ID

2109

Beschrijving

CALGB-10501 Hospital Anxiety And Depression Scale Form Early or Delayed Fludarabine and Rituximab in Treating Patients With Previously Untreated Chronic Lymphocytic Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=340EDF8E-59E2-1F88-E044-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=340EDF8E-59E2-1F88-E044-0003BA3F9857

Trefwoorden

Versies (3)
  1. 19-09-12 19-09-12 - Philipp Bruland
  2. 09-01-15 09-01-15 - Martin Dugas
  3. 18-06-15 18-06-15 -
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19 september 2012

DOI

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Creative Commons BY-NC 3.0 Legacy
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Leukemia NCT00513747 Quality of Life - CALGB-10501 Hospital Anxiety And Depression Scale Form - 2661485v1.0

Engels

INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice

1 Formulieren  
Unnamed1
Beschrijving

Unnamed1

CALGB Form
Beschrijving

CALGBFormIdentifierNumber

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C19464
UMLS 2011AA ObjectClass
C0376315
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ObjectClass
C25442
UMLS 2011AA ObjectClass
C1516238
CALGB Study No
Beschrijving

ProtocolCALGBIdentifierNumber

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C25320
UMLS 2011AA ObjectClass
C1507394
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus Property
C25442
UMLS 2011AA Property
C1516238
CALGB Patient ID
Beschrijving

PatientCALGBIdentifierNumber

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus Property
C25442
UMLS 2011AA Property
C1516238
Date Form Completed
Beschrijving

FormCompleteDate

Datatype

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C40988
UMLS 2011AA ObjectClass
C1516308
NCI Thesaurus Property
C25250
UMLS 2011AA Property
C0205197
NCI Thesaurus ValueDomain
C25367
Are data amended
Beschrijving

DataAmendedInd-3

Datatype

text

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass
C25474
UMLS 2011AA ObjectClass
C1511726
NCI Thesaurus Property
C25416
UMLS 2011AA Property
C1691222
Unnamed2
Beschrijving

Unnamed2

Patient Initials (Last, First Middle)
Beschrijving

PatientInitialsName

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25536
UMLS 2011AA Property
C1555582
Patient Hospital No.
Beschrijving

PatientMedicalRecordNumber

Datatype

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
Institution/Affiliate
Beschrijving

CombinedInstitutionName

Datatype

text

Alias
NCI Thesaurus ObjectClass
C25454
UMLS 2011AA ObjectClass
C0205195
NCI Thesaurus ObjectClass
C21541
UMLS 2011AA ObjectClass
C0018704
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ValueDomain
C21541
UMLS 2011AA ValueDomain
C0018704
Participating Group
Beschrijving

ParticipatingGroupName

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C25608
UMLS 2011AA ObjectClass
C0679823
NCI Thesaurus ObjectClass
C17005
UMLS 2011AA ObjectClass
C1257890
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Participating Group Study No
Beschrijving

ProtocolParticipatingIdentifierNumber

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C25320
UMLS 2011AA ObjectClass
C1507394
NCI Thesaurus Property
C25608
UMLS 2011AA Property
C0679823
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Participating Group Patient ID
Beschrijving

PatientParticipatingIdentifierNumber

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25608
UMLS 2011AA Property
C0679823
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Unnamed1
Beschrijving

Unnamed1

Responsible CRA
Beschrijving

ClinicalResearchAssociateResponsiblePersonName

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C25657
UMLS 2011AA ObjectClass
C1273518
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ObjectClass
C25465
UMLS 2011AA ObjectClass
C1516627
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
Unnamed2
Beschrijving

Unnamed2

I feel tense or wound up (Mark one with an X.)
Beschrijving

AnxietyPersonQualityofLifeAssessmentScale

Datatype

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ObjectClass
C26696
UMLS 2011AA ObjectClass
C0003467
NCI Thesaurus Property
C17047
UMLS 2011AA Property
C0518214
NCI Thesaurus Property
C25367
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
I still enjoy the things I used to enjoy (Mark one with an X.)
Beschrijving

