Anglais

Protocol medication AIEOP-BFM ALL 2009 NCT01117441

1 Formulaires  
Patient Information
Description

Patient Information

Alias
UMLS CUI-1
C1955348
ID of patient
Description

Patient ID

Type de données

text

Alias
UMLS CUI [1]
C2348585
Patient Birth Date
Description

Birth Date

Type de données

date

Alias
UMLS CUI [1]
C0421451
First Element
Description

First Element

Alias
UMLS CUI-1
C0205435
UMLS CUI-2
C3812827
First Element:
Description

First Element

Type de données

text

Alias
UMLS CUI [1,1]
C0205435
UMLS CUI [1,2]
C3812827
First Element: If "other", specify:
Description

First Element Specifciation

Type de données

text

Alias
UMLS CUI [1,1]
C0205435
UMLS CUI [1,2]
C3812827
UMLS CUI [1,3]
C2348235
First Element: Therapy documentation available?
Description

First Element Documentation

Type de données

boolean

Alias
UMLS CUI [1,1]
C0205435
UMLS CUI [1,2]
C3812827
UMLS CUI [1,3]
C0920316
First Element: Start Date
Description

First Element Start Date

Type de données

date

Alias
UMLS CUI [1,1]
C0205435
UMLS CUI [1,2]
C3812827
UMLS CUI [1,3]
C0808070
First Element: End Date
Description

First Element End Date

Type de données

date

Alias
UMLS CUI [1,1]
C0205435
UMLS CUI [1,2]
C3812827
UMLS CUI [1,3]
C0806020
Second Element
Description

Second Element

Alias
UMLS CUI-1
C0205436
UMLS CUI-2
C3812827
Second Element:
Description

Second Element

Type de données

text

Alias
UMLS CUI [1,1]
C0205436
UMLS CUI [1,2]
C3812827
Second Element: If "other", specify:
Description

Second Element Specifciation

Type de données

text

Alias
UMLS CUI [1,1]
C0205436
UMLS CUI [1,2]
C3812827
UMLS CUI [1,3]
C2348235
Second Element: Therapy documentation available?
Description

Second Element Documentation

Type de données

boolean

Alias
UMLS CUI [1,1]
C0205436
UMLS CUI [1,2]
C3812827
UMLS CUI [1,3]
C0920316
Second Element: Start Date
Description

Second Element Start Date

Type de données

date

Alias
UMLS CUI [1,1]
C0205436
UMLS CUI [1,2]
C3812827
UMLS CUI [1,3]
C0808070
Second Element: End Date
Description

Second Element End Date

Type de données

date

Alias
UMLS CUI [1,1]
C0205436
UMLS CUI [1,2]
C3812827
UMLS CUI [1,3]
C0806020
Thrid Element
Description

Thrid Element

Alias
UMLS CUI-1
C0205437
UMLS CUI-2
C3812827
Third Element:
Description

Third Element

Type de données

text

Alias
UMLS CUI [1,1]
C0205437
UMLS CUI [1,2]
C3812827
Third Element: If "other", specify:
Description

Third Element Specifciation

Type de données

text

Alias
UMLS CUI [1,1]
C0205437
UMLS CUI [1,2]
C3812827
UMLS CUI [1,3]
C2348235
Third Element: Therapy documentation available?
Description

Third Element Documentation

Type de données

boolean

Alias
UMLS CUI [1,1]
C0205437
UMLS CUI [1,2]
C3812827
UMLS CUI [1,3]
C0920316
Third Element: Start Date
Description

Third Element Start Date

Type de données

date

Alias
UMLS CUI [1,1]
C0205437
UMLS CUI [1,2]
C3812827
UMLS CUI [1,3]
C0808070
Third Element: End Date
Description

Third Element End Date

Type de données

date

Alias
UMLS CUI [1,1]
C0205437
UMLS CUI [1,2]
C3812827
UMLS CUI [1,3]
C0806020
Fourth Element
Description

