ID

1235

Description

SOUTHWEST ONCOLOGY GROUP FOLLOW-UP TUMOR ASSESSMENT FORM S0227 Comparison of Cisplatin Combined With Either Paclitaxel or Gemcitabine in Treating Patients With Recurrent, Persistent, or Metastatic Cervical Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A9C28ABD-653E-36E3-E034-0003BA12F5E7

Lien

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A9C28ABD-653E-36E3-E034-0003BA12F5E7

Mots-clés

Versions (2)
  1. 27/08/2012 27/08/2012 -
  2. 09/01/2015 09/01/2015 - Martin Dugas
Téléchargé le

27 août 2012

DOI

Pour une demande vous connecter.

Licence

Creative Commons BY-NC 3.0 Legacy
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Cervical Cancer NCT00057928 Follow-Up - SOUTHWEST ONCOLOGY GROUP FOLLOW-UP TUMOR ASSESSMENT FORM - 2056737v3.0

Anglais

No Instruction available.

1 Formulaires  
  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP FOLLOW-UP TUMOR ASSESSMENT FORM
    1. No Instruction available.
Unnamed1
Description

Unnamed1

SWOG Patient ID
Description

SWOGPatientID

Type de données

text

SWOG Study No.
Description

SWOGStudyNo.

Type de données

text

Registration Step
Description

RegistrationStep

Type de données

text

Patient Initials (L, F M)
Description

PatientInitialsName

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25536
UMLS 2011AA Property
C1555582
Date form completed
Description

FormCompletionDate,Original

Type de données

date

Institution / Affiliate
Description

InstitutionName

Type de données

text

Physician (Groups Other than SWOG)
Description

RegisteredInvestigator

Type de données

text

Group Name
Description

ParticipatingGroupName

Type de données

text

Study No.
Description

Particip.GroupProtocolNumber

Type de données

double

Pt. ID (Instructions: Record the requested information for all target lesions and all sites of other disease. Lesion and site numbers L1, S1, etc. should correspond to the same lesions and sites of disease as indicated on the baseline tumor assessment form. If a target lesion was assessed but measurements were not obtainable, complete assessment type and assessment date, and state lesion number and reason measurement was not obtained in Comments section on page 2. Record site of any new lesions since baseline in the New Lesions section. Place an X in appropriate boxes.)
Description

