ID
1321
Beschrijving
The Pharmacogenomic Submission and Quality Assurance Form, a CDE-compliant CALGB CRF to be used on CALGB protocols. Cetuximab and/or Bevacizumab Combined With Combination Chemotherapy in Treating Patients With Metastatic Colorectal Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=136FE59E-9938-7353-E044-0003BA3F9857
Link
Trefwoorden
Versies (3)
- 27-08-12 27-08-12 -
- 09-01-15 09-01-15 - Martin Dugas
- 18-06-15 18-06-15 -
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27 augustus 2012
DOI
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Creative Commons BY-NC 3.0 Legacy
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Colorectal Cancer NCT00265850 Lab - CALGB: 80405 Pharmacogenomic Submission and Quality Assurance Form - 2480929v1.0
For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice. Print text in capital letters. Avoid contact with the edges of the boxes. If data are amended, circle amended items and check the "Yes" box.
- StudyEvent: CALGB: 80405 Pharmacogenomic Submission and Quality Assurance Form
Beschrijving
Unnamed2
Beschrijving
PatientInitialsName
Datatype
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
Beschrijving
HospitalPatientIdentifierNumber
Datatype
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
- NCI Thesaurus Property
- C16960
- UMLS 2011AA Property
- C0030705
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
- NCI Thesaurus ObjectClass
- C16696
- UMLS 2011AA ObjectClass
- C0019994
Beschrijving
CombinedInstitutionName
Datatype
text
Alias
- NCI Thesaurus ObjectClass
- C25454
- UMLS 2011AA ObjectClass
- C0205195
- NCI Thesaurus ObjectClass
- C21541
- UMLS 2011AA ObjectClass
- C0018704
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
- NCI Thesaurus ValueDomain
- C25191
- UMLS 2011AA ValueDomain
- C1547383
- NCI Thesaurus ValueDomain
- C21541
- UMLS 2011AA ValueDomain
- C0018704
Beschrijving
ParticipatingGroupName
Datatype
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS 2011AA ValueDomain
- C1547383
- NCI Thesaurus ObjectClass
- C25608
- UMLS 2011AA ObjectClass
- C0679823
- NCI Thesaurus ObjectClass
- C17005
- UMLS 2011AA ObjectClass
- C1257890
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
Beschrijving
ProtocolParticipatingIdentifierNumber
Datatype
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
- NCI Thesaurus ObjectClass
- C25320
- UMLS 2011AA ObjectClass
- C1507394
- NCI Thesaurus Property
- C25608
- UMLS 2011AA Property
- C0679823
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
Beschrijving
PatientParticipatingIdentifierNumber
Datatype
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C25608
- UMLS 2011AA Property
- C0679823
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
Beschrijving
Unnamed3
Beschrijving
SpecimenFormSubmittedInd-2
Datatype
text
Alias
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
- NCI Thesaurus Property
- C19464
- UMLS 2011AA Property
- C0376315
- NCI Thesaurus ObjectClass
- C19157
- UMLS 2011AA ObjectClass
- C0370003
- NCI Thesaurus Property
- C25695
- UMLS 2011AA Property
- C1515023
Beschrijving
SpecimenNotSubmittedReason
Datatype
text
Alias
- NCI Thesaurus ValueDomain
- C25638
- UMLS 2011AA ValueDomain
- C0392360
- NCI Thesaurus Property
- C25594
- UMLS 2011AA Property
- C1518422
- NCI Thesaurus ObjectClass
- C19157
- UMLS 2011AA ObjectClass
- C0370003
- NCI Thesaurus Property
- C25695
- UMLS 2011AA Property
- C1515023
Beschrijving
Unnamed4
Beschrijving
SpecimenCollectedDate
Datatype
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ObjectClass
- C19157
- UMLS 2011AA ObjectClass
- C0370003
- NCI Thesaurus Property
- C25452
- NCI Thesaurus Property
- C25275
- UMLS 2011AA Property
- C2745955
Beschrijving
