ID

11405

Beskrivning

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

Länk

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

Nyckelord

Versioner (3)
  1. 2012-09-19 2012-09-19 -
  2. 2015-01-09 2015-01-09 - Martin Dugas
  3. 2015-07-03 2015-07-03 -
Uppladdad den

3 juli 2015

DOI

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Licens

Creative Commons BY-NC 3.0 Legacy
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Southwest Oncology Group Follow-Up Tumor Assessment Form

Engelsk

No Instruction available.

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

SWOG clinical trial administrative data

SWOG Patient ID
Beskrivning

SWOGPatientID

Datatyp

text

SWOG Study No.
Beskrivning

SWOGStudyNo.

Datatyp

text

Registration Step
Beskrivning

RegistrationStep

Datatyp

text

Patient Initials (L, F M)
Beskrivning

Patient Initials

Datatyp

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986440
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25536
Date form completed
Beskrivning

FormCompletionDate,Original

Datatyp

date

Institution/Affiliate
Beskrivning

MainMemberInstitution/Affiliate

Datatyp

text

Physician (Groups other than SWOG)
Beskrivning

RegisteredInvestigator

Datatyp

text

Group Name
Beskrivning

GroupName

Datatyp

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.
Beskrivning

StudyNo.

Datatyp

text

Pt. ID
Beskrivning

Pt.ID

Datatyp

text

Target Lesions
Beskrivning

Target Lesions

(L1, etc. question)
Beskrivning

Lesion,ReferenceNumber,Target

Datatyp

text

Site of Lesions
Beskrivning

Lesion,AnatomicSite,Target

Datatyp

text

Longest Diameter of Lesions (cm)
Beskrivning

Lesion,TumorDiameter

Datatyp

float

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

AssessmentType

Datatyp

text

Assessment Date
Beskrivning

AssessmentDate

Datatyp

date

Non-target Disease
Beskrivning

Non-target Disease

(S1, etc. question)
Beskrivning

Lesion,ReferenceNumber,Nontarget

Datatyp

text

Site of Disease
Beskrivning

Lesion,AnatomicSite,Nontarget

Datatyp

text

Disease Extent
Beskrivning

DiseaseExtent

Datatyp

text

Assessment Type
Beskrivning

AssessmentType

Datatyp

text

Assessment Date
Beskrivning

AssessmentDate

Datatyp

date

New Lesions
Beskrivning

New Lesions

(S1, etc. question)
Beskrivning

Lesion,ReferenceNumber,New

Datatyp

text

New Lesions, specify site
Beskrivning

Lesion,AnatomicSite,New

Datatyp

text

Assessment Type
Beskrivning

AssessmentType

Datatyp

text

Assessment Date
Beskrivning

AssessmentDate

Datatyp

date

Symptomatic deterioration
Beskrivning

Symptomatic deterioration

Symptomatic deterioration
Beskrivning

SymptomaticDeteriorationInd

Datatyp

boolean

Comments
Beskrivning

Comments

Comments
Beskrivning

Comments

Datatyp

text

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

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

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Similar models

No Instruction available.

1 Formulär
  1. StudyEvent: Southwest Oncology Group Follow-Up Tumor Assessment Form
    1. No Instruction available.
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
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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