ID
11119
Description
CALGB-10501 Hospital Anxiety And Depression Scale 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=340EDF8E-59E2-1F88-E044-0003BA3F9857
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Mots-clés
Versions (3)
- 19/09/2012 19/09/2012 -
- 09/01/2015 09/01/2015 - Martin Dugas
- 18/06/2015 18/06/2015 -
Téléchargé le
18 juin 2015
DOI
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Creative Commons BY-NC 3.0 Legacy
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CALGB-10501 Hospital Anxiety And Depression Scale 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 Hospital Anxiety And Depression Scale Form
Description
Patient demographics
Description
Patient Initials
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS CUI-1
- C2986440
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25536
Description
Medical Record Number
Type de données
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
Type de données
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
Type de données
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
Type de données
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
Type de données
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
Visit number
Type de données
float
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS CUI-1
- C1549755
- NCI Thesaurus ObjectClass
- C16696
- NCI Thesaurus Property
- C25385
Description
Hospital Anxiety And Depression Assessment
Description
AnxietyPersonQualityofLifeAssessmentScale
Type de données
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus ObjectClass-2
- C26696
- UMLS 2011AA ObjectClass-2
- C0003467
- NCI Thesaurus Property
- C17047
- UMLS 2011AA Property
- C0518214
- NCI Thesaurus Property-2
- C25367
- NCI Thesaurus ValueDomain
- C25664
- UMLS 2011AA ValueDomain
- C0349674
Description
EmotionDissatisfactionAbsentPersonQualityofLifeAssessmentScale
Type de données
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus ObjectClass-2
- C54266
- UMLS 2011AA ObjectClass-2
- C0013987
- NCI Thesaurus ObjectClass-3
- C48190
- UMLS 2011AA ObjectClass-3
- C0332197
- NCI Thesaurus ObjectClass-4
- C62184
- UMLS 2011AA ObjectClass-4
- C0870433
- NCI Thesaurus Property
- C17047
- UMLS 2011AA Property
- C0518214
- NCI Thesaurus Property-2
- C25367
- NCI Thesaurus ValueDomain
- C25664
- UMLS 2011AA ValueDomain
- C0349674
Description
AnxietyDistressPersonQualityofLifeAssessmentScale
Type de données
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus ObjectClass-2
- C26696
- UMLS 2011AA ObjectClass-2
- C0003467
- NCI Thesaurus ObjectClass-3
- C37942
- UMLS 2011AA ObjectClass-3
- C0231303
- NCI Thesaurus Property
- C17047
- UMLS 2011AA Property
- C0518214
- NCI Thesaurus Property-2
- C25367
- NCI Thesaurus ValueDomain
- C25664
- UMLS 2011AA ValueDomain
- C0349674
Description
EmotionPositiveMoodAlterationPersonQualityofLifeAssessmentScale
Type de données
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus ObjectClass-2
- C54266
- UMLS 2011AA ObjectClass-2
- C0013987
- NCI Thesaurus ObjectClass-3
- C25246
- UMLS 2011AA ObjectClass-3
- C1446409
- NCI Thesaurus ObjectClass-4
- C62592
- UMLS 2011AA ObjectClass-4
- C2939186
- NCI Thesaurus Property
- C17047
- UMLS 2011AA Property
- C0518214
- NCI Thesaurus Property-2
- C25367
- NCI Thesaurus ValueDomain
- C25664
- UMLS 2011AA ValueDomain
- C0349674
Description
AnxietyThinkingPersonQualityofLifeAssessmentScale
Type de données
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus ObjectClass-2
- C26696
- UMLS 2011AA ObjectClass-2
- C0003467
- NCI Thesaurus ObjectClass-3
- C54226
- UMLS 2011AA ObjectClass-3
- C0039869
- NCI Thesaurus Property
- C17047
- UMLS 2011AA Property
- C0518214
- NCI Thesaurus Property-2
- C25367
- NCI Thesaurus ValueDomain
- C25664
- UMLS 2011AA ValueDomain
- C0349674
Description
EmotionPositivePersonQualityofLifeAssessmentScale
Type de données
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus ObjectClass-2
- C54266
- UMLS 2011AA ObjectClass-2
- C0013987
- NCI Thesaurus ObjectClass-3
- C25246
- UMLS 2011AA ObjectClass-3
- C1446409
- NCI Thesaurus Property
- C17047
- UMLS 2011AA Property
- C0518214
- NCI Thesaurus Property-2
- C25367
- NCI Thesaurus ValueDomain
- C25664