SpecimenCollectedTime
Datatype
time
Alias
- NCI Thesaurus ValueDomain
- C25207
- UMLS 2011AA ValueDomain
- C0040223
- NCI Thesaurus ObjectClass
- C19157
- UMLS 2011AA ObjectClass
- C0370003
- NCI Thesaurus Property
- C25452
- NCI Thesaurus Property
- C25275
- UMLS 2011AA Property
- C2745955
Beschrijving
BloodSpecimenTubeCollectedInd-2
Datatype
text
Alias
- NCI Thesaurus ObjectClass
- C12434
- UMLS 2011AA ObjectClass
- C0229664
- NCI Thesaurus ObjectClass
- C19157
- UMLS 2011AA ObjectClass
- C0370003
- NCI Thesaurus Property
- C25452
- NCI Thesaurus Property
- C41277
- UMLS 2011AA Property
- C1561954
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Beschrijving
BloodSpecimenFrozenCollectedInd-2
Datatype
text
Alias
- NCI Thesaurus ObjectClass
- C12434
- UMLS 2011AA ObjectClass
- C0229664
- NCI Thesaurus ObjectClass
- C19157
- UMLS 2011AA ObjectClass
- C0370003
- NCI Metathesaurus Property
- CL267638
- NCI Thesaurus Property
- C25452
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Beschrijving
HematologySpecimenColdPackSubmissionInd-2
Datatype
text
Alias
- NCI Thesaurus ObjectClass
- C16673
- UMLS 2011AA ObjectClass
- C0018943
- NCI Thesaurus ObjectClass
- C19157
- UMLS 2011AA ObjectClass
- C0370003
- NCI Thesaurus Property
- C62653
- UMLS 2011AA Property
- C2825051
- NCI Thesaurus Property
- C25695
- UMLS 2011AA Property
- C1515023
- NCI Thesaurus Property
- C62180
- UMLS 2011AA Property
- C0009264
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Beschrijving
Unnamed5
Beschrijving
SpecimenLabSubmittedDate
Datatype
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus Property
- C25294
- UMLS 2011AA Property
- C0022885
- NCI Thesaurus ObjectClass
- C19157
- UMLS 2011AA ObjectClass
- C0370003
- NCI Thesaurus Property
- C25695
- UMLS 2011AA Property
- C1515023
Beschrijving
SpecimenLaboratoryProcedureSubmissionTime
Datatype
time
Alias
- NCI Thesaurus ValueDomain
- C25207
- UMLS 2011AA ValueDomain
- C0040223
- NCI Thesaurus Property
- C25294
- UMLS 2011AA Property
- C0022885
- NCI Thesaurus ObjectClass
- C19157
- UMLS 2011AA ObjectClass
- C0370003
- NCI Thesaurus Property
- C25695
- UMLS 2011AA Property
- C1515023
Beschrijving
LabSpecimenIdentifierNumber
Datatype
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
- NCI Thesaurus ObjectClass
- C37984
- UMLS 2011AA ObjectClass
- C0022877
- NCI Thesaurus Property
- C19157
- UMLS 2011AA Property
- C0370003
Beschrijving
LabTransportIdentifierNumber
Datatype
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
- NCI Thesaurus ObjectClass
- C37984
- UMLS 2011AA ObjectClass
- C0022877
- NCI Thesaurus Property
- C61560
Beschrijving
PersonSpecimenSubmittedName
Datatype
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS 2011AA ValueDomain
- C1547383
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C19157
- UMLS 2011AA Property
- C0370003
- NCI Thesaurus Property
- C25695
- UMLS 2011AA Property
- C1515023
Beschrijving
ClinicalResearchAssociatePersonEmailAddressText
Datatype
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus ObjectClass
- C25465
- UMLS 2011AA ObjectClass
- C1516627
- NCI Thesaurus Property
- C42775
- UMLS 2011AA Property
- C1705961
Beschrijving
ClinicalResearchAssociatePersonTelephoneNumber
Datatype
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C25395
- UMLS 2011AA Property
- C0039457
- NCI Thesaurus ObjectClass
- C25465
- UMLS 2011AA ObjectClass
- C1516627
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For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice. Print text in capital letters. Avoid contact with the edges of the boxes. If data are amended, circle amended items and check the "Yes" box.
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