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ID

23816

Beskrivning

The patient's status for each item of the eligibility checklist. Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=ACFB66E7-BD58-6D16-E040-BB89AD4363C3

Länk

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=ACFB66E7-BD58-6D16-E040-BB89AD4363C3

Nyckelord

Versioner (2)
  1. 2012-08-27 2012-08-27 -
  2. 2017-07-14 2017-07-14 - Martin Dugas
Uppladdad den

14 juli 2017

DOI

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Licens

Creative Commons BY-NC 3.0
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    Eligibility Checklist

    Engelsk

    No Instruction available.

    1 Formulär  
    1. StudyEvent: Eligibility Checklist
      1. No Instruction available.
    Eligibility Checklist
    Beskrivning

    Eligibility Checklist

    Alias
    UMLS CUI-1
    C0013893 (Eligibility Determination)
    Visit Date
    Beskrivning

    Enter the date the form was completed i.e. the date information was gathered.

    Datatyp

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164 (undefined)
    NCI Thesaurus ObjectClass
    C40988 (undefined)
    NCI Thesaurus Property
    C25250 (undefined)
    UMLS CUI [1]
    C1115437 (Date form completed)
    LOINC
    MTHU014518
    Checklist Number
    Beskrivning

    Note: This field cannot be modified by the user.

    Datatyp

    text

    Alias
    NCI Thesaurus Property
    C25337 (undefined)
    NCI Thesaurus ValueDomain
    C25337 (undefined)
    NCI Thesaurus ObjectClass
    C16112 (undefined)
    NCI Thesaurus ValueDomain-2
    C49073 (undefined)
    UMLS CUI [1,1]
    C1707357 (Checklist)
    LOINC
    LP200110-7
    UMLS CUI [1,2]
    C1516637 (Clinical Trial Eligibility Criteria)
    UMLS CUI [1,3]
    C0237753 (Numbers)
    SNOMED
    260299005
    LOINC
    LP6841-3
    Effective Date
    Beskrivning

    Note: This field cannot be modified by the user.

    Datatyp

    date

    Alias
    NCI Thesaurus Property
    C25164 (undefined)
    NCI Thesaurus ValueDomain
    C25164 (undefined)
    NCI Metathesaurus ObjectClass
    CL067459 (undefined)
    UMLS CUI [1]
    C0011008 (Date in time)
    SNOMED
    410671006
    Waiver Number
    Beskrivning

    Waiver Number

    Datatyp

    text

    Alias
    NCI Thesaurus Property
    C25337 (undefined)
    NCI Thesaurus ObjectClass
    C42580 (undefined)
    UMLS CUI [1,1]
    C1707901 (Eligibility Waiver)
    UMLS CUI [1,2]
    C0237753 (Numbers)
    SNOMED
    260299005
    LOINC
    LP6841-3
    Criterion Response
    Beskrivning

    Select the patient's status relative to the eligibility inclusion criterion.

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960 (undefined)
    NCI Thesaurus ObjectClass-2
    C25171 (undefined)
    NCI Metathesaurus Property
    C0750484 (Confirmation)
    LOINC
    LA15290-2
    NCI Thesaurus ValueDomain
    C25162 (undefined)
    NCI Thesaurus ValueDomain-2
    C25180 (undefined)
    NCI Thesaurus ValueDomain-3
    C49488 (undefined)
    NCI Thesaurus ValueDomain-4
    C49487 (undefined)
    NCI Thesaurus ValueDomain-5
    C48660 (undefined)
    UMLS CUI [1]
    C1302261 (Patient eligible for clinical trial)
    SNOMED
    399223003
    Sequence
    Beskrivning

    Question Display Sequence

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C21153 (undefined)
    NCI Thesaurus Property
    C25673 (undefined)
    NCI Thesaurus Property-2
    C25485 (undefined)
    UMLS CUI [1]
    C1519249 (Sequence)
    Eligibility Waiver Reason
    Beskrivning

    Eligibility Waiver Reason

    Datatyp

    text

    Alias
    NCI Thesaurus Property
    C25638 (undefined)
    NCI Thesaurus ValueDomain
    C25638 (undefined)
    NCI Thesaurus ObjectClass
    C42580 (undefined)
    NCI Thesaurus ValueDomain-2
    C42580 (undefined)
    UMLS CUI [1,1]
    C1707901 (Eligibility Waiver)
    UMLS CUI [1,2]
    C0566251 (Reason and justification)
    SNOMED
    288830005
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    Similar models

    No Instruction available.

    1 Formulär
    1. StudyEvent: Eligibility Checklist
      1. No Instruction available.
    Name
    Typ
    Description | Question | Decode (Coded Value)
    Datatyp
    Alias
    Item Group
    Eligibility Checklist
    C0013893 (UMLS CUI-1)
    Form Completion Date
    Item
    Visit Date
    date
    C25164 (NCI Thesaurus ValueDomain)
    C40988 (NCI Thesaurus ObjectClass)
    C25250 (NCI Thesaurus Property)
    C1115437 (UMLS CUI [1])
    Checklist Number
    Item
    Checklist Number
    text
    C25337 (NCI Thesaurus Property)
    C25337 (NCI Thesaurus ValueDomain)
    C16112 (NCI Thesaurus ObjectClass)
    C49073 (NCI Thesaurus ValueDomain-2)
    C1707357 (UMLS CUI [1,1])
    C1516637 (UMLS CUI [1,2])
    C0237753 (UMLS CUI [1,3])
    Effective Date
    Item
    Effective Date
    date
    C25164 (NCI Thesaurus Property)
    C25164 (NCI Thesaurus ValueDomain)
    CL067459 (NCI Metathesaurus ObjectClass)
    C0011008 (UMLS CUI [1])
    Waiver Number
    Item
    Waiver Number
    text
    C25337 (NCI Thesaurus Property)
    C42580 (NCI Thesaurus ObjectClass)
    C1707901 (UMLS CUI [1,1])
    C0237753 (UMLS CUI [1,2])
    Item
    Criterion Response
    text
    C16960 (NCI Thesaurus ObjectClass)
    C25171 (NCI Thesaurus ObjectClass-2)
    C0750484 (NCI Metathesaurus Property)
    C25162 (NCI Thesaurus ValueDomain)
    C25180 (NCI Thesaurus ValueDomain-2)
    C49488 (NCI Thesaurus ValueDomain-3)
    C49487 (NCI Thesaurus ValueDomain-4)
    C48660 (NCI Thesaurus ValueDomain-5)
    C1302261 (UMLS CUI [1])
    CL.1
    Code List
    Criterion Response
    CL Item
    Yes, All (Y)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    CL Item
    No (N)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Not Applicable (X)
    C48660 (NCI Thesaurus)
    C1272460 (UMLS 2011AA)
    Question Display Sequence
    Item
    Sequence
    text
    C21153 (NCI Thesaurus ObjectClass)
    C25673 (NCI Thesaurus Property)
    C25485 (NCI Thesaurus Property-2)
    C1519249 (UMLS CUI [1])
    Eligibility Waiver Reason
    Item
    Eligibility Waiver Reason
    text
    C25638 (NCI Thesaurus Property)
    C25638 (NCI Thesaurus ValueDomain)
    C42580 (NCI Thesaurus ObjectClass)
    C42580 (NCI Thesaurus ValueDomain-2)
    C1707901 (UMLS CUI [1,1])
    C0566251 (UMLS CUI [1,2])
    Tillbaka till toppen 

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