ID

11396

Description

Southwest Oncology Group S0201 Pathology Submission Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A8BA7D80-B069-121E-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A8BA7D80-B069-121E-E034-0003BA12F5E7

Keywords

Versions (3)
  1. 9/19/12 9/19/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
  3. 7/3/15 7/3/15 -
Uploaded on

July 3, 2015

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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Southwest Oncology Group S0201 Pathology Submission Form

English

No Instruction available.

1 forms  
  1. StudyEvent: Southwest Oncology Group S0201 Pathology Submission Form
    1. No Instruction available.
SWOG clinical trial administrative data
Description

SWOG clinical trial administrative data

SWOG Patient ID
Description

SWOGPatientID

Data type

text

Patient Initials (L, F M)
Description

Patient Initials

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986440
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25536
Disease
Description

Disease

Data type

text

Institution/Member
Description

MainMemberInstitution/Affiliate

Data type

text

Physician (Groups other than SWOG)
Description

TreatingPhysician

Data type

text

Alias
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ObjectClass
C25741
UMLS 2011AA ObjectClass
C0031831
NCI Thesaurus ObjectClass-2
C25705
UMLS 2011AA ObjectClass-2
C1522326
Group Name
Description

GroupName

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C17005
UMLS 2011AA ObjectClass
C1257890
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Study No.
Description

StudyNo.

Data type

text

Pt. No
Description

Pt.ID

Data type

text

Pathology submission
Description

Pathology submission

No. of slides
Description

SpecimenSlideCount

Data type

text

No. of blocks
Description

SpecimenBlockSubmissionCount

Data type

text

Alias
NCI Thesaurus ValueDomain
C25463
UMLS 2011AA ValueDomain
C0750480
NCI Thesaurus Property
C25436
UMLS 2011AA Property
C1533157
NCI Thesaurus ObjectClass
C19157
UMLS 2011AA ObjectClass
C0370003
NCI Thesaurus Property-2
C25694
UMLS 2011AA Property-2
C1515022
Date sample obtained
Description

SpecimenCollectionDate

Data type

date

One representative H&E stained section from each block of the primary tumor
Description

OnerepresentativeH&Estainedsectionfromeachblockoftheprimarytumor

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Section of sentinel regional lymph node(s) (ind)
Description

Sectionofsentinelregionallymphnode(s)(ind)

Data type

boolean

Sections of non-sentinel lymph node(s) (Ind)
Description

Sectionsofnon-sentinellymphnode(s)(Ind)

Data type

boolean

Operative reports (ind)
Description

Operativereports(ind)

Data type

boolean

Pathology reports (ind)
Description

Pathologyreports(ind)

Data type

boolean

Specimen Number
Description

SpecimenID

Data type

float

Comments
Description

Comments

Data type

text

Ccrr Module For Southwest Oncology Group S0201 Pathology Submission Form
Description

Ccrr Module For Southwest Oncology Group S0201 Pathology Submission Form

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Similar models

No Instruction available.

1 forms
  1. StudyEvent: Southwest Oncology Group S0201 Pathology Submission Form
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
SWOG clinical trial administrative data
SWOGPatientID
Item
SWOG Patient ID
text
Patient Initials
Item
Patient Initials (L, F M)
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
Disease
Item
Disease
text
MainMemberInstitution/Affiliate
Item
Institution/Member
text
TreatingPhysician
Item
Physician (Groups other than SWOG)
text
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25741 (NCI Thesaurus ObjectClass)
C0031831 (UMLS 2011AA ObjectClass)
C25705 (NCI Thesaurus ObjectClass-2)
C1522326 (UMLS 2011AA ObjectClass-2)
GroupName
Item
Group Name
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C17005 (NCI Thesaurus ObjectClass)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
StudyNo.
Item
Study No.
text
Pt.ID
Item
Pt. No
text
Item Group
Pathology submission
SpecimenSlideCount
Item
No. of slides
text
SpecimenBlockSubmissionCount
Item
No. of blocks
text
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C25436 (NCI Thesaurus Property)
C1533157 (UMLS 2011AA Property)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C25694 (NCI Thesaurus Property-2)
C1515022 (UMLS 2011AA Property-2)
SpecimenCollectionDate
Item
Date sample obtained
date
OnerepresentativeH&Estainedsectionfromeachblockoftheprimarytumor
Item
One representative H&E stained section from each block of the primary tumor
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
Sectionofsentinelregionallymphnode(s)(ind)
Item
Section of sentinel regional lymph node(s) (ind)
boolean
Sectionsofnon-sentinellymphnode(s)(Ind)
Item
Sections of non-sentinel lymph node(s) (Ind)
boolean
Operativereports(ind)
Item
Operative reports (ind)
boolean
Pathologyreports(ind)
Item
Pathology reports (ind)
boolean
SpecimenID
Item
Specimen Number
float
Comments
Item
Comments
text
Item Group
Ccrr Module For Southwest Oncology Group S0201 Pathology Submission Form
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