ID

11020

Beschrijving

EBS Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FF198F4E-0236-24CA-E034-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FF198F4E-0236-24CA-E034-0003BA3F9857

Trefwoorden

Versies (3)
  1. 19-09-12 19-09-12 -
  2. 09-01-15 09-01-15 - Martin Dugas
  3. 16-06-15 16-06-15 -
Geüploaded op

16 juni 2015

DOI

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Licentie

Creative Commons BY-NC 3.0 Legacy
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EBS

Engels

No Instruction available.

1 Formulieren  
Header module
Beschrijving

Header module

Visit number
Beschrijving

Visit number

Datatype

float

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C1549755
NCI Thesaurus ObjectClass
C16696
NCI Thesaurus Property
C25385
If yes, record the date the peripheral blood sample for EBV testing was shipped
Beschrijving

SpecimenLabSubmittedDate

Datatype

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus Property
C25294
UMLS 2011AA Property
C0022885
NCI Thesaurus ObjectClass
C19157
UMLS 2011AA ObjectClass
C0370003
NCI Thesaurus Property-2
C25695
UMLS 2011AA Property-2
C1515023
Date rituximab administered
Beschrijving

Agent Administered Date

Datatype

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS CUI-1
C0450442
NCI Thesaurus ValueDomain-2
C25367
NCI Thesaurus ObjectClass
C1708
UMLS CUI-2
C1521801
NCI Thesaurus Property
C25382
UMLS CUI-3
C0011008
Dose of rituximab administered
Beschrijving

Medication Dose

Datatype

float

Alias
NCI Thesaurus ValueDomain
C25488
UMLS CUI-1
C3174092
NCI Thesaurus ObjectClass
C1708
NCI Thesaurus ValueDomain-2
C1708
NCI Thesaurus Property
C25382
Has the patient developed a post-transplant lymphopropliferative disorder
Beschrijving

DiagnosisLymphoproliferativePresentTransplantInd-3

Datatype

text

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass
C38008
UMLS 2011AA ObjectClass
C0687676
NCI Thesaurus ObjectClass-2
C12981
UMLS 2011AA ObjectClass-2
C0332835
NCI Metathesaurus Property
CL051528
Was a peripheral blood sample drawn for EBV testing during this assessment period
Beschrijving

WasaperipheralbloodsampledrawnforEBVtestingduringthisassessmentperiod

Datatype

boolean

Were the results greater than 1000 copies/mL
Beschrijving

Weretheresultsgreaterthan1000copies/mL

Datatype

text

If yes was rituximab administered
Beschrijving

Ifyeswasrituximabadministered

Datatype

boolean

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Similar models

No Instruction available.

1 Formulieren
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Header module
Visit number
Item
Visit number
float
C25337 (NCI Thesaurus ValueDomain)
C1549755 (UMLS CUI-1)
C16696 (NCI Thesaurus ObjectClass)
C25385 (NCI Thesaurus Property)
SpecimenLabSubmittedDate
Item
If yes, record the date the peripheral blood sample for EBV testing was shipped
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25294 (NCI Thesaurus Property)
C0022885 (UMLS 2011AA Property)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C25695 (NCI Thesaurus Property-2)
C1515023 (UMLS 2011AA Property-2)
Agent Administered Date
Item
Date rituximab administered
date
C25164 (NCI Thesaurus ValueDomain)
C0450442 (UMLS CUI-1)
C25367 (NCI Thesaurus ValueDomain-2)
C1708 (NCI Thesaurus ObjectClass)
C1521801 (UMLS CUI-2)
C25382 (NCI Thesaurus Property)
C0011008 (UMLS CUI-3)
Medication Dose
Item
Dose of rituximab administered
float
C25488 (NCI Thesaurus ValueDomain)
C3174092 (UMLS CUI-1)
C1708 (NCI Thesaurus ObjectClass)
C1708 (NCI Thesaurus ValueDomain-2)
C25382 (NCI Thesaurus Property)
Item
Has the patient developed a post-transplant lymphopropliferative disorder
text
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C38008 (NCI Thesaurus ObjectClass)
C0687676 (UMLS 2011AA ObjectClass)
C12981 (NCI Thesaurus ObjectClass-2)
C0332835 (UMLS 2011AA ObjectClass-2)
CL051528 (NCI Metathesaurus Property)
CL.4
Code List
Has the patient developed a post-transplant lymphopropliferative disorder
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Comments (Comments)
WasaperipheralbloodsampledrawnforEBVtestingduringthisassessmentperiod
Item
Was a peripheral blood sample drawn for EBV testing during this assessment period
boolean
Item
Were the results greater than 1000 copies/mL
text
CL.2
Code List
Were the results greater than 1000 copies/mL
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Results not available (Results not available)
Ifyeswasrituximabadministered
Item
If yes was rituximab administered
boolean
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