PatientStudyID,ParticipatingGroup

Type de données

text

Target Lesions
Description

Target Lesions

Unnamed2 (Lesion number)
Description

Lesion,ReferenceNumber

Type de données

double

Unnamed3 (Lesion site)
Description

Lesion,AnatomicSite

Type de données

text

Longest Diameter (cm)
Description

Lesion,TumorDiameter

Type de données

double

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

AssessmentType

Type de données

text

Assessment Date
Description

AssessmentDate

Type de données

date

Non-target Disease
Description

Non-target Disease

Unnamed2 (Lesion number)
Description

Lesion,ReferenceNumber

Type de données

double

Unnamed3 (Lesion site)
Description

Lesion,AnatomicSite

Type de données

text

Extent
Description

Lesion,Follow-upStatus

Type de données

text

Assessment Type
Description

AssessmentType

Type de données

text

Assessment Date
Description

AssessmentDate

Type de données

date

New Lesions
Description

New Lesions

Unnamed2 (Lesion number)
Description

Lesion,ReferenceNumber

Type de données

double

Unnamed3 (Lesion site)
Description

Lesion,AnatomicSite

Type de données

text

Assessment Type
Description

AssessmentType

Type de données

text

Assessment Date
Description

AssessmentDate

Type de données

date

Assessment Date
Description

AssessmentDate

Type de données

date

Symptomatic deterioration
Description

SymptomaticDeteriorationInd

Type de données

text

Comments
Description

Comments

Comments
Description

Comments

Type de données

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 Formulaires
  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP FOLLOW-UP TUMOR ASSESSMENT FORM
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Type de données
Alias
Item Group
Unnamed1
SWOGPatientID
Item
SWOG Patient ID
text
SWOGStudyNo.
Item
SWOG Study No.
text
RegistrationStep
Item
Registration Step
text
PatientInitialsName
Item
Patient Initials (L, F M)
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25536 (NCI Thesaurus Property)
C1555582 (UMLS 2011AA Property)
FormCompletionDate,Original
Item
Date form completed
date
InstitutionName
Item
Institution / Affiliate
text
RegisteredInvestigator
Item
Physician (Groups Other than SWOG)
text
ParticipatingGroupName
Item
Group Name
text
Particip.GroupProtocolNumber
Item
Study No.
double
PatientStudyID,ParticipatingGroup
Item
Pt. ID (Instructions: Record the requested information for all target lesions and all sites of other disease. Lesion and site numbers L1, S1, etc. should correspond to the same lesions and sites of disease as indicated on the baseline tumor assessment form. If a target lesion was assessed but measurements were not obtainable, complete assessment type and assessment date, and state lesion number and reason measurement was not obtained in Comments section on page 2. Record site of any new lesions since baseline in the New Lesions section. Place an X in appropriate boxes.)
text
Item Group
Target Lesions
Lesion,ReferenceNumber
Item
Unnamed2 (Lesion number)
double
Lesion,AnatomicSite
Item
Unnamed3 (Lesion site)
text
Lesion,TumorDiameter
Item
Longest Diameter (cm)
double
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
Item
Assessment Type
text
CL.4
Code List
Assessment Type
CL Item
Clinical Examination (Palpation)
CL Item
Laparotomy (Visualization)
C15266 (NCI Thesaurus)
C0023038 (UMLS 2011AA)
CL Item
Laparoscopy (Colposcopy)
C16969 (NCI Thesaurus)
C0031150 (UMLS 2011AA)
CL Item
Laparoscopy (Endoscopy)
C16969 (NCI Thesaurus)
C0031150 (UMLS 2011AA)
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
Radiograph (Radioisotope scan)
CL Item
Ultrasound (Ultrasound)
C64384 (NCI Thesaurus)
C1456803 (UMLS 2011AA)
CL Item
PET scan (PET scan)
CL Item
Spiral Ct Scan (Spiral 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
Lesion,ReferenceNumber
Item
Unnamed2 (Lesion number)
double
Lesion,AnatomicSite
Item
Unnamed3 (Lesion site)
text
Item
Extent
text
CL.2
Code List
Extent
CL Item
Complete disappearance (Complete disappearance)
CL Item
Present (Present)
CL Item
Clear increase (Clear increase)
CL Item
Not assessed (Not assessed)
Item
Assessment Type
text
CL.4
Code List
Assessment Type
CL Item
Clinical Examination (Palpation)
CL Item
Laparotomy (Visualization)
C15266 (NCI Thesaurus)
C0023038 (UMLS 2011AA)
CL Item
Laparoscopy (Colposcopy)
C16969 (NCI Thesaurus)
C0031150 (UMLS 2011AA)
CL Item
Laparoscopy (Endoscopy)
C16969 (NCI Thesaurus)
C0031150 (UMLS 2011AA)
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
Radiograph (Radioisotope scan)
CL Item
Ultrasound (Ultrasound)
C64384 (NCI Thesaurus)
C1456803 (UMLS 2011AA)
CL Item
PET scan (PET scan)
CL Item
Spiral Ct Scan (Spiral 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
Item
Unnamed2 (Lesion number)
double
Lesion,AnatomicSite
Item
Unnamed3 (Lesion site)
text
Item
Assessment Type
text
CL.4
Code List
Assessment Type
CL Item
Clinical Examination (Palpation)
CL Item
Laparotomy (Visualization)
C15266 (NCI Thesaurus)
C0023038 (UMLS 2011AA)
CL Item
Laparoscopy (Colposcopy)
C16969 (NCI Thesaurus)
C0031150 (UMLS 2011AA)
CL Item
Laparoscopy (Endoscopy)
C16969 (NCI Thesaurus)
C0031150 (UMLS 2011AA)
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
Radiograph (Radioisotope scan)
CL Item
Ultrasound (Ultrasound)
C64384 (NCI Thesaurus)
C1456803 (UMLS 2011AA)
CL Item
PET scan (PET scan)
CL Item
Spiral Ct Scan (Spiral 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
AssessmentDate
Item
Assessment Date
date
Item
Symptomatic deterioration
text
CL.5
Code List
Symptomatic deterioration
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item Group
Comments
Comments
Item
Comments
text
Item Group
Ccrr Module For Southwest Oncology Group Follow-up Tumor Assessment Form
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