Fourth Element

Alias
UMLS CUI-1
C0205438
UMLS CUI-2
C3812827
Fourth Element:
Description

Fourth Element

Type de données

text

Alias
UMLS CUI [1,1]
C0205438
UMLS CUI [1,2]
C3812827
Fourth Element: If "other", specify:
Description

Fourth Element Specifciation

Type de données

text

Alias
UMLS CUI [1,1]
C0205438
UMLS CUI [1,2]
C3812827
UMLS CUI [1,3]
C2348235
Fourth Element: Therapy documentation available?
Description

Fourth Element Documentation

Type de données

boolean

Alias
UMLS CUI [1,1]
C0205438
UMLS CUI [1,2]
C3812827
UMLS CUI [1,3]
C0920316
Fourth Element: Start Date
Description

Fourth Element Start Date

Type de données

date

Alias
UMLS CUI [1,1]
C0205438
UMLS CUI [1,2]
C3812827
UMLS CUI [1,3]
C0808070
Fourth Element: End Date
Description

Fourth Element End Date

Type de données

date

Alias
UMLS CUI [1,1]
C0205438
UMLS CUI [1,2]
C3812827
UMLS CUI [1,3]
C0806020
Fifth Element
Description

Fifth Element

Alias
UMLS CUI-1
C0205439
UMLS CUI-2
C3812827
Fifth Element:
Description

Fifth Element

Type de données

text

Alias
UMLS CUI [1,1]
C0205439
UMLS CUI [1,2]
C3812827
Fifth Element: If "other", specify:
Description

Fifth Element Specifciation

Type de données

text

Alias
UMLS CUI [1,1]
C0205439
UMLS CUI [1,2]
C3812827
UMLS CUI [1,3]
C2348235
Fifth Element: Therapy documentation available?
Description

Fifth Element Documentation

Type de données

boolean

Alias
UMLS CUI [1,1]
C0205439
UMLS CUI [1,2]
C3812827
UMLS CUI [1,3]
C0920316
Fifth Element: Start Date
Description

Fifth Element Start Date

Type de données

date

Alias
UMLS CUI [1,1]
C0205439
UMLS CUI [1,2]
C3812827
UMLS CUI [1,3]
C0808070
Fifth Element: End Date
Description

Fifth Element End Date

Type de données

date

Alias
UMLS CUI [1,1]
C0205439
UMLS CUI [1,2]
C3812827
UMLS CUI [1,3]
C0806020
Sixth Element
Description

Sixth Element

Alias
UMLS CUI-1
C0205440
UMLS CUI-2
C3812827
Sixth Element:
Description

Sixth Element

Type de données

text

Alias
UMLS CUI [1,1]
C0205440
UMLS CUI [1,2]
C3812827
Sixth Element: If "other", specify:
Description

Sixth Element Specifciation

Type de données

text

Alias
UMLS CUI [1,1]
C0205440
UMLS CUI [1,2]
C3812827
UMLS CUI [1,3]
C2348235
Sixth Element: Therapy documentation available?
Description

Sixth Element Documentation

Type de données

boolean

Alias
UMLS CUI [1,1]
C0205440
UMLS CUI [1,2]
C3812827
UMLS CUI [1,3]
C0920316
Sixth Element: Start Date
Description

Sixth Element Start Date

Type de données

date

Alias
UMLS CUI [1,1]
C0205440
UMLS CUI [1,2]
C3812827
UMLS CUI [1,3]
C0808070
Sixth Element: End Date
Description

Sixth Element End Date

Type de données

date

Alias
UMLS CUI [1,1]
C0205440
UMLS CUI [1,2]
C3812827
UMLS CUI [1,3]
C0806020
Seveneth Element
Description

Seveneth Element

Alias
UMLS CUI-1
C0205441
UMLS CUI-2
C3812827
Seventh Element:
Description

Seventh Element

Type de données

text

Alias
UMLS CUI [1,1]
C0205441
UMLS CUI [1,2]
C3812827
Seventh Element: If "other", specify:
Description

Seventh Element Specifciation

Type de données

text

Alias
UMLS CUI [1,1]
C0205441
UMLS CUI [1,2]
C3812827
UMLS CUI [1,3]
C2348235
Seventh Element: Therapy documentation available?
Description