- UMLS 2011AA ValueDomain
- C0349674
Description
RelaxationPersonQualityofLifeAssessmentScale
Type de données
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus ObjectClass-2
- C62188
- UMLS 2011AA ObjectClass-2
- C0035028
- NCI Thesaurus Property
- C17047
- UMLS 2011AA Property
- C0518214
- NCI Thesaurus Property-2
- C25367
- NCI Thesaurus ValueDomain
- C25664
- UMLS 2011AA ValueDomain
- C0349674
Description
DepressionFatiguePersonQualityofLifeAssessmentScale
Type de données
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus ObjectClass-2
- C3036
- UMLS 2011AA ObjectClass-2
- C0015672
- NCI Thesaurus ObjectClass-3
- C2982
- UMLS 2011AA ObjectClass-3
- C0011570
- NCI Thesaurus Property
- C17047
- UMLS 2011AA Property
- C0518214
- NCI Thesaurus Property-2
- C25367
- NCI Thesaurus ValueDomain
- C25664
- UMLS 2011AA ValueDomain
- C0349674
Description
AnxietyNauseaPersonQualityofLifeAssessmentScale
Type de données
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus ObjectClass-2
- C26696
- UMLS 2011AA ObjectClass-2
- C0003467
- NCI Thesaurus ObjectClass-3
- C3258
- UMLS 2011AA ObjectClass-3
- C0027497
- NCI Thesaurus Property
- C17047
- UMLS 2011AA Property
- C0518214
- NCI Thesaurus Property-2
- C25367
- NCI Thesaurus ValueDomain
- C25664
- UMLS 2011AA ValueDomain
- C0349674
Description
DepressionAppearancePersonQualityofLifeAssessmentScale
Type de données
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus ObjectClass-2
- C25377
- UMLS 2011AA ObjectClass-2
- C0700364
- NCI Thesaurus ObjectClass-3
- C2982
- UMLS 2011AA ObjectClass-3
- C0011570
- NCI Thesaurus Property
- C17047
- UMLS 2011AA Property
- C0518214
- NCI Thesaurus Property-2
- C25367
- NCI Thesaurus ValueDomain
- C25664
- UMLS 2011AA ValueDomain
- C0349674
Description
AnxietyMovementPersonQualityofLifeAssessmentScale
Type de données
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus ObjectClass-2
- C26696
- UMLS 2011AA ObjectClass-2
- C0003467
- NCI Thesaurus ObjectClass-3
- C37994
- UMLS 2011AA ObjectClass-3
- C0026649
- NCI Thesaurus Property
- C17047
- UMLS 2011AA Property
- C0518214
- NCI Thesaurus Property-2
- C25367
- NCI Thesaurus ValueDomain
- C25664
- UMLS 2011AA ValueDomain
- C0349674
Description
EmotionConfidencePersonQualityofLifeAssessmentScale
Type de données
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus ObjectClass-2
- C54266
- UMLS 2011AA ObjectClass-2
- C0013987
- NCI Thesaurus ObjectClass-3
- C43367
- UMLS 2011AA ObjectClass-3
- C1704726
- NCI Thesaurus Property
- C17047
- UMLS 2011AA Property
- C0518214
- NCI Thesaurus Property-2
- C25367
- NCI Thesaurus ValueDomain
- C25664
- UMLS 2011AA ValueDomain
- C0349674
Description
AnxietyAcuteDistressPersonQualityofLifeAssessmentScale
Type de données
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus ObjectClass-2
- C26696
- UMLS 2011AA ObjectClass-2
- C0003467
- NCI Thesaurus ObjectClass-3
- C14140
- UMLS 2011AA ObjectClass-3
- C0205178
- NCI Thesaurus ObjectClass-4
- C37942
- UMLS 2011AA ObjectClass-4
- C0231303
- NCI Thesaurus Property
- C17047
- UMLS 2011AA Property
- C0518214
- NCI Thesaurus Property-2
- C25367
- NCI Thesaurus ValueDomain
- C25664
- UMLS 2011AA ValueDomain
- C0349674
Description
EmotionActivityPersonQualityofLifeAssessmentScale
Type de données
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus ObjectClass-2
- C54266
- UMLS 2011AA ObjectClass-2
- C0013987
- NCI Thesaurus ObjectClass-3
- C43431
- UMLS 2011AA ObjectClass-3
- C0441655
- NCI Thesaurus Property
- C17047
- UMLS 2011AA Property
- C0518214
- NCI Thesaurus Property-2
- C25367
- NCI Thesaurus ValueDomain
- C25664
- UMLS 2011AA ValueDomain
- C0349674
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 Hospital Anxiety And Depression Scale 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)
C1115437 (UMLS CUI-1)
C40988 (NCI Thesaurus ObjectClass)
C25250 (NCI Thesaurus Property)
C25367 (NCI Thesaurus ValueDomain-2)
C0680532 (UMLS CUI-1)
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)
C1547383 (UMLS 2011AA ValueDomain)
C25657 (NCI Thesaurus ObjectClass)
C1273518 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25465 (NCI Thesaurus ObjectClass-2)
C1516627 (UMLS 2011AA ObjectClass-2)
