ID

1929

Beschrijving

HEM Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FF1B0A30-0B37-31B9-E034-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FF1B0A30-0B37-31B9-E034-0003BA3F9857

Trefwoorden

Versies (2)
  1. 19-09-12 19-09-12 -
  2. 28-05-15 28-05-15 -
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19 september 2012

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Creative Commons BY-NC 3.0 Legacy
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Leukemia, Myelocytic, Acute null Treatment - HEM - 2396086v3.0

Engels

No Instruction available.

1 Formulieren  
Unnamed 1
Beschrijving

Unnamed 1

Visit number
Beschrijving

HospitalAdmissionOrdinalNumber

Datatype

double

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C16696
UMLS 2011AA ObjectClass
C0019994
NCI Thesaurus Property
C25385
UMLS 2011AA Property
C0809949
Segment
Beschrijving

Segment

Datatype

text

Did the patient achieve ANC recovery =>500/mm3 on three consecutive
Beschrijving

DidthepatientachieveANCrecovery=>500/mm3onthreeconsecutive

Datatype

text

Record Neutrophil Count And Specimen Collection Dates
Beschrijving

Record Neutrophil Count And Specimen Collection Dates

Day 3
Beschrijving

LaboratoryProcedureNeutrophilResultTotalValue

Datatype

double

Alias
NCI Thesaurus ObjectClass
C25294
UMLS 2011AA ObjectClass
C0022885
NCI Thesaurus Property
C12533
UMLS 2011AA Property
C0027950
NCI Thesaurus Property
C20200
UMLS 2011AA Property
C1274040
NCI Thesaurus ValueDomain
C25304
UMLS 2011AA ValueDomain
C0439810
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
Day 3
Beschrijving

LaboratoryProcedureNeutrophilResultTotalValue

Datatype

double

Alias
NCI Thesaurus ObjectClass
C25294
UMLS 2011AA ObjectClass
C0022885
NCI Thesaurus Property
C12533
UMLS 2011AA Property
C0027950
NCI Thesaurus Property
C20200
UMLS 2011AA Property
C1274040
NCI Thesaurus ValueDomain
C25304
UMLS 2011AA ValueDomain
C0439810
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
Day 3
Beschrijving

LaboratoryProcedureNeutrophilResultTotalValue

Datatype

double

Alias
NCI Thesaurus ObjectClass
C25294
UMLS 2011AA ObjectClass
C0022885
NCI Thesaurus Property
C12533
UMLS 2011AA Property
C0027950
NCI Thesaurus Property
C20200
UMLS 2011AA Property
C1274040
NCI Thesaurus ValueDomain
C25304
UMLS 2011AA ValueDomain
C0439810
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
Date specimen collected
Beschrijving

SpecimenCollectedDate

Datatype

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C19157
UMLS 2011AA ObjectClass
C0370003
NCI Thesaurus Property
C25452
NCI Thesaurus Property
C25275
UMLS 2011AA Property
C2745955
Date specimen collected
Beschrijving

SpecimenCollectedDate

Datatype

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C19157
UMLS 2011AA ObjectClass
C0370003
NCI Thesaurus Property
C25452
NCI Thesaurus Property
C25275
UMLS 2011AA Property
C2745955
Date specimen collected
Beschrijving

SpecimenCollectedDate

Datatype

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C19157
UMLS 2011AA ObjectClass
C0370003
NCI Thesaurus Property
C25452
NCI Thesaurus Property
C25275
UMLS 2011AA Property
C2745955
Record Chimerism Assay Data For Marrow And/or Blood
Beschrijving

Record Chimerism Assay Data For Marrow And/or Blood

Marrow
Beschrijving

Marrow

Method of evaluation
Beschrijving

AssessmentMethodType

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C16847
UMLS 2011AA Property
C0449851
Specify other
Beschrijving

AssessmentMethodSpecify

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C16847
UMLS 2011AA Property
C0449851
Cell type
Beschrijving

CellSpecimenCollectionType

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C12508
UMLS 2011AA ObjectClass
C0007634
NCI Thesaurus Property
C25453
UMLS 2011AA Property
C1516698
NCI Thesaurus ObjectClass
C19157
UMLS 2011AA ObjectClass
C0370003
Date specimen collected
Beschrijving

