ID
2058
Descrição
E1906 Registration Worksheet (step 1) Comparing Three Different Combination Chemotherapy Regimens in Treating Patients With Relapsed or Refractory Acute Myeloid Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=580BE65D-2E90-52E8-E044-0003BA3F9857
Link
Palavras-chave
Versões (4)
- 19/09/2012 19/09/2012 -
- 09/01/2015 09/01/2015 - Martin Dugas
- 23/01/2015 23/01/2015 - Martin Dugas
- 20/09/2021 20/09/2021 -
Transferido a
19 de setembro de 2012
DOI
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Licença
Creative Commons BY-NC 3.0 Legacy
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Leukemia NCT00634244 Eligibility - E1906 Registration Worksheet (step 1) - 2789743v1.0
No Instruction available.
- StudyEvent: E1906 Registration Worksheet (step 1)
Descrição
Patient Demographics / Pre-treatment Characteristics
Descrição
PatientSexCode
Tipo de dados
text
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C28421
- UMLS 2011AA Property
- C1522384
- NCI Thesaurus ValueDomain
- C25162
- UMLS 2011AA ValueDomain
- C0805701
- NCI Thesaurus ValueDomain
- C16960
- UMLS 2011AA ValueDomain
- C0030705
- NCI Thesaurus ValueDomain
- C28421
- UMLS 2011AA ValueDomain
- C1522384
Descrição
PatientBirthDate
Tipo de dados
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C25155
- UMLS 2011AA Property
- C0005615
Descrição
PatientRaceCategory
Tipo de dados
text
Alias
- NCI Thesaurus ValueDomain
- C25372
- UMLS 2011AA ValueDomain
- C0683312
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C17049
- UMLS 2011AA Property
- C0034510
Descrição
AddressPostalCodeIdentifier
Tipo de dados
text
Alias
- NCI Thesaurus ObjectClass
- C25407
- UMLS 2011AA ObjectClass
- C1442065
- NCI Thesaurus Property
- C25621
- UMLS 2011AA Property
- C1514254
- NCI Thesaurus ValueDomain
- C25364
- UMLS 2011AA ValueDomain
- C0600091
- NCI Thesaurus ValueDomain
- C25407
- UMLS 2011AA ValueDomain
- C1442065
- NCI Thesaurus ValueDomain
- C25621
- UMLS 2011AA ValueDomain
- C1514254
Descrição
PatientEthnicGroupCategory
Tipo de dados
text
Alias
- NCI Thesaurus ValueDomain
- C25372
- UMLS 2011AA ValueDomain
- C0683312
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C16564
- UMLS 2011AA Property
- C0015031
Descrição
PatientMedicalRecordNumber
Tipo de dados
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C25261
- UMLS 2011AA Property
- C0205476
- NCI Thesaurus Property
- C25198
- UMLS 2011AA Property
- C0034869
Descrição
PatientSSNNumber
Tipo de dados
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C25686
- UMLS 2011AA Property
- C1301821
Descrição
PatientInternationalPaymentType
Tipo de dados
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C25371
- UMLS 2011AA Property
- C0680264
- NCI Thesaurus Property
- C25541
- UMLS 2011AA Property
- C1512888
Descrição
PatientAddressCountryCode
Tipo de dados
text
Alias
- NCI Thesaurus ValueDomain
- C25162
- UMLS 2011AA ValueDomain
- C0805701
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C25407
- UMLS 2011AA Property
- C1442065
Descrição
ResearchCommentsText
Tipo de dados
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ObjectClass
- C15319
- NCI Thesaurus Property
- C25393
- UMLS 2011AA Property
- C0282411
Descrição
I Have Reviewed The Above Data And Agree The Date Are Accurate And Correct
Descrição
TreatingPhysicianSignatureText
Tipo de dados
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus Property
- C25678
- UMLS 2011AA Property
- C1519316
- NCI Thesaurus ObjectClass
- C51883
- UMLS 2011AA ObjectClass
- C1710470
Descrição
TreatingPhysicianSignatureDate
Tipo de dados
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus Property
- C25678
- UMLS 2011AA Property
- C1519316
- NCI Thesaurus ObjectClass
- C51883
- UMLS 2011AA ObjectClass
- C1710470
Similar models
No Instruction available.