Seventh Element Documentation

Type de données

boolean

Alias
UMLS CUI [1,1]
C0205441
UMLS CUI [1,2]
C3812827
UMLS CUI [1,3]
C0920316
Seventh Element: Start Date
Description

Seventh Element Start Date

Type de données

date

Alias
UMLS CUI [1,1]
C0205441
UMLS CUI [1,2]
C3812827
UMLS CUI [1,3]
C0808070
Seventh Element: End Date
Description

Seventh Element End Date

Type de données

date

Alias
UMLS CUI [1,1]
C0205441
UMLS CUI [1,2]
C3812827
UMLS CUI [1,3]
C0806020
Eighth Element
Description

Eighth Element

Alias
UMLS CUI-1
C0205442
UMLS CUI-2
C3812827
Eighth Element:
Description

Eighth Element

Type de données

text

Alias
UMLS CUI [1,1]
C0205442
UMLS CUI [1,2]
C3812827
Eighth Element: If "other", specify:
Description

Eighth Element Specifciation

Type de données

text

Alias
UMLS CUI [1,1]
C0205442
UMLS CUI [1,2]
C3812827
UMLS CUI [1,3]
C2348235
Eighth Element: Therapy documentation available?
Description

Eighth Element Documentation

Type de données

boolean

Alias
UMLS CUI [1,1]
C0205442
UMLS CUI [1,2]
C3812827
UMLS CUI [1,3]
C0920316
Eighth Element: Start Date
Description

Eighth Element Start Date

Type de données

date

Alias
UMLS CUI [1,1]
C0205442
UMLS CUI [1,2]
C3812827
UMLS CUI [1,3]
C0808070
Eighth Element: End Date
Description

Eighth Element End Date

Type de données

date

Alias
UMLS CUI [1,1]
C0205442
UMLS CUI [1,2]
C3812827
UMLS CUI [1,3]
C0806020
Ninth Element
Description

Ninth Element

Alias
UMLS CUI-1
C0205443
UMLS CUI-2
C3812827
Ninth Element:
Description

Ninth Element

Type de données

text

Alias
UMLS CUI [1,1]
C0205443
UMLS CUI [1,2]
C3812827
Ninth Element: If "other", specify:
Description

Ninth Element Specifciation

Type de données

text

Alias
UMLS CUI [1,1]
C0205443
UMLS CUI [1,2]
C3812827
UMLS CUI [1,3]
C2348235
Ninth Element: Therapy documentation available?
Description

Ninth Element Documentation

Type de données

boolean

Alias
UMLS CUI [1,1]
C0205443
UMLS CUI [1,2]
C3812827
UMLS CUI [1,3]
C0920316
Ninth Element: Start Date
Description

Ninth Element Start Date

Type de données

date

Alias
UMLS CUI [1,1]
C0205443
UMLS CUI [1,2]
C3812827
UMLS CUI [1,3]
C0808070
Ninth Element: End Date
Description

Ninth Element End Date

Type de données

date

Alias
UMLS CUI [1,1]
C0205443
UMLS CUI [1,2]
C3812827
UMLS CUI [1,3]
C0806020
Cranial radiation
Description

Cranial radiation

Alias
UMLS CUI-1
C1997353
Cranial radiation?
Description

Cranial radiation

Type de données

boolean

Alias
UMLS CUI [1]
C1997353
Cranial radiation: Start Date:
Description

Cranial radiation: Start Date

Type de données

date

Alias
UMLS CUI [1,1]
C1997353
UMLS CUI [1,2]
C0808070
Cranial radiation: End Date
Description

Cranial radiation: End Date

Type de données

date

Alias
UMLS CUI [1,1]
C1997353
UMLS CUI [1,2]
C0806020
Cranial radiation: total dose
Description

Cranial radiation: Total dose

Type de données

float

Unités de mesure
  • Gy
Alias
UMLS CUI [1,1]
C1997353
UMLS CUI [1,2]
C2986497
Gy
Maintenance treatment
Description

