ID
1775
Description
RTOG-0522 QP: Radiation Therapy Oncology Group Miscellaneous Patient Assessment Form Radiation Therapy and Cisplatin With or Without Cetuximab in Treating Patients With Stage III or Stage IV Head and Neck Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=F6217E11-C5E7-5543-E034-0003BA3F9857
Link
Keywords
Versions (3)
- 9/19/12 9/19/12 -
- 1/9/15 1/9/15 - Martin Dugas
- 6/21/15 6/21/15 -
Uploaded on
September 19, 2012
DOI
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License
Creative Commons BY-NC 3.0 Legacy
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Head and Neck Cancer NCT00265941 Quality of Life - RTOG-0522 QP: Miscellaneous Patient Assessment Form - 2222948v1.0
No Instruction available.
- StudyEvent: RTOG-0522 QP: Miscellaneous Patient Assessment Form
Description
Unamed Module 2
Description
DataAssessmentTimePeriodType
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C20989
- UMLS 2011AA ObjectClass
- C0031809
- NCI Thesaurus ObjectClass
- C25474
- UMLS 2011AA ObjectClass
- C1511726
- NCI Thesaurus Property
- C25616
- UMLS 2011AA Property
- C1948053
- NCI Thesaurus Property
- C25207
- UMLS 2011AA Property
- C0040223
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
Description
DataAssessmentTimePeriodUnspecifiedText
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C20989
- UMLS 2011AA ObjectClass
- C0031809
- NCI Thesaurus ObjectClass
- C25474
- UMLS 2011AA ObjectClass
- C1511726
- NCI Thesaurus Property
- C25616
- UMLS 2011AA Property
- C1948053
- NCI Thesaurus Property
- C25207
- UMLS 2011AA Property
- C0040223
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
Description
DataAssessmentTimePeriodOtherText
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C20989
- UMLS 2011AA ObjectClass
- C0031809
- NCI Thesaurus ObjectClass
- C25474
- UMLS 2011AA ObjectClass
- C1511726
- NCI Thesaurus Property
- C25616
- UMLS 2011AA Property
- C1948053
- NCI Thesaurus Property
- C25207
- UMLS 2011AA Property
- C0040223
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ValueDomain
- C17649
- UMLS 2011AA ValueDomain
- C0205394
Description
AssessmentNotPerformedReason
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25638
- UMLS 2011AA ValueDomain
- C0392360
- NCI Thesaurus Property
- C49487
- UMLS 2011AA Property
- C1298908
- NCI Thesaurus ObjectClass
- C25217
- UMLS 2011AA ObjectClass
- C1516048
- NCI Thesaurus Property
- C38000
- UMLS 2011AA Property
- C0884358
Description
PatientTelephoneAssessmentRefusaltoParticipateReason
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25638
- UMLS 2011AA ValueDomain
- C0392360
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C20989
- UMLS 2011AA Property
- C0031809
- NCI Thesaurus Property
- C25395
- UMLS 2011AA Property
- C0039457
Description
PatientAssessmentRefusaltoParticipateReason
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25638
- UMLS 2011AA ValueDomain
- C0392360
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C20989
- UMLS 2011AA Property
- C0031809
Description
OtherPatientAssessmentRefusaltoParticipateReason
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C17649
- UMLS 2011AA ObjectClass
- C0205394
- NCI Thesaurus ValueDomain
- C25638
- UMLS 2011AA ValueDomain
- C0392360
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C25367
Description
PatientTelephoneAssessmentInd-2
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C20989
- UMLS 2011AA Property
- C0031809
- NCI Thesaurus Property
- C25395
- UMLS 2011AA Property
- C0039457
Description
LesionAssessmentDate
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ObjectClass
- C3824
- UMLS 2011AA ObjectClass
- C0221198
- NCI Thesaurus Property
- C20989
- UMLS 2011AA Property
- C0031809
- NCI Thesaurus ValueDomain
- C25367
Description
PatientTelephoneAssessmentInterviewersName
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS 2011AA ValueDomain
- C1547383
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C20989
- UMLS 2011AA Property
- C0031809
- NCI Thesaurus Property
- C25395
- UMLS 2011AA Property
- C0039457
Description
DietPerformanceStatusAssessmentIntakeScale
Data type
text
Alias
- NCI Metathesaurus ObjectClass
- CL092952
- NCI Thesaurus ObjectClass
- C15222
- UMLS 2011AA ObjectClass
- C0012155
- NCI Thesaurus Property
- C20989
- UMLS 2011AA Property
- C0031809
- NCI Thesaurus ValueDomain
- C25664
- UMLS 2011AA ValueDomain
- C0349674
- NCI Thesaurus ValueDomain
- C25538
- UMLS 2011AA ValueDomain
- C1512806
Description
DietaryPerformanceStatusAssessmentLocationScale
Data type
text
Alias
- NCI Metathesaurus ObjectClass
- CL092952
- NCI Thesaurus ObjectClass
- C15222
- UMLS 2011AA ObjectClass
- C0012155
- NCI Thesaurus Property
- C20989
- UMLS 2011AA Property
- C0031809
- NCI Thesaurus ValueDomain
- C25664
- UMLS 2011AA ValueDomain
- C0349674
