ID

1665

Description

Information concerning the patient's off study date and reason. Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AD006CC7-CCBA-B0A3-E040-BB89AD437A16

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AD006CC7-CCBA-B0A3-E040-BB89AD437A16

Keywords

Versions (2)
  1. 9/19/12 9/19/12 -
  2. 7/14/17 7/14/17 - Martin Dugas
Uploaded on

September 19, 2012

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License

Creative Commons BY-NC 3.0
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Follow-Up - Off Study - 3278634v1.0

English

No Instruction available.

1 forms  
  1. StudyEvent: Off Study
    1. No Instruction available.
Off Study
Description

Off Study

Visit Date (Enter the date the form is being completed.)
Description

FormCompletionDate

Data type

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
Date Off Study (For protocols with a specific follow-up period, enter the date that corresponds to the date when all protocol specific follow-up has been completed.)
Description

OffStudyDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C15206
UMLS 2011AA ObjectClass
C0008972
NCI Thesaurus Property
C25275
UMLS 2011AA Property
C2745955
Reason off study (For protocols without a protocol specific follow-up, use the same 'Reason Off Treatment' entered on the Off Treatment case report form.)
Description

OffStudyReasonCode

Data type

text

Alias
NCI Thesaurus ValueDomain
C25162
UMLS 2011AA ValueDomain
C0805701
NCI Thesaurus Property
C25638
UMLS 2011AA Property
C0392360
NCI Thesaurus ObjectClass
C15206
UMLS 2011AA ObjectClass
C0008972
NCI Thesaurus ObjectClass
C40450
UMLS 2011AA ObjectClass
C1518543
Explain 'Other' Reason
Description

OffStudyOtherReason

Data type

text

Alias
NCI Thesaurus ObjectClass
C15206
UMLS 2011AA ObjectClass
C0008972
NCI Thesaurus ObjectClass
C40450
UMLS 2011AA ObjectClass
C1518543
NCI Thesaurus Property
C25638
UMLS 2011AA Property
C0392360
NCI Thesaurus ValueDomain
C45255
UMLS 2011AA ValueDomain
C1708523
NCI Thesaurus ValueDomain
C42614
UMLS 2011AA ValueDomain
C0027365
NCI Thesaurus ValueDomain
C68805
UMLS 2011AA ValueDomain
C2350015
Date of Disease Progression
Description

ProgressionDate

Data type

date

Alias
NCI Thesaurus Property
C25164
UMLS 2011AA Property
C0011008
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C17747
UMLS 2011AA ObjectClass
C0242656
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Similar models

No Instruction available.

1 forms
  1. StudyEvent: Off Study
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Off Study
FormCompletionDate
Item
Visit Date (Enter the date the form is being completed.)
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)
OffStudyDate
Item
Date Off Study (For protocols with a specific follow-up period, enter the date that corresponds to the date when all protocol specific follow-up has been completed.)
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C15206 (NCI Thesaurus ObjectClass)
C0008972 (UMLS 2011AA ObjectClass)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
Item
Reason off study (For protocols without a protocol specific follow-up, use the same 'Reason Off Treatment' entered on the Off Treatment case report form.)
text
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
C25638 (NCI Thesaurus Property)
C0392360 (UMLS 2011AA Property)
C15206 (NCI Thesaurus ObjectClass)
C0008972 (UMLS 2011AA ObjectClass)
C40450 (NCI Thesaurus ObjectClass)
C1518543 (UMLS 2011AA ObjectClass)
CL.1
Code List
Reason off study (For protocols without a protocol specific follow-up, use the same 'Reason Off Treatment' entered on the Off Treatment case report form.)
CL Item
Patient Noncompliance (2)
C0376405 (NCI Metathesaurus)
CL Item
Withdrawal Of Informed Consent (3)
CL Item
Alternative Medicine (A)
C19936 (NCI Thesaurus)
C1515928 (UMLS 2011AA)
CL Item
Disease Progression Before Treatment (B)
CL Item
Study Complete (C)
CL Item
Death (D)
C26554 (NCI Thesaurus)
C1366479 (UMLS 2011AA)
CL Item
Late Adverse Events/side Effects (E)
CL Item
Cytogenetic Resistance (G)
CL Item
Follow-up Period Completed (H)
CL Item
Ineligible (I)
C40412 (NCI Thesaurus)
C1512714 (UMLS 2011AA)
CL Item
Lost To Follow-up (L)
C48227 (NCI Thesaurus)
C1302313 (UMLS 2011AA)
CL Item
Death During Follow-up Period (M)
CL Item
Not Treated (N)
CL Item
Other (O)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
CL Item
Disease Progression (P)
C17747 (NCI Thesaurus)
C0242656 (UMLS 2011AA)
CL Item
Refused Further Treatment (R)
CL Item
Complicating Disease (S)
C16457 (NCI Thesaurus)
C0009488 (UMLS 2011AA)
CL Item
Toxicity (T)
C27990 (NCI Thesaurus)
C0600688 (UMLS 2011AA)
CL Item
Not Treated - Other Reasons (U)
CL Item
Protocol Violation (V)
C48251 (NCI Thesaurus)
C1709750 (UMLS 2011AA)
CL Item
Refused Further Follow-up (W)
CL Item
Declined To Participate (X)
CL Item
No Treatment, Per Protocol Criteria (Z)
OffStudyOtherReason
Item
Explain 'Other' Reason
text
C15206 (NCI Thesaurus ObjectClass)
C0008972 (UMLS 2011AA ObjectClass)
C40450 (NCI Thesaurus ObjectClass)
C1518543 (UMLS 2011AA ObjectClass)
C25638 (NCI Thesaurus Property)
C0392360 (UMLS 2011AA Property)
C45255 (NCI Thesaurus ValueDomain)
C1708523 (UMLS 2011AA ValueDomain)
C42614 (NCI Thesaurus ValueDomain)
C0027365 (UMLS 2011AA ValueDomain)
C68805 (NCI Thesaurus ValueDomain)
C2350015 (UMLS 2011AA ValueDomain)
ProgressionDate
Item
Date of Disease Progression
date
C25164 (NCI Thesaurus Property)
C0011008 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C17747 (NCI Thesaurus ObjectClass)
C0242656 (UMLS 2011AA ObjectClass)
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