Maintenance treatment

Alias
UMLS CUI-1
C0677908
Maintenance treatment: Start Date
Description

Maintenance treatment: Start Date

Type de données

text

Alias
UMLS CUI [1,1]
C0677908
UMLS CUI [1,2]
C0808070
Maintenance treatment: MTX i.th. 6x
Description

Maintenance treatment: MTX

Type de données

boolean

Alias
UMLS CUI [1,1]
C0677908
UMLS CUI [1,2]
C0025677
Comments
Description

Comments

Alias
UMLS CUI-1
C0947611
Comment:
Description

Comment

Type de données

text

Alias
UMLS CUI [1]
C0947611
Identification and Signature
Description

Identification and Signature

Alias
UMLS CUI-1
C0205396
UMLS CUI-2
C1519316
Doctor's name:
Description

Doctor's name

Type de données

text

Alias
UMLS CUI [1,1]
C0027365
UMLS CUI [1,2]
C0031831
Date of report
Description

Date of report

Type de données

date

Alias
UMLS CUI [1]
C1302584
Signature
Description

Signature

Type de données

text

Alias
UMLS CUI [1]
C1519316
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Similar models

Protocol medication AIEOP-BFM ALL 2009 NCT01117441

1 Formulaires
Name
Type
Description | Question | Decode (Coded Value)
Type de données
Alias
Item Group
Patient Information
C1955348 (UMLS CUI-1)
Patient ID
Item
ID of patient
text
C2348585 (UMLS CUI [1])
Birth Date
Item
Patient Birth Date
date
C0421451 (UMLS CUI [1])
Item Group
First Element
C0205435 (UMLS CUI-1)
C3812827 (UMLS CUI-2)
Item
First Element:
text
C0205435 (UMLS CUI [1,1])
C3812827 (UMLS CUI [1,2])
First Element
Code List
First Element:
CL Item
Prot. IA (Prot. IA)
CL Item
Prot. IA' (Prot. IA')
CL Item
Prot. IAD (Prot. IAD)
CL Item
Prot. IA-CPM (Prot. IA-CPM)
CL Item
Other (Other)
First Element Specifciation
Item
First Element: If "other", specify:
text
C0205435 (UMLS CUI [1,1])
C3812827 (UMLS CUI [1,2])
C2348235 (UMLS CUI [1,3])
First Element Documentation
Item
First Element: Therapy documentation available?
boolean
C0205435 (UMLS CUI [1,1])
C3812827 (UMLS CUI [1,2])
C0920316 (UMLS CUI [1,3])
First Element Start Date
Item
First Element: Start Date
date
C0205435 (UMLS CUI [1,1])
C3812827 (UMLS CUI [1,2])
C0808070 (UMLS CUI [1,3])
First Element End Date
Item
First Element: End Date
date
C0205435 (UMLS CUI [1,1])
C3812827 (UMLS CUI [1,2])
C0806020 (UMLS CUI [1,3])
Item Group
Second Element
C0205436 (UMLS CUI-1)
C3812827 (UMLS CUI-2)
Item
Second Element:
text
C0205436 (UMLS CUI [1,1])
C3812827 (UMLS CUI [1,2])
First Element
Code List
Second Element:
CL Item
Other (Other)
CL Item
Prot. IB (Prot. IB)
CL Item
Prot. IB-ASP+ (Prot. IB-ASP+)
Second Element Specifciation
Item
Second Element: If "other", specify:
text
C0205436 (UMLS CUI [1,1])
C3812827 (UMLS CUI [1,2])
C2348235 (UMLS CUI [1,3])
Second Element Documentation
Item
Second Element: Therapy documentation available?
boolean
