ID
1931
Description
E2902 Material Submission Form - Form 1845 Tipifarnib in Treating Patients With Acute Myeloid Leukemia in Remission Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=DBE41C5E-4D6F-6206-E034-0003BA12F5E7
Link
Keywords
Versions (3)
- 9/19/12 9/19/12 -
- 1/9/15 1/9/15 - Martin Dugas
- 6/16/15 6/16/15 -
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September 19, 2012
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Creative Commons BY-NC 3.0 Legacy
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Leukemia NCT00093470 Lab - E2902 Material Submission Form - Form 1845 - 2282893v3.0
No Instruction available.
- StudyEvent: E2902 Material Submission Form - Form 1845
Description
Completed By Submitting Institutions
Description
SpecimenCentralLaboratorySubmissionDate
Data type
date
Alias
- NCI Thesaurus ObjectClass
- C19157
- UMLS 2011AA ObjectClass
- C0370003
- NCI Thesaurus Property
- C37984
- UMLS 2011AA Property
- C0022877
- NCI Metathesaurus Property
- C0205099
- NCI Thesaurus Property
- C25694
- UMLS 2011AA Property
- C1515022
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Description
SpecimenLaboratoryReceivedLocationName
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C19157
- UMLS 2011AA ObjectClass
- C0370003
- NCI Thesaurus Property
- C25341
- UMLS 2011AA Property
- C0450429
- NCI Thesaurus Property
- C25639
- UMLS 2011AA Property
- C1514756
- NCI Thesaurus Property
- C37984
- UMLS 2011AA Property
- C0022877
- NCI Thesaurus ValueDomain
- C25191
- UMLS 2011AA ValueDomain
- C1547383
Description
InformedConsentSignedInd
Data type
text
Description
SampleNo.
Data type
text
Description
SpecimenCollectedDate
Data type
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
Description
SpecimenSubmittedType
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
Description
Typeofcollection/stain/process
Data type
text
Description
SpecimenCollectionPeriodType
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
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- NCI Thesaurus Property
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- NCI Thesaurus Property
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- C1516698
- NCI Thesaurus ObjectClass
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Description
SpecimenSubmittedCount
Data type
double
Alias
- NCI Thesaurus ValueDomain
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- NCI Thesaurus ObjectClass
- C19157
- UMLS 2011AA ObjectClass
- C0370003
- NCI Thesaurus Property
- C25695
- UMLS 2011AA Property
- C1515023
Description
Completed By Central Lab
Description
SpecimenLaboratoryReceivedDate
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus Property
- C25639
- UMLS 2011AA Property
- C1514756
- NCI Thesaurus Property
- C37984
- UMLS 2011AA Property
- C0022877
- NCI Thesaurus ObjectClass
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- UMLS 2011AA ObjectClass
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Description
SpecimenCondition
Data type
text
Description
Aliquotsofsamplemade
Data type
text
Alias
- NCI Thesaurus ValueDomain
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Description
Unnamed 2
Description
InstitutionContactPersonName
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS 2011AA ValueDomain
- C1547383
- NCI Thesaurus ObjectClass
- C21541
- UMLS 2011AA ObjectClass
- C0018704
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
- NCI Thesaurus ObjectClass
- C25461
- UMLS 2011AA ObjectClass
- C0337611
Description
InstitutionContactTelephoneNumber
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
- NCI Thesaurus ObjectClass
- C21541
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- C0018704
- NCI Thesaurus Property
- C25395
- UMLS 2011AA Property
- C0039457
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Description
RegisteredInvestigatorName
Data type
text
Alias
- NCI Thesaurus ValueDomain
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- UMLS 2011AA ObjectClass
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- NCI Thesaurus ObjectClass
- C25644
Description
InstitutionContactFaxNumber
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
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- NCI Thesaurus ObjectClass
- C25461
- UMLS 2011AA ObjectClass
- C0337611
- NCI Thesaurus Property
- C25210
- UMLS 2011AA Property
- C0085205
Description
CentralLaboratoryContactPersonName
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus ObjectClass
- C37984
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- NCI Metathesaurus ObjectClass
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- NCI Thesaurus ObjectClass
- C25461
- UMLS 2011AA ObjectClass
- C0337611
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
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- UMLS 2011AA ValueDomain
- C1547383
Description
CentralLabContactPhoneNumber
Data type
double
Description
CentralLabContactFaxNumb
Data type
double
Description
Comments
Description
ResearchCommentsText
Data type
text
Alias
- NCI Thesaurus ValueDomain
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- C0282411
Description
InvestigatorSignatureText
Data type
text
Alias
- NCI Thesaurus ValueDomain
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- NCI Thesaurus Property
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- NCI Thesaurus ObjectClass
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- UMLS 2011AA ObjectClass
- C0035173
Description
InvestigatorSignatureDate
Data type
date
Alias
- NCI Thesaurus ValueDomain
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- UMLS 2011AA ValueDomain
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- C1519316
- NCI Thesaurus ValueDomain
- C25367
- NCI Thesaurus ObjectClass
- C17089
- UMLS 2011AA ObjectClass
- C0035173
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No Instruction available.
