AA Property
- C0884358
- NCI Thesaurus ObjectClass
- C25163
- UMLS 2011AA ObjectClass
- C0009961
- NCI Metathesaurus ObjectClass
- C0488535
Description
Overall Response
Description
Person Completing Form
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS CUI-1
- C1550483
- NCI Thesaurus ObjectClass
- C25657
- NCI Thesaurus Property
- C25364
Description
Date Form Completed
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C1115437
- NCI Thesaurus ObjectClass
- C40988
- NCI Thesaurus Property
- C25250
- NCI Thesaurus ValueDomain-2
- C25367
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-10501 Two Month Post First Treatment Restaging 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)
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)
C0023508 (UMLS CUI-1)
C12529 (NCI Thesaurus Property)
C20200 (NCI Thesaurus Property-2)
C25712 (NCI Thesaurus ValueDomain)
C38024 (NCI Thesaurus ValueDomain-2)
C0200633 (UMLS CUI-1)
C12533 (NCI Thesaurus Property)
C20200 (NCI Thesaurus Property-2)
C25304 (NCI Thesaurus ValueDomain)
C25712 (NCI Thesaurus ValueDomain-2)
C0019046 (UMLS 2011AA Property)
C20200 (NCI Thesaurus Property-2)
C1274040 (UMLS 2011AA Property-2)
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C0022885 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C568 (NCI Thesaurus Property-2)
C0020852 (UMLS 2011AA Property-2)
C25675 (NCI Thesaurus Property-3)
C1519267 (UMLS 2011AA Property-3)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C0022885 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C565 (NCI Thesaurus Property-2)
C0020835 (UMLS 2011AA Property-2)
C25675 (NCI Thesaurus Property-3)
C1519267 (UMLS 2011AA Property-3)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C0022885 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C569 (NCI Thesaurus Property-2)
C0020861 (UMLS 2011AA Property-2)
C25675 (NCI Thesaurus Property-3)
C1519267 (UMLS 2011AA Property-3)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C0005821 (UMLS CUI-1)
C12520 (NCI Thesaurus Property-2)
C25294 (NCI Thesaurus ObjectClass)
C25712 (NCI Thesaurus ValueDomain)
C1274040 (UMLS 2011AA Property)
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C62657 (NCI Thesaurus Property-2)
C0005149 (UMLS 2011AA Property-2)
C0022885 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C62657 (NCI Thesaurus Property-2)
C0005149 (UMLS 2011AA Property-2)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C25706 (NCI Thesaurus ValueDomain-2)
C1519815 (UMLS 2011AA ValueDomain-2)
C1522602 (UMLS 2011AA ValueDomain)
C16950 (NCI Thesaurus Property)
C0030247 (UMLS 2011AA Property)
C3384 (NCI Thesaurus ObjectClass)
C0038002 (UMLS 2011AA ObjectClass)
C25356 (NCI Thesaurus ValueDomain-2)
C1301725 (UMLS 2011AA ValueDomain-2)
C1522602 (UMLS 2011AA ValueDomain)
C16950 (NCI Thesaurus Property)
C0030247 (UMLS 2011AA Property)
C3100 (NCI Thesaurus ObjectClass)
C0017924 (UMLS 2011AA ObjectClass)
C25356 (NCI Thesaurus ValueDomain-2)
C1301725 (UMLS 2011AA ValueDomain-2)
C0332307 (UMLS 2011AA ValueDomain)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C25163 (NCI Thesaurus ObjectClass)
C0009961 (UMLS 2011AA ObjectClass)
C0488535 (NCI Metathesaurus ObjectClass)
C0332307 (UMLS 2011AA ValueDomain)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C25163 (NCI Thesaurus ObjectClass)
C0009961 (UMLS 2011AA ObjectClass)
C62255 (NCI Thesaurus ObjectClass-2)
C0439852 (UMLS 2011AA ObjectClass-2)
C0011008 (UMLS 2011AA ValueDomain)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C25163 (NCI Thesaurus ObjectClass)
C0009961 (UMLS 2011AA ObjectClass)
C0488535 (NCI Metathesaurus ObjectClass)
C1550483 (UMLS CUI-1)
C25657 (NCI Thesaurus ObjectClass)
C25364 (NCI Thesaurus Property)
C1115437 (UMLS CUI-1)
C40988 (NCI Thesaurus ObjectClass)
C25250 (NCI Thesaurus Property)
C25367 (NCI Thesaurus ValueDomain-2)