ID

11405

Description

Southwest Oncology Group Follow-Up Tumor Assessment Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A50B6C19-55BD-164C-E034-080020C9C0E0

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A50B6C19-55BD-164C-E034-080020C9C0E0

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 Follow-Up Tumor Assessment Form

English

No Instruction available.

1 forms  
  1. StudyEvent: Southwest Oncology Group Follow-Up Tumor Assessment Form
    1. No Instruction available.
SWOG clinical trial administrative data
Description

SWOG clinical trial administrative data

SWOG Patient ID
Description

SWOGPatientID

Data type

text

SWOG Study No.
Description

SWOGStudyNo.

Data type

text

Registration Step
Description

RegistrationStep

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
Date form completed
Description

FormCompletionDate,Original

Data type

date

Institution/Affiliate
Description

MainMemberInstitution/Affiliate

Data type

text

Physician (Groups other than SWOG)
Description

RegisteredInvestigator

Data type

text

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. ID
Description

Pt.ID

Data type

text

Target Lesions
Description

Target Lesions

(L1, etc. question)
Description

Lesion,ReferenceNumber,Target

Data type

text

Site of Lesions
Description

Lesion,AnatomicSite,Target

Data type

text

Longest Diameter of Lesions (cm)
Description

Lesion,TumorDiameter

Data type

float

Alias
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
Assessment Type
Description

AssessmentType

Data type

text

Assessment Date
Description

AssessmentDate

Data type

date

Non-target Disease
Description

Non-target Disease

(S1, etc. question)
Description

Lesion,ReferenceNumber,Nontarget

Data type

text

Site of Disease
Description

Lesion,AnatomicSite,Nontarget

Data type

text

Disease Extent
Description

DiseaseExtent

Data type

text

Assessment Type
Description

AssessmentType

Data type

text

Assessment Date
Description

AssessmentDate

Data type

date

New Lesions
Description

New Lesions

(S1, etc. question)
Description

Lesion,ReferenceNumber,New

Data type

text

New Lesions, specify site
Description

Lesion,AnatomicSite,New

Data type

text

Assessment Type
Description

AssessmentType

Data type

text

Assessment Date
Description

AssessmentDate

Data type

date

Symptomatic deterioration
Description

Symptomatic deterioration

Symptomatic deterioration
Description

SymptomaticDeteriorationInd

Data type

boolean

Comments
Description

Comments

Comments
Description

Comments

Data type

text

Ccrr Module For Southwest Oncology Group Follow-up Tumor Assessment Form
Description

Ccrr Module For Southwest Oncology Group Follow-up Tumor Assessment Form

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Similar models

No Instruction available.