- StudyEvent: E2902 Material Submission Form - Form 1845
C0237753 (UMLS 2011AA ValueDomain)
C25646 (NCI Thesaurus ObjectClass)
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C16154 (NCI Thesaurus Property)
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C0237753 (UMLS 2011AA ValueDomain)
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C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
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C1507394 (UMLS 2011AA ObjectClass)
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C25491 (NCI Thesaurus Property)
C1512162 (UMLS 2011AA Property)
C0237753 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
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C1512162 (UMLS 2011AA Property)
C0237753 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
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C25320 (NCI Thesaurus ObjectClass)
C1507394 (UMLS 2011AA ObjectClass)
C25608 (NCI Thesaurus Property)
C0679823 (UMLS 2011AA Property)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C0237753 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25608 (NCI Thesaurus Property)
C0679823 (UMLS 2011AA Property)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C0205195 (UMLS 2011AA ObjectClass)
C21541 (NCI Thesaurus ObjectClass)
C0018704 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C21541 (NCI Thesaurus ValueDomain)
C0018704 (UMLS 2011AA ValueDomain)
C0370003 (UMLS 2011AA ObjectClass)
C37984 (NCI Thesaurus Property)
C0022877 (UMLS 2011AA Property)
C0205099 (NCI Metathesaurus Property)
C25694 (NCI Thesaurus Property)
C1515022 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C0370003 (UMLS 2011AA ObjectClass)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C25639 (NCI Thesaurus Property)
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C1298908 (UMLS 2011AA)
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C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C25452 (NCI Thesaurus Property)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
C0332307 (UMLS 2011AA ValueDomain)
C0005954 (UMLS 2011AA)
C1261273 (UMLS 2011AA)
C0205394 (UMLS 2011AA)
C1261273 (UMLS 2011AA)
C0205394 (UMLS 2011AA)
C0332307 (UMLS 2011AA ValueDomain)
C25616 (NCI Thesaurus Property)
C1948053 (UMLS 2011AA Property)
C25453 (NCI Thesaurus Property)
C1516698 (UMLS 2011AA Property)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C0205394 (UMLS 2011AA)
C0750480 (UMLS 2011AA ValueDomain)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C25695 (NCI Thesaurus Property)
C1515023 (UMLS 2011AA Property)
C0011008 (UMLS 2011AA ValueDomain)
C25639 (NCI Thesaurus Property)
C1514756 (UMLS 2011AA Property)
C37984 (NCI Thesaurus Property)
C0022877 (UMLS 2011AA Property)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
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C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
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C0018704 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
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C0337611 (UMLS 2011AA ObjectClass)
C0237753 (UMLS 2011AA ValueDomain)
C21541 (NCI Thesaurus ObjectClass)
C0018704 (UMLS 2011AA ObjectClass)
C25395 (NCI Thesaurus Property)
C0039457 (UMLS 2011AA Property)
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C25210 (NCI Thesaurus Property)
C0085205 (UMLS 2011AA Property)
C0027361 (UMLS 2011AA ObjectClass)
C37984 (NCI Thesaurus ObjectClass)
C0022877 (UMLS 2011AA ObjectClass)
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