ID

16397

Beschreibung

International Collaborative Treatment Protocol For Children And Adolescents With Acute Lymphoblastic Leukemia. Phase 3 Study. Documentation of administered protocol medication Clinical Trial Number: NCT01117441.

Stichworte

Versionen (1)
  1. 14.07.16 14.07.16 -
Hochgeladen am

14. Juli 2016

DOI

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Lizenz

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Protocol medication AIEOP-BFM ALL 2009 DRKS00003772 NCT01117441

Englisch

Protocol medication AIEOP-BFM ALL 2009 NCT01117441

1 Formulare  
Patient Information
Beschreibung

Patient Information

Alias
UMLS CUI-1
C1955348
ID of patient
Beschreibung

Patient ID

Datentyp

text

Alias
UMLS CUI [1]
C2348585
Patient Birth Date
Beschreibung

Birth Date

Datentyp

date

Alias
UMLS CUI [1]
C0421451
First Element
Beschreibung

First Element

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

First Element

Datentyp

text

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

First Element Specifciation

Datentyp

text

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

First Element Documentation

Datentyp

boolean

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

First Element Start Date

Datentyp

date

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

First Element End Date

Datentyp

date

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

Second Element

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

Second Element

Datentyp

text

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

Second Element Specifciation

Datentyp

text

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

Second Element Documentation

Datentyp

boolean

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

Second Element Start Date

Datentyp

date

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

Second Element End Date

Datentyp

date

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

Thrid Element

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

Third Element

Datentyp

text

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

Third Element Specifciation

Datentyp

text

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

Third Element Documentation

Datentyp

boolean

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

Third Element Start Date

Datentyp

date

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

Third Element End Date

Datentyp

date

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

Fourth Element

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

Fourth Element

Datentyp

text

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

Fourth Element Specifciation

Datentyp

text

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

Fourth Element Documentation

Datentyp

boolean

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

Fourth Element Start Date

Datentyp

date

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

Fourth Element End Date

Datentyp

date

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

Fifth Element

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

Fifth Element

Datentyp

text

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

Fifth Element Specifciation

Datentyp

text

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

Fifth Element Documentation

Datentyp

boolean

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

Fifth Element Start Date

Datentyp

date

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

Fifth Element End Date

Datentyp

date

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

Sixth Element

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

Sixth Element

Datentyp

text

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

Sixth Element Specifciation

Datentyp

text

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

Sixth Element Documentation

Datentyp

boolean

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

Sixth Element Start Date

Datentyp

date

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

Sixth Element End Date

Datentyp

date

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

Seveneth Element

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

Seventh Element

Datentyp

text

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

Seventh Element Specifciation

Datentyp

text

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

Seventh Element Documentation

Datentyp

boolean

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

Seventh Element Start Date

Datentyp

date

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

Seventh Element End Date

Datentyp

date

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

Eighth Element

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

Eighth Element

Datentyp

text

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

Eighth Element Specifciation

Datentyp

text

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

Eighth Element Documentation

Datentyp

boolean

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

Eighth Element Start Date

Datentyp

date

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

Eighth Element End Date

Datentyp

date

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

Ninth Element

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

Ninth Element

Datentyp

text

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

Ninth Element Specifciation

Datentyp

text

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

Ninth Element Documentation

Datentyp

boolean

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

Ninth Element Start Date

Datentyp

date

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

Ninth Element End Date

Datentyp

date

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

Cranial radiation

Alias
UMLS CUI-1
C1997353
Cranial radiation?
Beschreibung

Cranial radiation

Datentyp

boolean

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

Cranial radiation: Start Date

Datentyp

date

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

Cranial radiation: End Date

Datentyp

date

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

Cranial radiation: Total dose

Datentyp

float

Maßeinheiten
  • Gy
Alias
UMLS CUI [1,1]
C1997353
UMLS CUI [1,2]
C2986497
Gy
Maintenance treatment
Beschreibung

Maintenance treatment

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

Maintenance treatment: Start Date

Datentyp

text

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

Maintenance treatment: MTX

Datentyp

boolean

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

Comments

Alias
UMLS CUI-1
C0947611
Comment:
Beschreibung

Comment

Datentyp

text

Alias
UMLS CUI [1]
C0947611
Identification and Signature
Beschreibung

Identification and Signature

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

Doctor's name

Datentyp

text

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

Date of report

Datentyp

date

Alias
UMLS CUI [1]
C1302584
Signature
Beschreibung

Signature

Datentyp

text

Alias
UMLS CUI [1]
C1519316
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Ähnliche Modelle

Protocol medication AIEOP-BFM ALL 2009 NCT01117441

1 Formulare
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
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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