EmotionDissatisfactionAbsentPersonQualityofLifeAssessmentScale

Datatype

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ObjectClass
C54266
UMLS 2011AA ObjectClass
C0013987
NCI Thesaurus ObjectClass
C48190
UMLS 2011AA ObjectClass
C0332197
NCI Thesaurus ObjectClass
C62184
UMLS 2011AA ObjectClass
C0870433
NCI Thesaurus Property
C17047
UMLS 2011AA Property
C0518214
NCI Thesaurus Property
C25367
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
I get a sort of frightened feeling as if something awful is about to happen (Mark one with an X.)
Beschrijving

AnxietyDistressPersonQualityofLifeAssessmentScale

Datatype

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ObjectClass
C26696
UMLS 2011AA ObjectClass
C0003467
NCI Thesaurus ObjectClass
C37942
UMLS 2011AA ObjectClass
C0231303
NCI Thesaurus Property
C17047
UMLS 2011AA Property
C0518214
NCI Thesaurus Property
C25367
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
I can laugh and see the funny side of things (Mark one with an X.)
Beschrijving

EmotionPositiveMoodAlterationPersonQualityofLifeAssessmentScale

Datatype

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ObjectClass
C54266
UMLS 2011AA ObjectClass
C0013987
NCI Thesaurus ObjectClass
C25246
UMLS 2011AA ObjectClass
C1446409
NCI Thesaurus ObjectClass
C62592
UMLS 2011AA ObjectClass
C2939186
NCI Thesaurus Property
C17047
UMLS 2011AA Property
C0518214
NCI Thesaurus Property
C25367
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Worrying thoughts go through my mind (Mark one with an X.)
Beschrijving

AnxietyThinkingPersonQualityofLifeAssessmentScale

Datatype

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ObjectClass
C26696
UMLS 2011AA ObjectClass
C0003467
NCI Thesaurus ObjectClass
C54226
UMLS 2011AA ObjectClass
C0039869
NCI Thesaurus Property
C17047
UMLS 2011AA Property
C0518214
NCI Thesaurus Property
C25367
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
I feel cheerful (Mark one with an X.)
Beschrijving

EmotionPositivePersonQualityofLifeAssessmentScale

Datatype

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ObjectClass
C54266
UMLS 2011AA ObjectClass
C0013987
NCI Thesaurus ObjectClass
C25246
UMLS 2011AA ObjectClass
C1446409
NCI Thesaurus Property
C17047
UMLS 2011AA Property
C0518214
NCI Thesaurus Property
C25367
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
I can sit at ease and feel relaxed (Mark one with an X.)
Beschrijving

RelaxationPersonQualityofLifeAssessmentScale

Datatype

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ObjectClass
C62188
UMLS 2011AA ObjectClass
C0035028
NCI Thesaurus Property
C17047
UMLS 2011AA Property
C0518214
NCI Thesaurus Property
C25367
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
I feel as if I am slowed down (Mark one with an X.)
Beschrijving

DepressionFatiguePersonQualityofLifeAssessmentScale

Datatype

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ObjectClass
C3036
UMLS 2011AA ObjectClass
C0015672
NCI Thesaurus ObjectClass
C2982
UMLS 2011AA ObjectClass
C0011570
NCI Thesaurus Property
C17047
UMLS 2011AA Property
C0518214
NCI Thesaurus Property
C25367
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
I get a sort of frightened feeling like butterflies in my stomach (Mark one with an X.)
Beschrijving

AnxietyNauseaPersonQualityofLifeAssessmentScale

Datatype

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ObjectClass
C26696
UMLS 2011AA ObjectClass
C0003467
NCI Thesaurus ObjectClass
C3258
UMLS 2011AA ObjectClass
C0027497
NCI Thesaurus Property
C17047
UMLS 2011AA Property
C0518214
NCI Thesaurus Property
C25367
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
I have lost interest in my appearance (Mark one with an X.)
Beschrijving

DepressionAppearancePersonQualityofLifeAssessmentScale

Datatype

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ObjectClass
C25377
UMLS 2011AA ObjectClass
C0700364
NCI Thesaurus ObjectClass
C2982
UMLS 2011AA ObjectClass
C0011570
NCI Thesaurus Property
C17047
UMLS 2011AA Property
C0518214
NCI Thesaurus Property
C25367
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
I feel restless as if I have to be on the move (Mark one with an X.)
Beschrijving

AnxietyMovementPersonQualityofLifeAssessmentScale

Datatype

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ObjectClass
C26696
UMLS 2011AA ObjectClass
C0003467
NCI Thesaurus ObjectClass
C37994
UMLS 2011AA ObjectClass
C0026649
NCI Thesaurus Property
C17047
UMLS 2011AA Property
C0518214
NCI Thesaurus Property
C25367
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
I look forward with enjoyment to things (Mark one with an X.)
Beschrijving

