ID
11116
Descrizione
CALGB-10501 Impact Of Event Scale- Revised 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=340EF355-2CAB-21DF-E044-0003BA3F9857
collegamento
Keywords
versioni (3)
- 19/09/12 19/09/12 -
- 09/01/15 09/01/15 - Martin Dugas
- 18/06/15 18/06/15 -
Caricato su
18 giugno 2015
DOI
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Licenza
Creative Commons BY-NC 3.0 Legacy
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CALGB-10501 Impact Of Event Scale- Revised 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 Impact Of Event Scale- Revised Form
Descrizione
Patient demographics
Descrizione
Patient Initials
Tipo di dati
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS CUI-1
- C2986440
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25536
Descrizione
Medical Record Number
Tipo di dati
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS CUI-1
- C1301894
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25261
- NCI Thesaurus Property-2
- C25198
Descrizione
Institution Name
Tipo di dati
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
Descrizione
Participating Group
Tipo di dati
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS CUI-1
- C2347449
- NCI Thesaurus ObjectClass
- C25608
- NCI Thesaurus ObjectClass-2
- C17005
- NCI Thesaurus Property
- C25364
Descrizione
Study Number Participating Group
Tipo di dati
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
Descrizione
Trial subject ID Participating Group
Tipo di dati
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
Descrizione
Visit number
Tipo di dati
float
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS CUI-1
- C1549755
- NCI Thesaurus ObjectClass
- C16696
- NCI Thesaurus Property
- C25385
Descrizione
Impact Of Event
Descrizione
EmotionReminderPersonLifeDistressAssessmentScale
Tipo di dati
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus ObjectClass-2
- C54266
- UMLS 2011AA ObjectClass-2
- C0013987
- NCI Thesaurus ObjectClass-3
- C54270
- UMLS 2011AA ObjectClass-3
- C1709896
- NCI Thesaurus Property
- C25367
- NCI Thesaurus Property-2
- C37987
- UMLS 2011AA Property
- C0376558
- NCI Thesaurus Property-3
- C37942
- UMLS 2011AA Property-2
- C0231303
- NCI Thesaurus ValueDomain
- C25664
- UMLS 2011AA ValueDomain
- C0349674
Descrizione
PatientDifficultySleepingAssessmentScale
Tipo di dati
text
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C25367
- NCI Thesaurus Property-2
- C73425
- UMLS 2011AA Property
- C0037313
- NCI Thesaurus Property-3
- C62189
- UMLS 2011AA Property-2
- C1299586
- NCI Thesaurus ValueDomain
- C25664
- UMLS 2011AA ValueDomain
- C0349674
Descrizione
ThinkingReminderPersonLifeDistressAssessmentScale
Tipo di dati
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus ObjectClass-2
- C54270
- UMLS 2011AA ObjectClass-2
- C1709896
- NCI Thesaurus ObjectClass-3
- C54226
- UMLS 2011AA ObjectClass-3
- C0039869
- NCI Thesaurus Property
- C25367
- NCI Thesaurus Property-2
- C37987
- UMLS 2011AA Property
- C0376558
- NCI Thesaurus Property-3
- C37942
- UMLS 2011AA Property-2
- C0231303
- NCI Thesaurus ValueDomain
- C25664
- UMLS 2011AA ValueDomain
- C0349674
Descrizione
ThinkingReminderAccidentPersonLifeDistressAssessmentScale
Tipo di dati
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus ObjectClass-2
- C34340
- UMLS 2011AA ObjectClass-2
- C0000924
- NCI Thesaurus ObjectClass-3
- C54270
- UMLS 2011AA ObjectClass-3
- C1709896
- NCI Thesaurus ObjectClass-4
- C54226
- UMLS 2011AA ObjectClass-4
- C0039869
- NCI Thesaurus Property
- C25367
- NCI Thesaurus Property-2
- C37987
- UMLS 2011AA Property
- C0376558
- NCI Thesaurus Property-3
- C37942
- UMLS 2011AA Property-2
- C0231303
- NCI Thesaurus ValueDomain
- C25664
- UMLS 2011AA ValueDomain
- C0349674
Descrizione
ThinkingPictureReminderPersonLifeDistressAssessmentScale
Tipo di dati
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus ObjectClass-2
- C54270
- UMLS 2011AA ObjectClass-2
- C1709896
- NCI Thesaurus ObjectClass-3
- C54226
- UMLS 2011AA ObjectClass-3
- C0039869
- NCI Thesaurus ObjectClass-4
- C54273
- UMLS 2011AA ObjectClass-4
- C0441469
- NCI Thesaurus Property
- C25367
- NCI Thesaurus Property-2
- C37987
- UMLS 2011AA Property
- C0376558
- NCI Thesaurus Property-3
