ID

8516

Description

Z4032 UCSD - Shortness of Breath Questionnaire Surgery With or Without Internal Radiation Therapy in Treating Patients With Stage I Non-Small Cell Lung Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=F21FBFC2-16CA-105F-E034-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=F21FBFC2-16CA-105F-E034-0003BA3F9857

Keywords

Versions (2)
  1. 9/19/12 9/19/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
Uploaded on

January 9, 2015

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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Lung Cancer NCT00107172 Quality of Life - Z4032 UCSD - Shortness of Breath Questionnaire - 2306605v3.0

English

No Instruction available.

1 forms  
  1. StudyEvent: Z4032 UCSD - Shortness of Breath Questionnaire
    1. No Instruction available.
Header Module
Description

Header Module

Visit
Description

AmericanCollegeofSurgeonsOncologyGroupVisitPeriodAmericanCollegeofSurgeonsOncologyGroupVisitPeriodType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus Property
C25616
UMLS 2011AA Property
C1948053
NCI Thesaurus ObjectClass
C19712
UMLS 2011AA ObjectClass
C1515944
NCI Thesaurus ObjectClass-2
C25716
UMLS 2011AA ObjectClass-2
C0545082
Patient ID (Pt. ID issued during registration or previously issued Patient ID)
Description

Patient Study ID

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25462
NCI Thesaurus Property-2
C25364
Institution ID
Description

Institution Number

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C1301943
NCI Thesaurus ObjectClass
C21541
UMLS CUI-2
C0805701
NCI Thesaurus Property
C25364
Patient Initials
Description

Patient Initials

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986440
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25536
Institution
Description

Institution Name

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C1301943
NCI Thesaurus ObjectClass
C21541
NCI Thesaurus ValueDomain-2
C21541
NCI Thesaurus Property
C25364
How Short Of Breath Do You Get
Description

How Short Of Breath Do You Get

At rest
Description

RestBreathShortnessAssessmentScale

Data type

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus ObjectClass
C0392680
NCI Metathesaurus ObjectClass-2
C0443144
Walking on a level at your own pace
Description

WalkFlatBreathShortnessAssessmentScale

Data type

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus ObjectClass
C0392680
NCI Metathesaurus ObjectClass-2
C0560049
Walking on a level with others your age
Description

WalkingBreathShortnessAssessmentScale

Data type

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus ObjectClass
C0080331
NCI Metathesaurus ObjectClass-2
C0392680
Walking up a hill
Description

WalkHillBreathShortnessAssessmentScale

Data type

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus ObjectClass
C0392680
NCI Metathesaurus ObjectClass-2
C0580809
Walking up stairs
Description

ClimbingStairsBreathShortnessAssessmentScale

Data type

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus ObjectClass
CL299704
NCI Metathesaurus ObjectClass-2
C0392680
While eating
Description

EatingBreathShortnessAssessmentScale

Data type

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus ObjectClass
C0392680
NCI Metathesaurus ObjectClass-2
C0013470
Standing up from a chair
Description

StandingUpBreathShortnessAssessmentScale

Data type

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus ObjectClass
C0392680
NCI Metathesaurus ObjectClass-2
C0444796
Brushing teeth
Description

ToothbrushingBreathShortnessAssessmentScale

Data type

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus ObjectClass
C0392680
NCI Thesaurus ObjectClass
C63734
UMLS 2011AA ObjectClass
C0040461
Shaving and/or brushing hair
Description

ShavingBreathShortnessAssessmentScale

Data type

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus ObjectClass
C0392680
NCI Metathesaurus ObjectClass-2
C0522772
Showering/bathing
Description

BathingBreathShortnessAssessmentScale

Data type

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus ObjectClass
C0150141
NCI Metathesaurus ObjectClass-2
C0392680
Dressing
Description

DressingBreathShortnessAssessmentScale

Data type

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus ObjectClass
C0392680
NCI Metathesaurus ObjectClass-2
CL313791
Picking up and straightening
Description

HouseCleaningBreathShortnessAssessmentScale

Data type

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus ObjectClass
C0392680
NCI Metathesaurus ObjectClass-2
C0564042
Doing dishes
Description

KitchenBreathShortnessAssessmentScale

Data type

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus ObjectClass
C0392680
NCI Metathesaurus ObjectClass-2
C0557653
Sweeping/vacuuming
Description