- StudyEvent: E1906 Registration Worksheet (step 1)
C1547383 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25536 (NCI Thesaurus Property)
C1555582 (UMLS 2011AA Property)
C25509 (NCI Thesaurus Property)
C1279901 (UMLS 2011AA Property)
C1547383 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25536 (NCI Thesaurus Property)
C1555582 (UMLS 2011AA Property)
C25551 (NCI Thesaurus Property)
C1517741 (UMLS 2011AA Property)
C1512698 (UMLS 2011AA ValueDomain)
C25250 (NCI Thesaurus Property)
C0205197 (UMLS 2011AA Property)
C25171 (NCI Thesaurus ObjectClass)
C0013893 (UMLS 2011AA ObjectClass)
C49073 (NCI Thesaurus Property)
C1707357 (UMLS 2011AA Property)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C1512699 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25171 (NCI Thesaurus Property)
C0013893 (UMLS 2011AA Property)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C1512698 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25678 (NCI Thesaurus Property)
C1519316 (UMLS 2011AA Property)
C25460 (NCI Thesaurus Property)
C1511481 (UMLS 2011AA Property)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain)
C16468 (NCI Thesaurus ObjectClass)
C0009797 (UMLS 2011AA ObjectClass)
C25679 (NCI Thesaurus Property)
C1522602 (UMLS 2011AA ValueDomain)
C62504 (NCI Thesaurus ObjectClass)
C0600593 (UMLS 2011AA ObjectClass)
C41192 (NCI Thesaurus Property)
C1524004 (UMLS 2011AA Property)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0030705 (UMLS 2011AA ObjectClass)
C25679 (NCI Thesaurus Property)
C0012621 (NCI Metathesaurus Property)
C45258 (NCI Thesaurus Property)
C0025102 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C0677874 (UMLS 2011AA ObjectClass)
C25509 (NCI Thesaurus ObjectClass)
C1279901 (UMLS 2011AA ObjectClass)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
C25330 (NCI Thesaurus ValueDomain)
C0449238 (UMLS 2011AA ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25646 (NCI Thesaurus Property)
C1514821 (UMLS 2011AA Property)
C16041 (NCI Thesaurus Property)
C1515980 (UMLS 2011AA Property)
C0027361 (UMLS 2011AA ObjectClass)
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C15189 (NCI Thesaurus Property)
C0005558 (UMLS 2011AA Property)
C25460 (NCI Thesaurus Property)
C1511481 (UMLS 2011AA Property)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0027361 (UMLS 2011AA ObjectClass)
C25168 (NCI Thesaurus Property)
C0040288 (UMLS 2011AA Property)
C19157 (NCI Thesaurus Property)
C0370003 (UMLS 2011AA Property)
C25460 (NCI Thesaurus Property)
C1511481 (UMLS 2011AA Property)
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0027361 (UMLS 2011AA ObjectClass)
C15319 (NCI Thesaurus Property)
C9305 (NCI Thesaurus Property)
C0006826 (UMLS 2011AA Property)
C19157 (NCI Thesaurus Property)
C0370003 (UMLS 2011AA Property)
C25460 (NCI Thesaurus Property)
C1511481 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0030705 (UMLS 2011AA ObjectClass)
C25699 (NCI Thesaurus ObjectClass)
C1519429 (UMLS 2011AA ObjectClass)
C12801 (NCI Thesaurus Property)
C0040300 (UMLS 2011AA Property)
C19157 (NCI Thesaurus Property)
C0370003 (UMLS 2011AA Property)
C25460 (NCI Thesaurus Property)
C1511481 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0030705 (UMLS 2011AA ObjectClass)
C15319 (NCI Thesaurus Property)
C25406 (NCI Thesaurus Property)