C0205436 (UMLS CUI [1,1])
C3812827 (UMLS CUI [1,2])
C0920316 (UMLS CUI [1,3])
Second Element Start Date
Item
Second Element: Start Date
date
C0205436 (UMLS CUI [1,1])
C3812827 (UMLS CUI [1,2])
C0808070 (UMLS CUI [1,3])
Second Element End Date
Item
Second Element: End Date
date
C0205436 (UMLS CUI [1,1])
C3812827 (UMLS CUI [1,2])
C0806020 (UMLS CUI [1,3])
Item Group
Thrid Element
C0205437 (UMLS CUI-1)
C3812827 (UMLS CUI-2)
Item
Third Element:
text
C0205437 (UMLS CUI [1,1])
C3812827 (UMLS CUI [1,2])
First Element
Code List
Third Element:
CL Item
Other (Other)
CL Item
Prot. M, total (Prot. M, total)
CL Item
Prot. M, 1st MTX (Prot. M, 1st MTX)
CL Item
Prot. M, 1st/ 2nd MTX (Prot. M, 1st/ 2nd MTX)
CL Item
Prot. M, 1st - 3rd MTX (Prot. M, 1st - 3rd MTX)
CL Item
HR-1' (HR-1')
CL Item
HR-2' (HR-2')
CL Item
HR-3' (HR-3')
Third Element Specifciation
Item
Third Element: If "other", specify:
text
C0205437 (UMLS CUI [1,1])
C3812827 (UMLS CUI [1,2])
C2348235 (UMLS CUI [1,3])
Third Element Documentation
Item
Third Element: Therapy documentation available?
boolean
C0205437 (UMLS CUI [1,1])
C3812827 (UMLS CUI [1,2])
C0920316 (UMLS CUI [1,3])
Third Element Start Date
Item
Third Element: Start Date
date
C0205437 (UMLS CUI [1,1])
C3812827 (UMLS CUI [1,2])
C0808070 (UMLS CUI [1,3])
Third Element End Date
Item
Third Element: End Date
date
C0205437 (UMLS CUI [1,1])
C3812827 (UMLS CUI [1,2])
C0806020 (UMLS CUI [1,3])
Item Group
Fourth Element
C0205438 (UMLS CUI-1)
C3812827 (UMLS CUI-2)
Item
Fourth Element:
text
C0205438 (UMLS CUI [1,1])
C3812827 (UMLS CUI [1,2])
First Element
Code List
Fourth Element:
CL Item
Other (Other)
CL Item
HR-1' (HR-1')
CL Item
HR-2' (HR-2')
CL Item
HR-3' (HR-3')
CL Item
Prot. II (Prot. II)
CL Item
Prot. II-ASP+ (Prot. II-ASP+)
Fourth Element Specifciation
Item
Fourth Element: If "other", specify:
text
C0205438 (UMLS CUI [1,1])
C3812827 (UMLS CUI [1,2])
C2348235 (UMLS CUI [1,3])
Fourth Element Documentation
Item
Fourth Element: Therapy documentation available?
boolean
C0205438 (UMLS CUI [1,1])
C3812827 (UMLS CUI [1,2])
C0920316 (UMLS CUI [1,3])
Fourth Element Start Date
Item
Fourth Element: Start Date
date
C0205438 (UMLS CUI [1,1])
C3812827 (UMLS CUI [1,2])
C0808070 (UMLS CUI [1,3])
Fourth Element End Date
Item
Fourth Element: End Date
date
C0205438 (UMLS CUI [1,1])
C3812827 (UMLS CUI [1,2])
C0806020 (UMLS CUI [1,3])
Item Group
Fifth Element
C0205439 (UMLS CUI-1)
C3812827 (UMLS CUI-2)
Item
Fifth Element:
text
C0205439 (UMLS CUI [1,1])
C3812827 (UMLS CUI [1,2])
First Element
Code List
Fifth Element:
CL Item
Other (Other)
CL Item
HR-1' (HR-1')
CL Item
HR-2' (HR-2')
CL Item
HR-3' (HR-3')
Fifth Element Specifciation
Item
Fifth Element: If "other", specify:
text
C0205439 (UMLS CUI [1,1])
C3812827 (UMLS CUI [1,2])
C2348235 (UMLS CUI [1,3])