SpecimenCollectedDate

Datatype

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C19157
UMLS 2011AA ObjectClass
C0370003
NCI Thesaurus Property
C25452
NCI Thesaurus Property
C25275
UMLS 2011AA Property
C2745955
Was a chimerism performed on a marrow sample
Beschrijving

Wasachimerismperformedonamarrowsample

Datatype

text

Marrow assay results
Beschrijving

Marrowassayresults

Datatype

text

% donor
Beschrijving

%donor

Datatype

text

T Cell Chimerism
Beschrijving

T Cell Chimerism

Type of sample
Beschrijving

TissueSpecimenType

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C12801
UMLS 2011AA ObjectClass
C0040300
NCI Thesaurus ObjectClass
C19157
UMLS 2011AA ObjectClass
C0370003
NCI Thesaurus Property
C25365
UMLS 2011AA Property
C0678257
Method of evaluation
Beschrijving

AssessmentMethodType

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C16847
UMLS 2011AA Property
C0449851
Specify other
Beschrijving

AssessmentMethodSpecify

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C16847
UMLS 2011AA Property
C0449851
Date specimen collected
Beschrijving

SpecimenCollectedDate

Datatype

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C19157
UMLS 2011AA ObjectClass
C0370003
NCI Thesaurus Property
C25452
NCI Thesaurus Property
C25275
UMLS 2011AA Property
C2745955
Record date of infusion
Beschrijving

PeripheralBloodStemCellTransplantInfusionDate

Datatype

date

Alias
NCI Thesaurus ObjectClass
C12981
UMLS 2011AA ObjectClass
C0332835
NCI Thesaurus ObjectClass
C12946
UMLS 2011AA ObjectClass
C1518999
NCI Thesaurus Property
C15388
UMLS 2011AA Property
C0574032
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ValueDomain
C25367
Comments
Beschrijving

ResearchCommentsText

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
UMLS 2011AA Property
C0282411
Was a chimerism performed on a T cell sample
Beschrijving

WasachimerismperformedonaTcellsample

Datatype

text

T cell assay results
Beschrijving

Tcellassayresults

Datatype

text

% donor
Beschrijving

%donor

Datatype

text

Did the patient achieve a stem cell re-infusion due to inadequate hematopoietic function
Beschrijving

Didthepatientachieveastemcellre-infusionduetoinadequatehematopoieticfunction

Datatype

text

Terug naar het begin van de pagina

Similar models

No Instruction available.