C1524062 (UMLS 2011AA Property)
C25460 (NCI Thesaurus Property)
C1511481 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C1547383 (UMLS 2011AA ValueDomain)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C16487 (NCI Thesaurus ObjectClass)
C0010802 (UMLS 2011AA ObjectClass)
C37984 (NCI Thesaurus ObjectClass)
C0022877 (UMLS 2011AA ObjectClass)
C0010802 (UMLS 2011AA ObjectClass)
C37984 (NCI Thesaurus ObjectClass)
C0022877 (UMLS 2011AA ObjectClass)
C25395 (NCI Thesaurus Property)
C0039457 (UMLS 2011AA Property)
C47954 (NCI Thesaurus Property)
C1705415 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C0030705 (UMLS 2011AA ObjectClass)
C28421 (NCI Thesaurus Property)
C1522384 (UMLS 2011AA Property)
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ValueDomain)
C0030705 (UMLS 2011AA ValueDomain)
C28421 (NCI Thesaurus ValueDomain)
C1522384 (UMLS 2011AA ValueDomain)
C0024554 (UMLS 2011AA)
C0015780 (UMLS 2011AA)
C0011008 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25155 (NCI Thesaurus Property)
C0005615 (UMLS 2011AA Property)
C0683312 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C17049 (NCI Thesaurus Property)
C0034510 (UMLS 2011AA Property)
C1515945 (UMLS 2011AA)
C0078988 (UMLS 2011AA)
C0085756 (UMLS 2011AA)
C1513907 (UMLS 2011AA)
C1706613 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C0007457 (UMLS 2011AA)
C1442065 (UMLS 2011AA ObjectClass)
C25621 (NCI Thesaurus Property)
C1514254 (UMLS 2011AA Property)
C25364 (NCI Thesaurus ValueDomain)
C0600091 (UMLS 2011AA ValueDomain)
C25407 (NCI Thesaurus ValueDomain)
C1442065 (UMLS 2011AA ValueDomain)
C25621 (NCI Thesaurus ValueDomain)
C1514254 (UMLS 2011AA ValueDomain)
C0683312 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C16564 (NCI Thesaurus Property)
C0015031 (UMLS 2011AA Property)
C0086409 (UMLS 2011AA)
C1518424 (UMLS 2011AA)
C1706613 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C0237753 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25261 (NCI Thesaurus Property)
C0205476 (UMLS 2011AA Property)
C25198 (NCI Thesaurus Property)
C0034869 (UMLS 2011AA Property)
C0237753 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25686 (NCI Thesaurus Property)
C1301821 (UMLS 2011AA Property)
C0332307 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25371 (NCI Thesaurus Property)
C0680264 (UMLS 2011AA Property)
C25541 (NCI Thesaurus Property)
C1512888 (UMLS 2011AA Property)
C0018717 (UMLS 2011AA)
C0205394 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C0805701 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25407 (NCI Thesaurus Property)
C1442065 (UMLS 2011AA Property)
C0002838 (UMLS 2011AA)
C0041698 (UMLS 2011AA)
C0001732 (UMLS 2011AA)
C0003354 (UMLS 2011AA)
C0003353 (UMLS 2011AA)
C0003798 (UMLS 2011AA)
C0003023 (UMLS 2011AA)
C0454691 (UMLS 2011AA)
C0003761 (UMLS 2011AA)
C0242536 (UMLS 2011AA)
C0004348 (UMLS 2011AA)
C0004340 (UMLS 2011AA)
C0282379 (UMLS 2011AA)
C0006036 (UMLS 2011AA)
C0004739 (UMLS 2011AA)
C0004732 (UMLS 2011AA)
C0004950 (UMLS 2011AA)
C0006409 (UMLS 2011AA)
C0006368 (UMLS 2011AA)
C0004684 (UMLS 2011AA)
C0006448 (UMLS 2011AA)
C0005126 (UMLS 2011AA)
C0006320 (UMLS 2011AA)
C0005918 (UMLS 2011AA)
C0006137 (UMLS 2011AA)
C0004683 (UMLS 2011AA)
C0005341 (UMLS 2011AA)
C1511278 (UMLS 2011AA)
C0006041 (UMLS 2011AA)
C0006539 (UMLS 2011AA)
