ID
11019
Descripción
CALGB: 40301 TREATMENT SUMMARY FORM (SUBSET OF PATIENTS) Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=E5A00141-D565-5413-E034-0003BA3F9857
Link
Palabras clave
Versiones (3)
- 27/8/12 27/8/12 -
- 9/1/15 9/1/15 - Martin Dugas
- 16/6/15 16/6/15 -
Subido en
16 de junio de 2015
DOI
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Licencia
Creative Commons BY-NC 3.0 Legacy
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CALGB: 40301 TREATMENT SUMMARY FORM (SUBSET OF PATIENTS)
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.
- StudyEvent: CALGB: 40301 TREATMENT SUMMARY FORM (SUBSET OF PATIENTS)
Descripción
Patient demographics
Descripción
Patient Initials
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS CUI-1
- C2986440
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25536
Descripción
PatientHospitalNumber
Tipo de datos
text
Descripción
Institution Name
Tipo de datos
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
Descripción
Participating Group
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS CUI-1
- C2347449
- NCI Thesaurus ObjectClass
- C25608
- NCI Thesaurus ObjectClass-2
- C17005
- NCI Thesaurus Property
- C25364
Descripción
Study Number Participating Group
Tipo de datos
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
Descripción
Trial subject ID Participating Group
Tipo de datos
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
Descripción
Assessment of Chemotherapy
Descripción
Chemotherapy Cycle Start Date
Tipo de datos
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C1302181
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus ValueDomain-2
- C25431
- UMLS CUI-2
- C3173309
- NCI Thesaurus Property
- C25379
Descripción
Cycle Number Chemotherapeutics
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS CUI-1
- C2045829
- NCI Thesaurus Property
- C25471
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus Property-2
- C25379
Descripción
PillsReceivedCount
Tipo de datos
text
Alias
- NCI Thesaurus Property
- C25639
- UMLS 2011AA Property
- C1514756
- NCI Thesaurus ValueDomain
- C25463
- UMLS 2011AA ValueDomain
- C0750480
- NCI Thesaurus ObjectClass
- C25394
- UMLS 2011AA ObjectClass
- C0994475
Descripción
Medication Dose
Tipo de datos
float
Alias
- NCI Thesaurus ValueDomain
- C25488
- UMLS CUI-1
- C3174092
- NCI Thesaurus ObjectClass
- C1708
- NCI Thesaurus ValueDomain-2
- C1708
- NCI Thesaurus Property
- C25382
Descripción
Chemotherapy Cycle End Date
Tipo de datos
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C1302181
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus Property
- C25379
- UMLS CUI-2
- C0806020
Descripción
PillsRemainingCount
Tipo de datos
float
Alias
- NCI Thesaurus ValueDomain
- C25463
- UMLS 2011AA ValueDomain
- C0750480
- NCI Thesaurus ObjectClass
- C25394
- UMLS 2011AA ObjectClass
- C0994475
- NCI Thesaurus Property
- C25649
- UMLS 2011AA Property
- C1527428
Descripción
Dose Modification
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C25180
- UMLS CUI-1
- C1707811
- NCI Thesaurus ObjectClass
- C25256
- NCI Thesaurus Property
- C25572
- NCI Thesaurus ValueDomain-2
- C25572
Descripción
PlannedDoseModificationSpecify
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
- NCI Thesaurus ObjectClass
- C25619
- UMLS 2011AA ObjectClass
- C1301732
- NCI Thesaurus ObjectClass-2
- C25488
- UMLS 2011AA ObjectClass-2
- C0178602
- NCI Thesaurus Property
- C25572
Descripción
DoseModificationText
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ObjectClass
- C25256
- UMLS 2011AA ObjectClass
- C1265611
- NCI Thesaurus Property
- C25572
Descripción
Person Completing Form
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS CUI-1
- C1550483
- NCI Thesaurus ObjectClass
- C25657
- NCI Thesaurus Property
- C25364
Descripción
Date Form Completed
Tipo de datos
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.
- StudyEvent: CALGB: 40301 TREATMENT SUMMARY FORM (SUBSET OF PATIENTS)
C1516238 (UMLS CUI-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)
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C1516238 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25442 (NCI Thesaurus Property-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)
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C25536 (NCI Thesaurus Property)
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C25191 (NCI Thesaurus ValueDomain)
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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)
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C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
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C1302181 (UMLS CUI-1)
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C25379 (NCI Thesaurus Property)
C2045829 (UMLS CUI-1)
C25471 (NCI Thesaurus Property)
C15368 (NCI Thesaurus ObjectClass)
C25379 (NCI Thesaurus Property-2)
C1514756 (UMLS 2011AA Property)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C25394 (NCI Thesaurus ObjectClass)
C0994475 (UMLS 2011AA ObjectClass)
C3174092 (UMLS CUI-1)
C1708 (NCI Thesaurus ObjectClass)
C1708 (NCI Thesaurus ValueDomain-2)
C25382 (NCI Thesaurus Property)
C1302181 (UMLS CUI-1)
C15368 (NCI Thesaurus ObjectClass)
C25379 (NCI Thesaurus Property)
C0806020 (UMLS CUI-2)
C0750480 (UMLS 2011AA ValueDomain)
C25394 (NCI Thesaurus ObjectClass)
C0994475 (UMLS 2011AA ObjectClass)
C25649 (NCI Thesaurus Property)
C1527428 (UMLS 2011AA Property)
C1707811 (UMLS CUI-1)
C25256 (NCI Thesaurus ObjectClass)
C25572 (NCI Thesaurus Property)
C25572 (NCI Thesaurus ValueDomain-2)
C1298908 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C1521902 (UMLS 2011AA ValueDomain)
C25619 (NCI Thesaurus ObjectClass)
C1301732 (UMLS 2011AA ObjectClass)
C25488 (NCI Thesaurus ObjectClass-2)
C0178602 (UMLS 2011AA ObjectClass-2)
C25572 (NCI Thesaurus Property)
C1527021 (UMLS 2011AA ValueDomain)
C25256 (NCI Thesaurus ObjectClass)
C1265611 (UMLS 2011AA ObjectClass)
C25572 (NCI Thesaurus Property)
C1550483 (UMLS CUI-1)
C25657 (NCI Thesaurus ObjectClass)
C25364 (NCI Thesaurus Property)
C1115437 (UMLS CUI-1)
C40988 (NCI Thesaurus ObjectClass)
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