EmotionConfidencePersonQualityofLifeAssessmentScale

Datatype

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ObjectClass
C54266
UMLS 2011AA ObjectClass
C0013987
NCI Thesaurus ObjectClass
C43367
UMLS 2011AA ObjectClass
C1704726
NCI Thesaurus Property
C17047
UMLS 2011AA Property
C0518214
NCI Thesaurus Property
C25367
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
I get sudden feelings of panic (Mark one with an X.)
Beschrijving

AnxietyAcuteDistressPersonQualityofLifeAssessmentScale

Datatype

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ObjectClass
C26696
UMLS 2011AA ObjectClass
C0003467
NCI Thesaurus ObjectClass
C14140
UMLS 2011AA ObjectClass
C0205178
NCI Thesaurus ObjectClass
C37942
UMLS 2011AA ObjectClass
C0231303
NCI Thesaurus Property
C17047
UMLS 2011AA Property
C0518214
NCI Thesaurus Property
C25367
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
I can enjoy a good book or radio or TV program (Mark one with an X.)
Beschrijving

EmotionActivityPersonQualityofLifeAssessmentScale

Datatype

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ObjectClass
C54266
UMLS 2011AA ObjectClass
C0013987
NCI Thesaurus ObjectClass
C43431
UMLS 2011AA ObjectClass
C0441655
NCI Thesaurus Property
C17047
UMLS 2011AA Property
C0518214
NCI Thesaurus Property
C25367
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
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Similar models

INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice

1 Formulieren
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Unnamed1
CALGBFormIdentifierNumber
Item
CALGB Form
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C19464 (NCI Thesaurus ObjectClass)
C0376315 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25442 (NCI Thesaurus ObjectClass)
C1516238 (UMLS 2011AA ObjectClass)
ProtocolCALGBIdentifierNumber
Item
CALGB Study No
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25320 (NCI Thesaurus ObjectClass)
C1507394 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25442 (NCI Thesaurus Property)
C1516238 (UMLS 2011AA Property)
PatientCALGBIdentifierNumber
Item
CALGB Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25442 (NCI Thesaurus Property)
C1516238 (UMLS 2011AA Property)
FormCompleteDate
Item
Date Form Completed
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C40988 (NCI Thesaurus ObjectClass)
C1516308 (UMLS 2011AA ObjectClass)
C25250 (NCI Thesaurus Property)
C0205197 (UMLS 2011AA Property)
C25367 (NCI Thesaurus ValueDomain)
Item
Are data amended
text
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
CL.1
Code List
Are data amended
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item Group
Unnamed2
PatientInitialsName
Item
Patient Initials (Last, First Middle)
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25536 (NCI Thesaurus Property)
C1555582 (UMLS 2011AA Property)
PatientMedicalRecordNumber
Item
Patient Hospital No.
text
C25337 (NCI Thesaurus ValueDomain)
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)
CombinedInstitutionName
Item
Institution/Affiliate
text
C25454 (NCI Thesaurus ObjectClass)
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)
ParticipatingGroupName
Item
Participating Group
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C25608 (NCI Thesaurus ObjectClass)
C0679823 (UMLS 2011AA ObjectClass)
C17005 (NCI Thesaurus ObjectClass)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
ProtocolParticipatingIdentifierNumber
Item
Participating Group Study No
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25320 (NCI Thesaurus ObjectClass)
C1507394 (UMLS 2011AA ObjectClass)
C25608 (NCI Thesaurus Property)
C0679823 (UMLS 2011AA Property)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
PatientParticipatingIdentifierNumber
Item
Participating Group Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
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)
Item Group
Unnamed1
ClinicalResearchAssociateResponsiblePersonName
Item
Responsible CRA
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C25657 (NCI Thesaurus ObjectClass)
C1273518 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25465 (NCI Thesaurus ObjectClass)
C1516627 (UMLS 2011AA ObjectClass)
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)
Item Group
Unnamed2
Item
I feel tense or wound up (Mark one with an X.)
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C26696 (NCI Thesaurus ObjectClass)
C0003467 (UMLS 2011AA ObjectClass)
C17047 (NCI Thesaurus Property)
C0518214 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.2
Code List
I feel tense or wound up (Mark one with an X.)
CL Item
Most Of The Time (Most of the time)
CL Item
A Lot Of The Time (A lot of the time)
CL Item
From Time To Time, Occasionally (From time to time, occasionally)
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus)
Item
I still enjoy the things I used to enjoy (Mark one with an X.)
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C54266 (NCI Thesaurus ObjectClass)
C0013987 (UMLS 2011AA ObjectClass)
C48190 (NCI Thesaurus ObjectClass)
C0332197 (UMLS 2011AA ObjectClass)
C62184 (NCI Thesaurus ObjectClass)
C0870433 (UMLS 2011AA ObjectClass)
C17047 (NCI Thesaurus Property)
C0518214 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.3
Code List
I still enjoy the things I used to enjoy (Mark one with an X.)
CL Item
Definitely As Much (Definitely as much)
CL Item
Not Quite So Much (Not quite so much)
CL Item
Only A Little (Only a little)
CL Item
Hardly At All (Hardly at all)
Item
I get a sort of frightened feeling as if something awful is about to happen (Mark one with an X.)
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C26696 (NCI Thesaurus ObjectClass)
C0003467 (UMLS 2011AA ObjectClass)
C37942 (NCI Thesaurus ObjectClass)
C0231303 (UMLS 2011AA ObjectClass)
C17047 (NCI Thesaurus Property)
C0518214 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.4
Code List
I get a sort of frightened feeling as if something awful is about to happen (Mark one with an X.)
CL Item
Very Definitely And Quite Badly (Very definitely and quite badly)
CL Item
Yes, But Not Too Badly (Yes, but not too badly)
CL Item
A Little, But It Doesn't Worry Me (A little, but it doesn't worry me)
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus)
Item
I can laugh and see the funny side of things (Mark one with an X.)
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C54266 (NCI Thesaurus ObjectClass)
C0013987 (UMLS 2011AA ObjectClass)
C25246 (NCI Thesaurus ObjectClass)
C1446409 (UMLS 2011AA ObjectClass)
C62592 (NCI Thesaurus ObjectClass)
C2939186 (UMLS 2011AA ObjectClass)
C17047 (NCI Thesaurus Property)
C0518214 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.5
Code List
I can laugh and see the funny side of things (Mark one with an X.)
CL Item
As Much As I Always Could (As much as I always could)
CL Item
Not Quite So Much Now (Not quite so much now)
CL Item
Definitely Not So Much Now (Definitely not so much now)
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus)
Item
Worrying thoughts go through my mind (Mark one with an X.)
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C26696 (NCI Thesaurus ObjectClass)
C0003467 (UMLS 2011AA ObjectClass)
C54226 (NCI Thesaurus ObjectClass)
C0039869 (UMLS 2011AA ObjectClass)
