ID

11405

Descrizione

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

collegamento

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

Keywords

versioni (3)
  1. 19/09/12 19/09/12 -
  2. 09/01/15 09/01/15 - Martin Dugas
  3. 03/07/15 03/07/15 -
Caricato su

3 luglio 2015

DOI

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Licenza

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

Inglese

No Instruction available.

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

SWOG clinical trial administrative data

SWOG Patient ID
Descrizione

SWOGPatientID

Tipo di dati

text

SWOG Study No.
Descrizione

SWOGStudyNo.

Tipo di dati

text

Registration Step
Descrizione

RegistrationStep

Tipo di dati

text

Patient Initials (L, F M)
Descrizione

Patient Initials

Tipo di dati

text

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

FormCompletionDate,Original

Tipo di dati

date

Institution/Affiliate
Descrizione

MainMemberInstitution/Affiliate

Tipo di dati

text

Physician (Groups other than SWOG)
Descrizione

RegisteredInvestigator

Tipo di dati

text

Group Name
Descrizione

GroupName

Tipo di dati

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.
Descrizione

StudyNo.

Tipo di dati

text

Pt. ID
Descrizione

Pt.ID

Tipo di dati

text

Target Lesions
Descrizione

Target Lesions

(L1, etc. question)
Descrizione

Lesion,ReferenceNumber,Target

Tipo di dati

text

Site of Lesions
Descrizione

Lesion,AnatomicSite,Target

Tipo di dati

text

Longest Diameter of Lesions (cm)
Descrizione

Lesion,TumorDiameter

Tipo di dati

float

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

AssessmentType

Tipo di dati

text

Assessment Date
Descrizione

AssessmentDate

Tipo di dati

date

Non-target Disease
Descrizione

Non-target Disease

(S1, etc. question)
Descrizione

Lesion,ReferenceNumber,Nontarget

Tipo di dati

text

Site of Disease
Descrizione

Lesion,AnatomicSite,Nontarget

Tipo di dati

text

Disease Extent
Descrizione

DiseaseExtent

Tipo di dati

text

Assessment Type
Descrizione

AssessmentType

Tipo di dati

text

Assessment Date
Descrizione

AssessmentDate

Tipo di dati

date

New Lesions
Descrizione

New Lesions

(S1, etc. question)
Descrizione

Lesion,ReferenceNumber,New

Tipo di dati

text

New Lesions, specify site
Descrizione

Lesion,AnatomicSite,New

Tipo di dati

text

Assessment Type
Descrizione

AssessmentType

Tipo di dati

text

Assessment Date
Descrizione

AssessmentDate

Tipo di dati

date

Symptomatic deterioration
Descrizione

Symptomatic deterioration

Symptomatic deterioration
Descrizione

SymptomaticDeteriorationInd

Tipo di dati

boolean

Comments
Descrizione

Comments

Comments
Descrizione

Comments

Tipo di dati

text

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

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

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Similar models

No Instruction available.

1 moduli
  1. StudyEvent: Southwest Oncology Group Follow-Up Tumor Assessment Form
    1. No Instruction available.
Name
genere
Description | Question | Decode (Coded Value)
Tipo di dati
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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