ID
2058
Beskrivning
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
Länk
Nyckelord
Versioner (4)
- 2012-09-19 2012-09-19 -
- 2015-01-09 2015-01-09 - Martin Dugas
- 2015-01-23 2015-01-23 - Martin Dugas
- 2021-09-20 2021-09-20 -
Uppladdad den
19 september 2012
DOI
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Licens
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)
Beskrivning
Patient Demographics / Pre-treatment Characteristics
Beskrivning
PatientSexCode
Datatyp
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
Beskrivning
PatientBirthDate
Datatyp
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
Beskrivning
PatientRaceCategory
Datatyp
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
Beskrivning
AddressPostalCodeIdentifier
Datatyp
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
Beskrivning
PatientEthnicGroupCategory
Datatyp
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
Beskrivning
PatientMedicalRecordNumber
Datatyp
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
Beskrivning
PatientSSNNumber
Datatyp
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
Beskrivning
PatientInternationalPaymentType
Datatyp
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
Beskrivning
PatientAddressCountryCode
Datatyp
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
Beskrivning
ResearchCommentsText
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ObjectClass
- C15319
- NCI Thesaurus Property
- C25393
- UMLS 2011AA Property
- C0282411
Beskrivning
I Have Reviewed The Above Data And Agree The Date Are Accurate And Correct
Beskrivning
TreatingPhysicianSignatureText
Datatyp
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
Beskrivning
TreatingPhysicianSignatureDate
Datatyp
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)