- NCI Thesaurus ValueDomain
- C25341
- UMLS 2011AA ValueDomain
- C0450429
Description
SpeechPerformanceStatusAssessmentComprehensionScale
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25664
- UMLS 2011AA ValueDomain
- C0349674
- NCI Thesaurus Property
- C20989
- UMLS 2011AA Property
- C0031809
- NCI Thesaurus ObjectClass
- C38025
- UMLS 2011AA ObjectClass
- C0037817
- NCI Metathesaurus ObjectClass
- CL092952
Description
Comments
Description
ResearchCommentsText
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ObjectClass
- C15319
- NCI Thesaurus Property
- C25393
- UMLS 2011AA Property
- C0282411
Description
ResponsiblePersonSignatureText
Data type
text
Alias
- NCI Thesaurus ValueDomain
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- UMLS 2011AA ValueDomain
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- C25190
- UMLS 2011AA ObjectClass
- C0027361
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- C25657
- UMLS 2011AA ObjectClass
- C1273518
- NCI Thesaurus Property
- C25678
- UMLS 2011AA Property
- C1519316
Description
FormOriginalCompleteDate
Data type
date
Alias
- NCI Thesaurus ObjectClass
- C19464
- UMLS 2011AA ObjectClass
- C0376315
- NCI Thesaurus Property
- C25250
- UMLS 2011AA Property
- C0205197
- NCI Thesaurus Property
- C25604
- UMLS 2011AA Property
- C0205313
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ValueDomain
- C25367
Similar models
No Instruction available.
- StudyEvent: RTOG-0522 QP: Miscellaneous Patient Assessment Form
C0237753 (UMLS 2011AA ValueDomain)
C25320 (NCI Thesaurus ObjectClass)
C1507394 (UMLS 2011AA ObjectClass)
C19778 (NCI Thesaurus Property)
C1514695 (UMLS 2011AA Property)
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C1706256 (UMLS 2011AA Property)
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C0018704 (UMLS 2011AA ObjectClass)
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C0600091 (UMLS 2011AA Property)
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C0600091 (UMLS 2011AA Property)
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C0030705 (UMLS 2011AA ObjectClass)
C25536 (NCI Thesaurus Property)
C1555582 (UMLS 2011AA Property)
C0237753 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C19778 (NCI Thesaurus Property)
C1514695 (UMLS 2011AA Property)
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C0600091 (UMLS 2011AA Property)
C0031809 (UMLS 2011AA ObjectClass)
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C1511726 (UMLS 2011AA ObjectClass)
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C0332307 (UMLS 2011AA ValueDomain)
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C0031809 (UMLS 2011AA ObjectClass)
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25616 (NCI Thesaurus Property)
C1948053 (UMLS 2011AA Property)
C25207 (NCI Thesaurus Property)
C0040223 (UMLS 2011AA Property)
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C0031809 (UMLS 2011AA ObjectClass)
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25616 (NCI Thesaurus Property)
C1948053 (UMLS 2011AA Property)
C25207 (NCI Thesaurus Property)
C0040223 (UMLS 2011AA Property)
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C17649 (NCI Thesaurus ValueDomain)
C0205394 (UMLS 2011AA ValueDomain)
C0392360 (UMLS 2011AA ValueDomain)
C49487 (NCI Thesaurus Property)
C1298908 (UMLS 2011AA Property)
C25217 (NCI Thesaurus ObjectClass)
C1516048 (UMLS 2011AA ObjectClass)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C0392360 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25395 (NCI Thesaurus Property)
C0039457 (UMLS 2011AA Property)
C0392360 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0205394 (UMLS 2011AA ObjectClass)
C25638 (NCI Thesaurus ValueDomain)
C0392360 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C1512698 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25395 (NCI Thesaurus Property)
C0039457 (UMLS 2011AA Property)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0011008 (UMLS 2011AA ValueDomain)
C3824 (NCI Thesaurus ObjectClass)
C0221198 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25367 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25395 (NCI Thesaurus Property)
C0039457 (UMLS 2011AA Property)
C15222 (NCI Thesaurus ObjectClass)
C0012155 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
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C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
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C0450429 (UMLS 2011AA ValueDomain)
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C38025 (NCI Thesaurus ObjectClass)
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C25393 (NCI Thesaurus Property)
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C25657 (NCI Thesaurus ObjectClass)
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