C17047 (NCI Thesaurus Property)
C0518214 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.6
Code List
Worrying thoughts go through my mind (Mark one with an X.)
CL Item
A Great Deal Of The Time (A great deal of the time)
CL Item
A Lot Of The Time (A lot of the time)
CL Item
From Time To Time But Not Too Often (From time to time but not too often)
CL Item
Only Occasionally (Only occasionally)
Item
I feel cheerful (Mark one with an X.)
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C54266 (NCI Thesaurus ObjectClass)
C0013987 (UMLS 2011AA ObjectClass)
C25246 (NCI Thesaurus ObjectClass)
C1446409 (UMLS 2011AA ObjectClass)
C17047 (NCI Thesaurus Property)
C0518214 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.7
Code List
I feel cheerful (Mark one with an X.)
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus)
CL Item
Not Often (Not often)
CL Item
Sometimes (Sometimes)
CL Item
Most Of The Time (Most of the time)
Item
I can sit at ease and feel relaxed (Mark one with an X.)
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C62188 (NCI Thesaurus ObjectClass)
C0035028 (UMLS 2011AA ObjectClass)
C17047 (NCI Thesaurus Property)
C0518214 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.8
Code List
I can sit at ease and feel relaxed (Mark one with an X.)
CL Item
Definitely (Definitely)
CL Item
Usually (Usually)
CL Item
Not Often (Not often)
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus)
Item
I feel as if I am slowed down (Mark one with an X.)
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C3036 (NCI Thesaurus ObjectClass)
C0015672 (UMLS 2011AA ObjectClass)
C2982 (NCI Thesaurus ObjectClass)
C0011570 (UMLS 2011AA ObjectClass)
C17047 (NCI Thesaurus Property)
C0518214 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.9
Code List
I feel as if I am slowed down (Mark one with an X.)
CL Item
Nearly All The Time (Nearly all the time)
CL Item
Very Often (Very often)
CL Item
Sometimes (Sometimes)
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus)
Item
I get a sort of frightened feeling like butterflies in my stomach (Mark one with an X.)
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C26696 (NCI Thesaurus ObjectClass)
C0003467 (UMLS 2011AA ObjectClass)
C3258 (NCI Thesaurus ObjectClass)
C0027497 (UMLS 2011AA ObjectClass)
C17047 (NCI Thesaurus Property)
C0518214 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.10
Code List
I get a sort of frightened feeling like butterflies in my stomach (Mark one with an X.)
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus)
CL Item
Occasionally (Occasionally)
CL Item
Quite Often (Quite often)
CL Item
Very Often (Very often)
Item
I have lost interest in my appearance (Mark one with an X.)
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25377 (NCI Thesaurus ObjectClass)
C0700364 (UMLS 2011AA ObjectClass)
C2982 (NCI Thesaurus ObjectClass)
C0011570 (UMLS 2011AA ObjectClass)
C17047 (NCI Thesaurus Property)
C0518214 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.11
Code List
I have lost interest in my appearance (Mark one with an X.)
CL Item
Definitely (Definitely)
CL Item
I Don't Take So Much Care As I Should (I don't take so much care as I should)
CL Item
I May Not Take Quite As Much Care (I may not take quite as much care)
CL Item
I Take Just As Much Care As Ever (I take just as much care as ever)
Item
I feel restless as if I have to be on the move (Mark one with an X.)
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C26696 (NCI Thesaurus ObjectClass)
C0003467 (UMLS 2011AA ObjectClass)
C37994 (NCI Thesaurus ObjectClass)
C0026649 (UMLS 2011AA ObjectClass)
C17047 (NCI Thesaurus Property)
C0518214 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.12
Code List
I feel restless as if I have to be on the move (Mark one with an X.)
CL Item
Very Much Indeed (Very much indeed)
CL Item
Not Very Much (Not very much)
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus)
Item
I look forward with enjoyment to things (Mark one with an X.)
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C54266 (NCI Thesaurus ObjectClass)
C0013987 (UMLS 2011AA ObjectClass)
C43367 (NCI Thesaurus ObjectClass)
C1704726 (UMLS 2011AA ObjectClass)
C17047 (NCI Thesaurus Property)
C0518214 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.13
Code List
I look forward with enjoyment to things (Mark one with an X.)
CL Item
As Much As I Ever Did (As much as I ever did)
CL Item
Rather Less Than I Used To (Rather less than I used to)
CL Item
Definitely Less Than I Used To (Definitely less than I used to)
CL Item
Hardly At All (Hardly at all)
Item
I get sudden feelings of panic (Mark one with an X.)
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C26696 (NCI Thesaurus ObjectClass)
C0003467 (UMLS 2011AA ObjectClass)
C14140 (NCI Thesaurus ObjectClass)
C0205178 (UMLS 2011AA ObjectClass)
C37942 (NCI Thesaurus ObjectClass)
C0231303 (UMLS 2011AA ObjectClass)
C17047 (NCI Thesaurus Property)
C0518214 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.14
Code List
I get sudden feelings of panic (Mark one with an X.)
CL Item
Very Often Indeed (Very often indeed)
CL Item
Quite Often (Quite often)
CL Item
Not Very Often (Not very often)
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus)
Item
I can enjoy a good book or radio or TV program (Mark one with an X.)
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C54266 (NCI Thesaurus ObjectClass)
C0013987 (UMLS 2011AA ObjectClass)
C43431 (NCI Thesaurus ObjectClass)
C0441655 (UMLS 2011AA ObjectClass)
C17047 (NCI Thesaurus Property)
C0518214 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.15
Code List
I can enjoy a good book or radio or TV program (Mark one with an X.)
CL Item
Often (Often)
CL Item
Sometimes (Sometimes)
CL Item
Not Often (Not often)
CL Item
Very Seldom (Very seldom)
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