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)
C26696 (NCI Thesaurus ObjectClass-2)
C0003467 (UMLS 2011AA ObjectClass-2)
C17047 (NCI Thesaurus Property)
C0518214 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C91213 (NCI Thesaurus-2)
C0027361 (UMLS 2011AA ObjectClass)
C54266 (NCI Thesaurus ObjectClass-2)
C0013987 (UMLS 2011AA ObjectClass-2)
C48190 (NCI Thesaurus ObjectClass-3)
C0332197 (UMLS 2011AA ObjectClass-3)
C62184 (NCI Thesaurus ObjectClass-4)
C0870433 (UMLS 2011AA ObjectClass-4)
C17047 (NCI Thesaurus Property)
C0518214 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C0027361 (UMLS 2011AA ObjectClass)
C26696 (NCI Thesaurus ObjectClass-2)
C0003467 (UMLS 2011AA ObjectClass-2)
C37942 (NCI Thesaurus ObjectClass-3)
C0231303 (UMLS 2011AA ObjectClass-3)
C17047 (NCI Thesaurus Property)
C0518214 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C91213 (NCI Thesaurus-2)
C0027361 (UMLS 2011AA ObjectClass)
C54266 (NCI Thesaurus ObjectClass-2)
C0013987 (UMLS 2011AA ObjectClass-2)
C25246 (NCI Thesaurus ObjectClass-3)
C1446409 (UMLS 2011AA ObjectClass-3)
C62592 (NCI Thesaurus ObjectClass-4)
C2939186 (UMLS 2011AA ObjectClass-4)
C17047 (NCI Thesaurus Property)
C0518214 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C91213 (NCI Thesaurus-2)
C0027361 (UMLS 2011AA ObjectClass)
C26696 (NCI Thesaurus ObjectClass-2)
C0003467 (UMLS 2011AA ObjectClass-2)
C54226 (NCI Thesaurus ObjectClass-3)
C0039869 (UMLS 2011AA ObjectClass-3)
C17047 (NCI Thesaurus Property)
C0518214 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C0027361 (UMLS 2011AA ObjectClass)
C54266 (NCI Thesaurus ObjectClass-2)
C0013987 (UMLS 2011AA ObjectClass-2)
C25246 (NCI Thesaurus ObjectClass-3)
C1446409 (UMLS 2011AA ObjectClass-3)
C17047 (NCI Thesaurus Property)
C0518214 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C91213 (NCI Thesaurus-2)
C0027361 (UMLS 2011AA ObjectClass)
C62188 (NCI Thesaurus ObjectClass-2)
C0035028 (UMLS 2011AA ObjectClass-2)
C17047 (NCI Thesaurus Property)
C0518214 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C91213 (NCI Thesaurus-2)
C0027361 (UMLS 2011AA ObjectClass)
C3036 (NCI Thesaurus ObjectClass-2)
C0015672 (UMLS 2011AA ObjectClass-2)
C2982 (NCI Thesaurus ObjectClass-3)
C0011570 (UMLS 2011AA ObjectClass-3)
C17047 (NCI Thesaurus Property)
C0518214 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C91213 (NCI Thesaurus-2)
C0027361 (UMLS 2011AA ObjectClass)
C26696 (NCI Thesaurus ObjectClass-2)
C0003467 (UMLS 2011AA ObjectClass-2)
C3258 (NCI Thesaurus ObjectClass-3)
C0027497 (UMLS 2011AA ObjectClass-3)
C17047 (NCI Thesaurus Property)
C0518214 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C91213 (NCI Thesaurus-2)
C0027361 (UMLS 2011AA ObjectClass)
C25377 (NCI Thesaurus ObjectClass-2)
C0700364 (UMLS 2011AA ObjectClass-2)
C2982 (NCI Thesaurus ObjectClass-3)
C0011570 (UMLS 2011AA ObjectClass-3)
C17047 (NCI Thesaurus Property)
C0518214 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C0027361 (UMLS 2011AA ObjectClass)
C26696 (NCI Thesaurus ObjectClass-2)
C0003467 (UMLS 2011AA ObjectClass-2)
C37994 (NCI Thesaurus ObjectClass-3)
C0026649 (UMLS 2011AA ObjectClass-3)
C17047 (NCI Thesaurus Property)
C0518214 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C91213 (NCI Thesaurus-2)
C0027361 (UMLS 2011AA ObjectClass)
C54266 (NCI Thesaurus ObjectClass-2)
C0013987 (UMLS 2011AA ObjectClass-2)
C43367 (NCI Thesaurus ObjectClass-3)
C1704726 (UMLS 2011AA ObjectClass-3)
C17047 (NCI Thesaurus Property)
C0518214 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C0027361 (UMLS 2011AA ObjectClass)
C26696 (NCI Thesaurus ObjectClass-2)
C0003467 (UMLS 2011AA ObjectClass-2)
C14140 (NCI Thesaurus ObjectClass-3)
C0205178 (UMLS 2011AA ObjectClass-3)
C37942 (NCI Thesaurus ObjectClass-4)
C0231303 (UMLS 2011AA ObjectClass-4)
C17047 (NCI Thesaurus Property)
C0518214 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C91213 (NCI Thesaurus-2)
C0027361 (UMLS 2011AA ObjectClass)
C54266 (NCI Thesaurus ObjectClass-2)
C0013987 (UMLS 2011AA ObjectClass-2)
C43431 (NCI Thesaurus ObjectClass-3)
C0441655 (UMLS 2011AA ObjectClass-3)
C17047 (NCI Thesaurus Property)
C0518214 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
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