VacuumCleanerBreathShortnessAssessmentScale

Data type

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus ObjectClass
C0392680
NCI Metathesaurus ObjectClass-2
C0392308
Making bed
Description

MakeBedBreathShortnessAssessmentScale

Data type

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus ObjectClass
C0392680
NCI Metathesaurus ObjectClass-2
C0564030
Shopping
Description

ShoppingBreathShortnessAssessmentScale

Data type

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus ObjectClass
C0392680
NCI Metathesaurus ObjectClass-2
CL112583
Doing laundry
Description

LaundryBreathShortnessAssessmentScale

Data type

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus ObjectClass
C0392680
NCI Metathesaurus ObjectClass-2
C0542293
Washing car
Description

WashingBreathShortnessAssessmentScale

Data type

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus ObjectClass
C0392680
NCI Metathesaurus ObjectClass-2
C0563947
Mowing lawn
Description

LawnmowerBreathShortnessAssessmentScale

Data type

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus ObjectClass
C0392680
NCI Metathesaurus ObjectClass-2
C0441054
Watering lawn
Description

WaterBreathShortnessAssessmentScale

Data type

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus ObjectClass
C0597678
NCI Metathesaurus ObjectClass-2
C0392680
Sexual activities
Description

SexualActivityBreathShortnessAssessmentScale

Data type

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus ObjectClass
C0392680
NCI Metathesaurus ObjectClass-2
CL197653
How Much Do These Limit Your Daily Life
Description

How Much Do These Limit Your Daily Life

Shortness of breath
Description

BreathShortnessAssessmentScale

Data type

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus ObjectClass
C0392680
Fear of "hurting myself" by overexerting
Description

OverexertionBreathShortnessAssessmentScale

Data type

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus ObjectClass
C0392680
NCI Metathesaurus ObjectClass-2
C0301616
Fear of shortness of breath
Description

FearBreathShortnessAssessmentScale

Data type

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus ObjectClass
C0392680
NCI Metathesaurus ObjectClass-2
C0015726
Footer Module
Description