1 Formulieren
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Unnamed 1
HospitalAdmissionOrdinalNumber
Item
Visit number
double
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16696 (NCI Thesaurus ObjectClass)
C0019994 (UMLS 2011AA ObjectClass)
C25385 (NCI Thesaurus Property)
C0809949 (UMLS 2011AA Property)
Segment
Item
Segment
text
Item
Did the patient achieve ANC recovery =>500/mm3 on three consecutive
text
CL.1
Code List
Did the patient achieve ANC recovery =>500/mm3 on three consecutive
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Previously reported (Previously reported)
Item Group
Record Neutrophil Count And Specimen Collection Dates
LaboratoryProcedureNeutrophilResultTotalValue
Item
Day 3
double
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
C12533 (NCI Thesaurus Property)
C0027950 (UMLS 2011AA Property)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C25304 (NCI Thesaurus ValueDomain)
C0439810 (UMLS 2011AA ValueDomain)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
LaboratoryProcedureNeutrophilResultTotalValue
Item
Day 3
double
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
C12533 (NCI Thesaurus Property)
C0027950 (UMLS 2011AA Property)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C25304 (NCI Thesaurus ValueDomain)
C0439810 (UMLS 2011AA ValueDomain)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
LaboratoryProcedureNeutrophilResultTotalValue
Item
Day 3
double
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
C12533 (NCI Thesaurus Property)
C0027950 (UMLS 2011AA Property)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C25304 (NCI Thesaurus ValueDomain)
C0439810 (UMLS 2011AA ValueDomain)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
SpecimenCollectedDate
Item
Date specimen collected
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C25452 (NCI Thesaurus Property)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
SpecimenCollectedDate
Item
Date specimen collected
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C25452 (NCI Thesaurus Property)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
SpecimenCollectedDate
Item
Date specimen collected
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C25452 (NCI Thesaurus Property)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
Item Group
Record Chimerism Assay Data For Marrow And/or Blood
Item Group
Marrow
Item
Method of evaluation
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C16847 (NCI Thesaurus Property)
C0449851 (UMLS 2011AA Property)
CL.8
Code List
Method of evaluation
CL Item
Standard cytogenetics (Standard cytogenetics)
CL Item
Fluorescent in situ hyrbidization (FISH) (Fluorescent in situ hyrbidization (FISH))
CL Item
Restriction fragment-length polymorphisms (RFLP) (Restriction fragment-length polymorphisms (RFLP))
CL Item
Polymerase chain reaction (Polymerase chain reaction)
CL Item
HLA serotyping (HLA serotyping)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
AssessmentMethodSpecify
Item
Specify other
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C16847 (NCI Thesaurus Property)
C0449851 (UMLS 2011AA Property)
Item
Cell type
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C12508 (NCI Thesaurus ObjectClass)
C0007634 (UMLS 2011AA ObjectClass)
C25453 (NCI Thesaurus Property)
C1516698 (UMLS 2011AA Property)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
CL.4
Code List
Cell type
CL Item
Unmanipulated (Unmanipulated)
CL Item
Granulocytes (Granulocytes)
SpecimenCollectedDate
Item
Date specimen collected
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C25452 (NCI Thesaurus Property)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
Item
Was a chimerism performed on a marrow sample
text
CL.2
Code List
Was a chimerism performed on a marrow sample
CL Item
Yes (Yes)
CL Item
No (No)
Item
Marrow assay results
text
CL.5
Code List
Marrow assay results
CL Item
All host cells (All host cells)
CL Item
All donor cells (All donor cells)
CL Item
Host and donor (Host and donor)
%donor
Item
% donor
text
Item Group
T Cell Chimerism
Item
Type of sample
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C12801 (NCI Thesaurus ObjectClass)
C0040300 (UMLS 2011AA ObjectClass)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
CL.7
Code List
Type of sample
CL Item
Blood (Blood)
CL Item
Marrow (Marrow)
Item
Method of evaluation
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C16847 (NCI Thesaurus Property)
C0449851 (UMLS 2011AA Property)
CL.8
Code List
Method of evaluation
CL Item
Standard cytogenetics (Standard cytogenetics)
CL Item
Fluorescent in situ hyrbidization (FISH) (Fluorescent in situ hyrbidization (FISH))
CL Item
Restriction fragment-length polymorphisms (RFLP) (Restriction fragment-length polymorphisms (RFLP))
CL Item
Polymerase chain reaction (Polymerase chain reaction)
CL Item
HLA serotyping (HLA serotyping)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
AssessmentMethodSpecify
Item
Specify other
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C16847 (NCI Thesaurus Property)
C0449851 (UMLS 2011AA Property)
SpecimenCollectedDate
Item
Date specimen collected
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C25452 (NCI Thesaurus Property)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
PeripheralBloodStemCellTransplantInfusionDate
Item
Record date of infusion
date
C12981 (NCI Thesaurus ObjectClass)
C0332835 (UMLS 2011AA ObjectClass)
C12946 (NCI Thesaurus ObjectClass)
C1518999 (UMLS 2011AA ObjectClass)
C15388 (NCI Thesaurus Property)
C0574032 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain)
ResearchCommentsText
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0282411 (UMLS 2011AA Property)
Item
Was a chimerism performed on a T cell sample
text
CL.6
Code List
Was a chimerism performed on a T cell sample
CL Item
Yes (Yes)
CL Item
No (No)
Item
T cell assay results
text
CL.9
Code List
T cell assay results
CL Item
All host cells (All host cells)
CL Item
All donor cells (All donor cells)
CL Item
Host and donor (Host and donor)
%donor
Item
% donor
text
Item
Did the patient achieve a stem cell re-infusion due to inadequate hematopoietic function
text
CL.10
Code List
Did the patient achieve a stem cell re-infusion due to inadequate hematopoietic function
CL Item
Yes (Yes)
CL Item
No (No)
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