1 forms
  1. StudyEvent: Southwest Oncology Group Follow-Up Tumor Assessment 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
SWOGStudyNo.
Item
SWOG Study No.
text
RegistrationStep
Item
Registration Step
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)
FormCompletionDate,Original
Item
Date form completed
date
MainMemberInstitution/Affiliate
Item
Institution/Affiliate
text
RegisteredInvestigator
Item
Physician (Groups other than SWOG)
text
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. ID
text
Item Group
Target Lesions
Item
(L1, etc. question)
text
CL.1
Code List
(L1, etc. question)
CL Item
L1 (L1)
CL Item
L2 (L2)
CL Item
L3 (L3)
CL Item
L4 (L4)
CL Item
L5 (L5)
CL Item
L6 (L6)
CL Item
L7 (L7)
CL Item
L8 (L8)
CL Item
L9 (L9)
CL Item
L10 (L10)
Lesion,AnatomicSite,Target
Item
Site of Lesions
text
Lesion,TumorDiameter
Item
Longest Diameter of Lesions (cm)
float
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
Item
Assessment Type
text
CL.6
Code List
Assessment Type
CL Item
Palpation (Palpation)
CL Item
Visualization (Visualization)
CL Item
Colposcopy (Colposcopy)
CL Item
Endoscopy (Endoscopy)
CL Item
Plain film/X-ray without contrast (Plain film/X-ray without contrast)
CL Item
Plain film/X-ray with contrast (Plain film/X-ray with contrast)
CL Item
Ct Scan (CT scan)
CL Item
Mri (MRI scan)
CL Item
Radioisotope scan (Radioisotope scan)
CL Item
Ultrasound (Ultrasound)
C64384 (NCI Thesaurus)
C1456803 (UMLS 2011AA)
CL Item
PET scan (PET scan)
CL Item
Spiral Ct Scan (Sprial CT scan)
CL Item
Histology (Histologic confirmation)
C16681 (NCI Thesaurus)
C0019638 (UMLS 2011AA)
CL Item
Cytology (Cytologic confirmation)
C16491 (NCI Thesaurus)
C0010819 (UMLS 2011AA)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
AssessmentDate
Item
Assessment Date
date
Item Group
Non-target Disease
Item
(S1, etc. question)
text
CL.3
Code List
(S1, etc. question)
CL Item
S1 (S1)
CL Item
S2 (S2)
CL Item
S3 (S3)
CL Item
S4 (S4)
CL Item
S5 (S5)
Lesion,AnatomicSite,Nontarget
Item
Site of Disease
text
Item
Disease Extent
text
CL.4
Code List
Disease Extent
CL Item
Complete disapperance (Complete disapperance)
CL Item
Present (Present)
CL Item
Clear increase (describe in comments on page 2) (Clear increase (describe in comments on page 2))
CL Item
Not assessed (Not assessed)
Item
Assessment Type
text
CL.6
Code List
Assessment Type
CL Item
Palpation (Palpation)
CL Item
Visualization (Visualization)
CL Item
Colposcopy (Colposcopy)
CL Item
Endoscopy (Endoscopy)
CL Item
Plain film/X-ray without contrast (Plain film/X-ray without contrast)
CL Item
Plain film/X-ray with contrast (Plain film/X-ray with contrast)
CL Item
Ct Scan (CT scan)
CL Item
Mri (MRI scan)
CL Item
Radioisotope scan (Radioisotope scan)
CL Item
Ultrasound (Ultrasound)
C64384 (NCI Thesaurus)
C1456803 (UMLS 2011AA)
CL Item
PET scan (PET scan)
CL Item
Spiral Ct Scan (Sprial CT scan)
CL Item
Histology (Histologic confirmation)
C16681 (NCI Thesaurus)
C0019638 (UMLS 2011AA)
CL Item
Cytology (Cytologic confirmation)
C16491 (NCI Thesaurus)
C0010819 (UMLS 2011AA)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
AssessmentDate
Item
Assessment Date
date
Item Group
New Lesions
Lesion,ReferenceNumber,New
Item
(S1, etc. question)
text
Lesion,AnatomicSite,New
Item
New Lesions, specify site
text
Item
Assessment Type
text
CL.6
Code List
Assessment Type
CL Item
Palpation (Palpation)
CL Item
Visualization (Visualization)
CL Item
Colposcopy (Colposcopy)
CL Item
Endoscopy (Endoscopy)
CL Item
Plain film/X-ray without contrast (Plain film/X-ray without contrast)
CL Item
Plain film/X-ray with contrast (Plain film/X-ray with contrast)
CL Item
Ct Scan (CT scan)
CL Item
Mri (MRI scan)
CL Item
Radioisotope scan (Radioisotope scan)
CL Item
Ultrasound (Ultrasound)
C64384 (NCI Thesaurus)
C1456803 (UMLS 2011AA)
CL Item
PET scan (PET scan)
CL Item
Spiral Ct Scan (Sprial CT scan)
CL Item
Histology (Histologic confirmation)
C16681 (NCI Thesaurus)
C0019638 (UMLS 2011AA)
CL Item
Cytology (Cytologic confirmation)
C16491 (NCI Thesaurus)
C0010819 (UMLS 2011AA)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
AssessmentDate
Item
Assessment Date
date
Item Group
Symptomatic deterioration
SymptomaticDeteriorationInd
Item
Symptomatic deterioration
boolean
Item Group
Comments
Comments
Item
Comments
text
Item Group
Ccrr Module For Southwest Oncology Group Follow-up Tumor Assessment Form
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