Footer Module

Date Form Completed
Description

Date Form Completed

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS CUI-1
C1115437
NCI Thesaurus ObjectClass
C40988
NCI Thesaurus Property
C25250
NCI Thesaurus ValueDomain-2
C25367
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1 forms
  1. StudyEvent: Z4032 UCSD - Shortness of Breath Questionnaire
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Header Module
Item
Visit
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25616 (NCI Thesaurus Property)
C1948053 (UMLS 2011AA Property)
C19712 (NCI Thesaurus ObjectClass)
C1515944 (UMLS 2011AA ObjectClass)
C25716 (NCI Thesaurus ObjectClass-2)
C0545082 (UMLS 2011AA ObjectClass-2)
CL.1
Code List
Visit
CL Item
Month 12 (Month 12)
CL Item
Month 24 (Month 24)
CL Item
Month 3 (Month 3)
CL Item
Registration (Registration)
C25646 (NCI Thesaurus)
C1514821 (UMLS 2011AA)
Patient Study ID
Item
Patient ID (Pt. ID issued during registration or previously issued Patient ID)
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25462 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Institution Number
Item
Institution ID
text
C25337 (NCI Thesaurus ValueDomain)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass)
C0805701 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
Patient Initials
Item
Patient Initials
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
Institution Name
Item
Institution
text
C25191 (NCI Thesaurus ValueDomain)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass)
C21541 (NCI Thesaurus ValueDomain-2)
C25364 (NCI Thesaurus Property)
Item Group
How Short Of Breath Do You Get
Item
At rest
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0392680 (NCI Metathesaurus ObjectClass)
C0443144 (NCI Metathesaurus ObjectClass-2)
CL.2
Code List
At rest
CL Item
Not At All (0)
C91213 (NCI Thesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
Maximum (5)
C25564 (NCI Thesaurus)
C0806909 (UMLS 2011AA)
Item
Walking on a level at your own pace
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0392680 (NCI Metathesaurus ObjectClass)
C0560049 (NCI Metathesaurus ObjectClass-2)
CL.3
Code List
Walking on a level at your own pace
CL Item
Not At All (0)
C91213 (NCI Thesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
Maximum (5)
C25564 (NCI Thesaurus)
C0806909 (UMLS 2011AA)
Item
Walking on a level with others your age
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0080331 (NCI Metathesaurus ObjectClass)
C0392680 (NCI Metathesaurus ObjectClass-2)
CL.4
Code List
Walking on a level with others your age
CL Item
Not At All (0)
C91213 (NCI Thesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
Maximum (5)
C25564 (NCI Thesaurus)
C0806909 (UMLS 2011AA)
Item
Walking up a hill
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0392680 (NCI Metathesaurus ObjectClass)
C0580809 (NCI Metathesaurus ObjectClass-2)
CL.5
Code List
Walking up a hill
CL Item
Not At All (0)
C91213 (NCI Thesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
Maximum (5)
C25564 (NCI Thesaurus)
C0806909 (UMLS 2011AA)
Item
Walking up stairs
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
CL299704 (NCI Metathesaurus ObjectClass)
C0392680 (NCI Metathesaurus ObjectClass-2)
CL.6
Code List
Walking up stairs
CL Item
Not At All (0)
C91213 (NCI Thesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
Maximum (5)
C25564 (NCI Thesaurus)
C0806909 (UMLS 2011AA)
Item
While eating
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0392680 (NCI Metathesaurus ObjectClass)
C0013470 (NCI Metathesaurus ObjectClass-2)
CL.7
Code List
While eating
CL Item
Not At All (0)
C91213 (NCI Thesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
Maximum (5)
C25564 (NCI Thesaurus)
C0806909 (UMLS 2011AA)
Item
Standing up from a chair
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0392680 (NCI Metathesaurus ObjectClass)
C0444796 (NCI Metathesaurus ObjectClass-2)
CL.8
Code List
Standing up from a chair
CL Item
Not At All (0)
C91213 (NCI Thesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
Maximum (5)
C25564 (NCI Thesaurus)
C0806909 (UMLS 2011AA)
Item
Brushing teeth
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0392680 (NCI Metathesaurus ObjectClass)
C63734 (NCI Thesaurus ObjectClass)
C0040461 (UMLS 2011AA ObjectClass)
CL.9
Code List
Brushing teeth
CL Item
Not At All (0)
C91213 (NCI Thesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
Maximum (5)
C25564 (NCI Thesaurus)
C0806909 (UMLS 2011AA)
Item
Shaving and/or brushing hair
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0392680 (NCI Metathesaurus ObjectClass)
C0522772 (NCI Metathesaurus ObjectClass-2)
CL.10
Code List
Shaving and/or brushing hair
CL Item
Not At All (0)
C91213 (NCI Thesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
Maximum (5)
C25564 (NCI Thesaurus)
C0806909 (UMLS 2011AA)
Item
Showering/bathing
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0150141 (NCI Metathesaurus ObjectClass)
C0392680 (NCI Metathesaurus ObjectClass-2)
CL.11
Code List
Showering/bathing
CL Item
Not At All (0)
C91213 (NCI Thesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
Maximum (5)
C25564 (NCI Thesaurus)
