FormCompletionDate
Item
Visit Date
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)
LastContactDate
Item
Date of Last Contact (Enter the date the patient was last contacted.)
date
C25164 (NCI Thesaurus Property)
C0011008 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C47954 (NCI Thesaurus ObjectClass)
C1705415 (UMLS 2011AA ObjectClass)
C25551 (NCI Thesaurus ObjectClass)
C1517741 (UMLS 2011AA ObjectClass)
Item
Type of Contact (Select how the information was obtained:)
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25461 (NCI Thesaurus Property)
C0337611 (UMLS 2011AA Property)
Code List
Type of Contact (Select how the information was obtained:)
CL Item
Telephone Contact With Patient/participant (Telephone contact with Patient/Participant)
CL Item
Telephone Contact With Patient/participant Family (Telephone contact with Patient/Participant Family)
CL Item
Telephone Contact With Patient/participant Local Physician (Telephone contact with Patient/Participant Local Physician)
CL Item
Social Security Death Index (ssdi) (Social Security Death Index (SSDI))
CL Item
Clinic Appointment (Clinic Appointment)
CL Item
Mail Contact With Patient/participant (Mail contact with Patient/Participant)
CL Item
Email Contact With Patient/participant (Email contact with Patient/Participant)
Item
Received Treatment Since Last Contact? (Note: When answering 'Yes' and the patient has died during the follow-up period, only the Date of Death, entered on the Survival case report form, is sent to CTMS.)
text
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C15368 (NCI Thesaurus ObjectClass)
C25461 (NCI Thesaurus Property)
C0337611 (UMLS 2011AA Property)
C25551 (NCI Thesaurus ObjectClass)
C1517741 (UMLS 2011AA ObjectClass)
Code List
Received Treatment Since Last Contact? (Note: When answering 'Yes' and the patient has died during the follow-up period, only the Date of Death, entered on the Survival case report form, is sent to CTMS.)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item
Patient Status (Select one of the options below that indicates the patient's last known status. If the patient has died, enter the date in the Date of Death field.)
text
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25688 (NCI Thesaurus Property)
C0449438 (UMLS 2011AA Property)
Code List
Patient Status (Select one of the options below that indicates the patient's last known status. If the patient has died, enter the date in the Date of Death field.)
CL Item
Alive With Disease (1)
CL Item
Alive With No Evidence Of Disease (2)
CL Item
Alive Disease Status Unknown (3)
CL Item
Unknown (4)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
SurvivalStatus,unknownexplanation
Item
Explain 'Unknown' Patient Status (If Patient Status is unknown, enter some explanation here. Include what attempts were made and how many attempts where made in order to obtain the patient's status i.e.: no response to 5 messages left.)
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25688 (NCI Thesaurus Property)
C0449438 (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)