- C37942
- UMLS 2011AA Property-2
- C0231303
- NCI Thesaurus ValueDomain
- C25664
- UMLS 2011AA ValueDomain
- C0349674
Descrizione
EmotionStrongPersonLifeDistressAssessmentScale
Tipo di dati
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus ObjectClass-2
- C54266
- UMLS 2011AA ObjectClass-2
- C0013987
- NCI Thesaurus ObjectClass-3
- C62223
- UMLS 2011AA ObjectClass-3
- C0442821
- NCI Thesaurus Property
- C25367
- NCI Thesaurus Property-2
- C37987
- UMLS 2011AA Property
- C0376558
- NCI Thesaurus Property-3
- C37942
- UMLS 2011AA Property-2
- C0231303
- NCI Thesaurus ValueDomain
- C25664
- UMLS 2011AA ValueDomain
- C0349674
Descrizione
DreamingPersonLifeDistressAssessmentScale
Tipo di dati
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus ObjectClass-2
- C54268
- UMLS 2011AA ObjectClass-2
- C0013117
- NCI Thesaurus Property
- C25367
- NCI Thesaurus Property-2
- C37987
- UMLS 2011AA Property
- C0376558
- NCI Thesaurus Property-3
- C37942
- UMLS 2011AA Property-2
- C0231303
- NCI Thesaurus ValueDomain
- C25664
- UMLS 2011AA ValueDomain
- C0349674
Descrizione
Overall Response
Descrizione
Person Completing Form
Tipo di dati
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS CUI-1
- C1550483
- NCI Thesaurus ObjectClass
- C25657
- NCI Thesaurus Property
- C25364
Descrizione
Date Form Completed
Tipo di dati
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 Impact Of Event Scale- Revised 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)
C1549755 (UMLS CUI-1)
C16696 (NCI Thesaurus ObjectClass)
C25385 (NCI Thesaurus Property)
C0027361 (UMLS 2011AA ObjectClass)
C54266 (NCI Thesaurus ObjectClass-2)
C0013987 (UMLS 2011AA ObjectClass-2)
C54270 (NCI Thesaurus ObjectClass-3)
C1709896 (UMLS 2011AA ObjectClass-3)
C25367 (NCI Thesaurus Property)
C37987 (NCI Thesaurus Property-2)
C0376558 (UMLS 2011AA Property)
C37942 (NCI Thesaurus Property-3)
C0231303 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C0030705 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C73425 (NCI Thesaurus Property-2)
C0037313 (UMLS 2011AA Property)
C62189 (NCI Thesaurus Property-3)
C1299586 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C91213 (NCI Thesaurus-2)
C91216 (NCI Thesaurus-2)
C0027361 (UMLS 2011AA ObjectClass)
C54270 (NCI Thesaurus ObjectClass-2)
C1709896 (UMLS 2011AA ObjectClass-2)
C54226 (NCI Thesaurus ObjectClass-3)
C0039869 (UMLS 2011AA ObjectClass-3)
C25367 (NCI Thesaurus Property)
C37987 (NCI Thesaurus Property-2)
C0376558 (UMLS 2011AA Property)
C37942 (NCI Thesaurus Property-3)
C0231303 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C0027361 (UMLS 2011AA ObjectClass)
C34340 (NCI Thesaurus ObjectClass-2)
C0000924 (UMLS 2011AA ObjectClass-2)
C54270 (NCI Thesaurus ObjectClass-3)
C1709896 (UMLS 2011AA ObjectClass-3)
C54226 (NCI Thesaurus ObjectClass-4)
C0039869 (UMLS 2011AA ObjectClass-4)
C25367 (NCI Thesaurus Property)
C37987 (NCI Thesaurus Property-2)
C0376558 (UMLS 2011AA Property)
C37942 (NCI Thesaurus Property-3)
C0231303 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C0027361 (UMLS 2011AA ObjectClass)
C54270 (NCI Thesaurus ObjectClass-2)
C1709896 (UMLS 2011AA ObjectClass-2)
C54226 (NCI Thesaurus ObjectClass-3)
C0039869 (UMLS 2011AA ObjectClass-3)
C54273 (NCI Thesaurus ObjectClass-4)
C0441469 (UMLS 2011AA ObjectClass-4)
C25367 (NCI Thesaurus Property)
C37987 (NCI Thesaurus Property-2)
C0376558 (UMLS 2011AA Property)
C37942 (NCI Thesaurus Property-3)
C0231303 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C0027361 (UMLS 2011AA ObjectClass)
C54266 (NCI Thesaurus ObjectClass-2)
C0013987 (UMLS 2011AA ObjectClass-2)
C62223 (NCI Thesaurus ObjectClass-3)
C0442821 (UMLS 2011AA ObjectClass-3)
C25367 (NCI Thesaurus Property)
C37987 (NCI Thesaurus Property-2)
C0376558 (UMLS 2011AA Property)
C37942 (NCI Thesaurus Property-3)
C0231303 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C0027361 (UMLS 2011AA ObjectClass)
C54268 (NCI Thesaurus ObjectClass-2)
C0013117 (UMLS 2011AA ObjectClass-2)
C25367 (NCI Thesaurus Property)
C37987 (NCI Thesaurus Property-2)
C0376558 (UMLS 2011AA Property)
C37942 (NCI Thesaurus Property-3)
C0231303 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
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)