C0806909 (UMLS 2011AA)
Item
Dressing
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0392680 (NCI Metathesaurus ObjectClass)
CL313791 (NCI Metathesaurus ObjectClass-2)
CL.12
Code List
Dressing
CL Item
Not At All (0)
C91213 (NCI Thesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
Maximum (5)
C25564 (NCI Thesaurus)
C0806909 (UMLS 2011AA)
Item
Picking up and straightening
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0392680 (NCI Metathesaurus ObjectClass)
C0564042 (NCI Metathesaurus ObjectClass-2)
CL.13
Code List
Picking up and straightening
CL Item
Not At All (0)
C91213 (NCI Thesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
Maximum (5)
C25564 (NCI Thesaurus)
C0806909 (UMLS 2011AA)
Item
Doing dishes
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0392680 (NCI Metathesaurus ObjectClass)
C0557653 (NCI Metathesaurus ObjectClass-2)
CL.14
Code List
Doing dishes
CL Item
Not At All (0)
C91213 (NCI Thesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
Maximum (5)
C25564 (NCI Thesaurus)
C0806909 (UMLS 2011AA)
Item
Sweeping/vacuuming
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0392680 (NCI Metathesaurus ObjectClass)
C0392308 (NCI Metathesaurus ObjectClass-2)
CL.15
Code List
Sweeping/vacuuming
CL Item
Not At All (0)
C91213 (NCI Thesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
Maximum (5)
C25564 (NCI Thesaurus)
C0806909 (UMLS 2011AA)
Item
Making bed
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0392680 (NCI Metathesaurus ObjectClass)
C0564030 (NCI Metathesaurus ObjectClass-2)
CL.16
Code List
Making bed
CL Item
Not At All (0)
C91213 (NCI Thesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
Maximum (5)
C25564 (NCI Thesaurus)
C0806909 (UMLS 2011AA)
Item
Shopping
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0392680 (NCI Metathesaurus ObjectClass)
CL112583 (NCI Metathesaurus ObjectClass-2)
CL.17
Code List
Shopping
CL Item
Not At All (0)
C91213 (NCI Thesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
Maximum (5)
C25564 (NCI Thesaurus)
C0806909 (UMLS 2011AA)
Item
Doing laundry
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0392680 (NCI Metathesaurus ObjectClass)
C0542293 (NCI Metathesaurus ObjectClass-2)
CL.18
Code List
Doing laundry
CL Item
Not At All (0)
C91213 (NCI Thesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
Maximum (5)
C25564 (NCI Thesaurus)
C0806909 (UMLS 2011AA)
Item
Washing car
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0392680 (NCI Metathesaurus ObjectClass)
C0563947 (NCI Metathesaurus ObjectClass-2)
CL.19
Code List
Washing car
CL Item
Not At All (0)
C91213 (NCI Thesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
Maximum (5)
C25564 (NCI Thesaurus)
C0806909 (UMLS 2011AA)
Item
Mowing lawn
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0392680 (NCI Metathesaurus ObjectClass)
C0441054 (NCI Metathesaurus ObjectClass-2)
CL.20
Code List
Mowing lawn
CL Item
Not At All (0)
C91213 (NCI Thesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
Maximum (5)
C25564 (NCI Thesaurus)
C0806909 (UMLS 2011AA)
Item
Watering lawn
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0597678 (NCI Metathesaurus ObjectClass)
C0392680 (NCI Metathesaurus ObjectClass-2)
CL.21
Code List
Watering lawn
CL Item
Not At All (0)
C91213 (NCI Thesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
Maximum (5)
C25564 (NCI Thesaurus)
C0806909 (UMLS 2011AA)
Item
Sexual activities
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0392680 (NCI Metathesaurus ObjectClass)
CL197653 (NCI Metathesaurus ObjectClass-2)
CL.22
Code List
Sexual activities
CL Item
Not At All (0)
C91213 (NCI Thesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
Maximum (5)
C25564 (NCI Thesaurus)
C0806909 (UMLS 2011AA)
Item Group
How Much Do These Limit Your Daily Life
Item
Shortness of breath
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0392680 (NCI Metathesaurus ObjectClass)
CL.23
Code List
Shortness of breath
CL Item
Not At All (0)
C91213 (NCI Thesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
Maximum (5)
C25564 (NCI Thesaurus)
C0806909 (UMLS 2011AA)
Item
Fear of "hurting myself" by overexerting
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0392680 (NCI Metathesaurus ObjectClass)
C0301616 (NCI Metathesaurus ObjectClass-2)
CL.24
Code List
Fear of "hurting myself" by overexerting
CL Item
Not At All (0)
C91213 (NCI Thesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
Maximum (5)
C25564 (NCI Thesaurus)
C0806909 (UMLS 2011AA)
Item
Fear of shortness of breath
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0392680 (NCI Metathesaurus ObjectClass)
C0015726 (NCI Metathesaurus ObjectClass-2)
CL.25
Code List
Fear of shortness of breath
CL Item
Not At All (0)
C91213 (NCI Thesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
Maximum (5)
C25564 (NCI Thesaurus)
C0806909 (UMLS 2011AA)
Item Group
Footer Module
Date Form Completed
Item
Date Form Completed
date
C25164 (NCI Thesaurus ValueDomain)
C1115437 (UMLS CUI-1)
C40988 (NCI Thesaurus ObjectClass)
C25250 (NCI Thesaurus Property)
C25367 (NCI Thesaurus ValueDomain-2)
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