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ID

1477

Descrizione

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

collegamento

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

Keywords

versioni (2)
  1. 27/08/12 27/08/12 -
  2. 14/07/17 14/07/17 - Martin Dugas
Caricato su

27 agosto 2012

DOI

Per favore, per richiedere un accesso.

Licenza

Creative Commons BY-NC 3.0
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    Eligibility - Eligibility Checklist - 3276641v1.0

    Inglese

    No Instruction available.

    1 moduli  
    1. StudyEvent: Eligibility Checklist
      1. No Instruction available.
    Eligibility Checklist
    Descrizione

    Eligibility Checklist

    Visit Date (Enter the date the form was completed i.e. the date information was gathered.)
    Descrizione

    FormCompletionDate

    Tipo di dati

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ObjectClass
    C40988
    UMLS 2011AA ObjectClass
    C1516308
    NCI Thesaurus Property
    C25250
    UMLS 2011AA Property
    C0205197
    Checklist Number (Note: This field cannot be modified by the user.)
    Descrizione

    ChecklistNumber

    Tipo di dati

    text

    Alias
    NCI Thesaurus Property
    C25337
    UMLS 2011AA Property
    C0237753
    NCI Thesaurus ValueDomain
    C25337
    UMLS 2011AA ValueDomain
    C0237753
    NCI Thesaurus ObjectClass
    C16112
    UMLS 2011AA ObjectClass
    C1516637
    NCI Thesaurus ValueDomain
    C49073
    UMLS 2011AA ValueDomain
    C1707357
    Effective Date (Note: This field cannot be modified by the user.)
    Descrizione

    EffectiveDate

    Tipo di dati

    date

    Alias
    NCI Thesaurus Property
    C25164
    UMLS 2011AA Property
    C0011008
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Metathesaurus ObjectClass
    CL067459
    Waiver Number
    Descrizione

    WaiverNumber

    Tipo di dati

    text

    Alias
    NCI Thesaurus Property
    C25337
    UMLS 2011AA Property
    C0237753
    NCI Thesaurus ObjectClass
    C42580
    UMLS 2011AA ObjectClass
    C1707901
    Criterion Response (Select the patient's status relative to the eligibility inclusion criterion.)
    Descrizione

    PatientEligibilityConfirmationCodeIndicator

    Tipo di dati

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus ObjectClass
    C25171
    UMLS 2011AA ObjectClass
    C0013893
    NCI Metathesaurus Property
    C0750484
    NCI Thesaurus ValueDomain
    C25162
    UMLS 2011AA ValueDomain
    C0805701
    NCI Thesaurus ValueDomain
    C25180
    UMLS 2011AA ValueDomain
    C1522602
    NCI Thesaurus ValueDomain
    C49488
    UMLS 2011AA ValueDomain
    C1705108
    NCI Thesaurus ValueDomain
    C49487
    UMLS 2011AA ValueDomain
    C1298908
    NCI Thesaurus ValueDomain
    C48660
    UMLS 2011AA ValueDomain
    C1272460
    Sequence
    Descrizione

    QuestionDisplaySequence

    Tipo di dati

    text

    Alias
    NCI Thesaurus ObjectClass
    C21153
    UMLS 2011AA ObjectClass
    C1516588
    NCI Thesaurus Property
    C25673
    UMLS 2011AA Property
    C1519249
    NCI Thesaurus Property
    C25485
    UMLS 2011AA Property
    C0870432
    Eligibility Waiver Reason
    Descrizione

    EligibilityWaiverReason

    Tipo di dati

    text

    Alias
    NCI Thesaurus Property
    C25638
    UMLS 2011AA Property
    C0392360
    NCI Thesaurus ValueDomain
    C25638
    UMLS 2011AA ValueDomain
    C0392360
    NCI Thesaurus ObjectClass
    C42580
    UMLS 2011AA ObjectClass
    C1707901
    NCI Thesaurus ValueDomain
    C42580
    UMLS 2011AA ValueDomain
    C1707901
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    Similar models

    No Instruction available.

    1 moduli
    1. StudyEvent: Eligibility Checklist
      1. No Instruction available.
    Name
    genere
    Description | Question | Decode (Coded Value)
    Tipo di dati
    Alias
    Item Group
    Eligibility Checklist
    FormCompletionDate
    Item
    Visit Date (Enter the date the form was completed i.e. the date information was gathered.)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C40988 (NCI Thesaurus ObjectClass)
    C1516308 (UMLS 2011AA ObjectClass)
    C25250 (NCI Thesaurus Property)
    C0205197 (UMLS 2011AA Property)
    ChecklistNumber
    Item
    Checklist Number (Note: This field cannot be modified by the user.)
    text
    C25337 (NCI Thesaurus Property)
    C0237753 (UMLS 2011AA Property)
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    C16112 (NCI Thesaurus ObjectClass)
    C1516637 (UMLS 2011AA ObjectClass)
    C49073 (NCI Thesaurus ValueDomain)
    C1707357 (UMLS 2011AA ValueDomain)
    EffectiveDate
    Item
    Effective Date (Note: This field cannot be modified by the user.)
    date
    C25164 (NCI Thesaurus Property)
    C0011008 (UMLS 2011AA Property)
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    CL067459 (NCI Metathesaurus ObjectClass)
    WaiverNumber
    Item
    Waiver Number
    text
    C25337 (NCI Thesaurus Property)
    C0237753 (UMLS 2011AA Property)
    C42580 (NCI Thesaurus ObjectClass)
    C1707901 (UMLS 2011AA ObjectClass)
    Item
    Criterion Response (Select the patient's status relative to the eligibility inclusion criterion.)
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25171 (NCI Thesaurus ObjectClass)
    C0013893 (UMLS 2011AA ObjectClass)
    C0750484 (NCI Metathesaurus Property)
    C25162 (NCI Thesaurus ValueDomain)
    C0805701 (UMLS 2011AA ValueDomain)
    C25180 (NCI Thesaurus ValueDomain)
    C1522602 (UMLS 2011AA ValueDomain)
    C49488 (NCI Thesaurus ValueDomain)
    C1705108 (UMLS 2011AA ValueDomain)
    C49487 (NCI Thesaurus ValueDomain)
    C1298908 (UMLS 2011AA ValueDomain)
    C48660 (NCI Thesaurus ValueDomain)
    C1272460 (UMLS 2011AA ValueDomain)
    CL.1
    Code List
    Criterion Response (Select the patient's status relative to the eligibility inclusion criterion.)
    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)
    QuestionDisplaySequence
    Item
    Sequence
    text
    C21153 (NCI Thesaurus ObjectClass)
    C1516588 (UMLS 2011AA ObjectClass)
    C25673 (NCI Thesaurus Property)
    C1519249 (UMLS 2011AA Property)
    C25485 (NCI Thesaurus Property)
    C0870432 (UMLS 2011AA Property)
    EligibilityWaiverReason
    Item
    Eligibility Waiver Reason
    text
    C25638 (NCI Thesaurus Property)
    C0392360 (UMLS 2011AA Property)
    C25638 (NCI Thesaurus ValueDomain)
    C0392360 (UMLS 2011AA ValueDomain)
    C42580 (NCI Thesaurus ObjectClass)
    C1707901 (UMLS 2011AA ObjectClass)
    C42580 (NCI Thesaurus ValueDomain)
    C1707901 (UMLS 2011AA ValueDomain)
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