Fifth Element Documentation
Item
Fifth Element: Therapy documentation available?
boolean
C0205439 (UMLS CUI [1,1])
C3812827 (UMLS CUI [1,2])
C0920316 (UMLS CUI [1,3])
Fifth Element Start Date
Item
Fifth Element: Start Date
date
C0205439 (UMLS CUI [1,1])
C3812827 (UMLS CUI [1,2])
C0808070 (UMLS CUI [1,3])
Fifth Element End Date
Item
Fifth Element: End Date
date
C0205439 (UMLS CUI [1,1])
C3812827 (UMLS CUI [1,2])
C0806020 (UMLS CUI [1,3])
Item Group
Sixth Element
C0205440 (UMLS CUI-1)
C3812827 (UMLS CUI-2)
Item
Sixth Element:
text
C0205440 (UMLS CUI [1,1])
C3812827 (UMLS CUI [1,2])
First Element
Code List
Sixth Element:
CL Item
Other (Other)
CL Item
HR-1' (HR-1')
CL Item
HR-2' (HR-2')
CL Item
HR-3' (HR-3')
CL Item
Prot. III (Prot. III)
CL Item
alloSCT (alloSCT)
CL Item
DNX-FLA (DNX-FLA)
Sixth Element Specifciation
Item
Sixth Element: If "other", specify:
text
C0205440 (UMLS CUI [1,1])
C3812827 (UMLS CUI [1,2])
C2348235 (UMLS CUI [1,3])
Sixth Element Documentation
Item
Sixth Element: Therapy documentation available?
boolean
C0205440 (UMLS CUI [1,1])
C3812827 (UMLS CUI [1,2])
C0920316 (UMLS CUI [1,3])
Sixth Element Start Date
Item
Sixth Element: Start Date
date
C0205440 (UMLS CUI [1,1])
C3812827 (UMLS CUI [1,2])
C0808070 (UMLS CUI [1,3])
Sixth Element End Date
Item
Sixth Element: End Date
date
C0205440 (UMLS CUI [1,1])
C3812827 (UMLS CUI [1,2])
C0806020 (UMLS CUI [1,3])
Item Group
Seveneth Element
C0205441 (UMLS CUI-1)
C3812827 (UMLS CUI-2)
Item
Seventh Element:
text
C0205441 (UMLS CUI [1,1])
C3812827 (UMLS CUI [1,2])
First Element
Code List
Seventh Element:
CL Item
Other (Other)
CL Item
HR-1' (HR-1')
CL Item
HR-2' (HR-2')
CL Item
HR-3' (HR-3')
CL Item
Prot. III (Prot. III)
CL Item
alloSCT (alloSCT)
CL Item
DNX-FLA (DNX-FLA)
Seventh Element Specifciation
Item
Seventh Element: If "other", specify:
text
C0205441 (UMLS CUI [1,1])
C3812827 (UMLS CUI [1,2])
C2348235 (UMLS CUI [1,3])
Seventh Element Documentation
Item
Seventh Element: Therapy documentation available?
boolean
C0205441 (UMLS CUI [1,1])
C3812827 (UMLS CUI [1,2])
C0920316 (UMLS CUI [1,3])
Seventh Element Start Date
Item
Seventh Element: Start Date
date
C0205441 (UMLS CUI [1,1])
C3812827 (UMLS CUI [1,2])
C0808070 (UMLS CUI [1,3])
Seventh Element End Date
Item
Seventh Element: End Date
date
C0205441 (UMLS CUI [1,1])
C3812827 (UMLS CUI [1,2])
C0806020 (UMLS CUI [1,3])
Item Group
Eighth Element
C0205442 (UMLS CUI-1)
C3812827 (UMLS CUI-2)
Item
Eighth Element:
text
C0205442 (UMLS CUI [1,1])
C3812827 (UMLS CUI [1,2])
First Element
Code List
Eighth Element:
CL Item
Other (Other)
CL Item
HR-1' (HR-1')
CL Item
HR-2' (HR-2')
CL Item
HR-3' (HR-3')
CL Item
Prot. III (Prot. III)
CL Item
alloSCT (alloSCT)
CL Item
DNX-FLA (DNX-FLA)
Eighth Element Specifciation
Item