C0004952 (UMLS 2011AA)
C0006823 (UMLS 2011AA)
C0009738 (UMLS 2011AA)
C0039021 (UMLS 2011AA)
C0009956 (UMLS 2011AA)
C0006802 (UMLS 2011AA)
C0008115 (UMLS 2011AA)
C0009367 (UMLS 2011AA)
C0010182 (UMLS 2011AA)
C0010435 (UMLS 2011AA)
C0006893 (UMLS 2011AA)
C0006888 (UMLS 2011AA)
C0010622 (UMLS 2011AA)
C0206578 (UMLS 2011AA)
C0019905 (UMLS 2011AA)
C0010343 (UMLS 2011AA)
C0018510 (UMLS 2011AA)
C0020174 (UMLS 2011AA)
C0021247 (UMLS 2011AA)
C0022067 (UMLS 2011AA)
C0022271 (UMLS 2011AA)
C0021201 (UMLS 2011AA)
C0022066 (UMLS 2011AA)
C0022065 (UMLS 2011AA)
C0020750 (UMLS 2011AA)
C0022277 (UMLS 2011AA)
C0022337 (UMLS 2011AA)
C0022418 (UMLS 2011AA)
C0022341 (UMLS 2011AA)
C0022558 (UMLS 2011AA)
C0006797 (UMLS 2011AA)
C0017550 (UMLS 2011AA)
C0009490 (UMLS 2011AA)
C0022804 (UMLS 2011AA)
C0007481 (UMLS 2011AA)
C0023190 (UMLS 2011AA)
C0036056 (UMLS 2011AA)
C0023668 (UMLS 2011AA)
C0038088 (UMLS 2011AA)
C0023617 (UMLS 2011AA)
C0023879 (UMLS 2011AA)
C0024176 (UMLS 2011AA)
C0023128 (UMLS 2011AA)
C0026544 (UMLS 2011AA)
C0026405 (UMLS 2011AA)
C0026374 (UMLS 2011AA)
C0024443 (UMLS 2011AA)
C0024851 (UMLS 2011AA)
C0024581 (UMLS 2011AA)
C0006416 (UMLS 2011AA)
C0026410 (UMLS 2011AA)
C0024403 (UMLS 2011AA)
C0024943 (UMLS 2011AA)
C0026514 (UMLS 2011AA)
C0024653 (UMLS 2011AA)
C0024944 (UMLS 2011AA)
C0024553 (UMLS 2011AA)
C0024548 (UMLS 2011AA)
C0025885 (UMLS 2011AA)
C0024552 (UMLS 2011AA)
C0026655 (UMLS 2011AA)
C0027366 (UMLS 2011AA)
C0028074 (UMLS 2011AA)
C0028366 (UMLS 2011AA)
C0028075 (UMLS 2011AA)
C0028002 (UMLS 2011AA)
C0027778 (UMLS 2011AA)
C0028423 (UMLS 2011AA)
C0027689 (UMLS 2011AA)
C0027496 (UMLS 2011AA)
C0028219 (UMLS 2011AA)
C0027978 (UMLS 2011AA)
C0028971 (UMLS 2011AA)
C0030266 (UMLS 2011AA)
C0031238 (UMLS 2011AA)
C0030375 (UMLS 2011AA)
C0030211 (UMLS 2011AA)
C0032356 (UMLS 2011AA)
C0031995 (UMLS 2011AA)
C0034044 (UMLS 2011AA)
C0032729 (UMLS 2011AA)
C0242397 (UMLS 2011AA)
C0030428 (UMLS 2011AA)
C0034366 (UMLS 2011AA)
C0035826 (UMLS 2011AA)
C0035978 (UMLS 2011AA)
C0036243 (UMLS 2011AA)
C0037623 (UMLS 2011AA)
C0036919 (UMLS 2011AA)
C0038642 (UMLS 2011AA)
C0038995 (UMLS 2011AA)
C0037173 (UMLS 2011AA)
C0037334 (UMLS 2011AA)
C0206579 (UMLS 2011AA)
C0037063 (UMLS 2011AA)
C0036154 (UMLS 2011AA)
C0036644 (UMLS 2011AA)
C0037640 (UMLS 2011AA)
C0038944 (UMLS 2011AA)
C0013754 (UMLS 2011AA)
C0039138 (UMLS 2011AA)
C0038983 (UMLS 2011AA)
C0007928 (UMLS 2011AA)
C0040363 (UMLS 2011AA)
C0039725 (UMLS 2011AA)
C0220928 (UMLS 2011AA)
C0041403 (UMLS 2011AA)
C0041388 (UMLS 2011AA)
C1452561 (UMLS 2011AA)
C0041400 (UMLS 2011AA)
C0041413 (UMLS 2011AA)
C0039260 (UMLS 2011AA)
C0039298 (UMLS 2011AA)
C0041580 (UMLS 2011AA)
C0041573 (UMLS 2011AA)
C0041700 (UMLS 2011AA)
C0042113 (UMLS 2011AA)
C0042177 (UMLS 2011AA)
C0042469 (UMLS 2011AA)
C0042658 (UMLS 2011AA)
C0042321 (UMLS 2011AA)
C0043402 (UMLS 2011AA)
C0024974 (UMLS 2011AA)
C0043445 (UMLS 2011AA)
C0043476 (UMLS 2011AA)
C1527021 (UMLS 2011AA ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0282411 (UMLS 2011AA Property)
C1527021 (UMLS 2011AA ValueDomain)
C25678 (NCI Thesaurus Property)
C1519316 (UMLS 2011AA Property)
C51883 (NCI Thesaurus ObjectClass)
C1710470 (UMLS 2011AA ObjectClass)
C0011008 (UMLS 2011AA ValueDomain)
C25678 (NCI Thesaurus Property)
C1519316 (UMLS 2011AA Property)
C51883 (NCI Thesaurus ObjectClass)
C1710470 (UMLS 2011AA ObjectClass)