Eighth Element: If "other", specify:
text
C0205442 (UMLS CUI [1,1])
C3812827 (UMLS CUI [1,2])
C2348235 (UMLS CUI [1,3])
Eighth Element Documentation
Item
Eighth Element: Therapy documentation available?
boolean
C0205442 (UMLS CUI [1,1])
C3812827 (UMLS CUI [1,2])
C0920316 (UMLS CUI [1,3])
Eighth Element Start Date
Item
Eighth Element: Start Date
date
C0205442 (UMLS CUI [1,1])
C3812827 (UMLS CUI [1,2])
C0808070 (UMLS CUI [1,3])
Eighth Element End Date
Item
Eighth Element: End Date
date
C0205442 (UMLS CUI [1,1])
C3812827 (UMLS CUI [1,2])
C0806020 (UMLS CUI [1,3])
Item Group
Ninth Element
C0205443 (UMLS CUI-1)
C3812827 (UMLS CUI-2)
Item
Ninth Element:
text
C0205443 (UMLS CUI [1,1])
C3812827 (UMLS CUI [1,2])
First Element
Code List
Ninth Element:
CL Item
Other (Other)
CL Item
HR-1' (HR-1')
CL Item
HR-2' (HR-2')
CL Item
HR-3' (HR-3')
CL Item
Prot. III (Prot. III)
CL Item
alloSCT (alloSCT)
CL Item
DNX-FLA (DNX-FLA)
Ninth Element Specifciation
Item
Ninth Element: If "other", specify:
text
C0205443 (UMLS CUI [1,1])
C3812827 (UMLS CUI [1,2])
C2348235 (UMLS CUI [1,3])
Ninth Element Documentation
Item
Ninth Element: Therapy documentation available?
boolean
C0205443 (UMLS CUI [1,1])
C3812827 (UMLS CUI [1,2])
C0920316 (UMLS CUI [1,3])
Ninth Element Start Date
Item
Ninth Element: Start Date
date
C0205443 (UMLS CUI [1,1])
C3812827 (UMLS CUI [1,2])
C0808070 (UMLS CUI [1,3])
Ninth Element End Date
Item
Ninth Element: End Date
date
C0205443 (UMLS CUI [1,1])
C3812827 (UMLS CUI [1,2])
C0806020 (UMLS CUI [1,3])
Item Group
Cranial radiation
C1997353 (UMLS CUI-1)
Cranial radiation
Item
Cranial radiation?
boolean
C1997353 (UMLS CUI [1])
Cranial radiation: Start Date
Item
Cranial radiation: Start Date:
date
C1997353 (UMLS CUI [1,1])
C0808070 (UMLS CUI [1,2])
Cranial radiation: End Date
Item
Cranial radiation: End Date
date
C1997353 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
Cranial radiation: Total dose
Item
Cranial radiation: total dose
float
C1997353 (UMLS CUI [1,1])
C2986497 (UMLS CUI [1,2])
Item Group
Maintenance treatment
C0677908 (UMLS CUI-1)
Maintenance treatment: Start Date
Item
Maintenance treatment: Start Date
text
C0677908 (UMLS CUI [1,1])
C0808070 (UMLS CUI [1,2])
Maintenance treatment: MTX
Item
Maintenance treatment: MTX i.th. 6x
boolean
C0677908 (UMLS CUI [1,1])
C0025677 (UMLS CUI [1,2])
Item Group
Comments
C0947611 (UMLS CUI-1)
Comment
Item
Comment:
text
C0947611 (UMLS CUI [1])
Item Group
Identification and Signature
C0205396 (UMLS CUI-1)
C1519316 (UMLS CUI-2)
Doctor's name
Item
Doctor's name:
text
C0027365 (UMLS CUI [1,1])
C0031831 (UMLS CUI [1,2])
Date of report
Item
Date of report
date
C1302584 (UMLS CUI [1])
Signature
Item
Signature
text
C1519316 (UMLS CUI [1])
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