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  1. StudyEvent: Radiation Therapy Oncology Group Phase III Lung Prophylactic Cranial RT Activities of Daily Living Scale
    1. No Instruction available.
Unnamed 1
Beschrijving

Unnamed 1

Case #
Beschrijving

Case#

Datatype

text

Institution
Beschrijving

Institution

Datatype

text

Institution No.
Beschrijving

InstitutionNo.

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
Patient's Name
Beschrijving

Patient'sName

Datatype

text

Patient's I.D. No.
Beschrijving

Patient'sI.D.No.

Datatype

text

If this is a revised or corrected form, indicate by checking box.
Beschrijving

Ifthisisarevisedorcorrectedform,indicatebycheckingbox.

Datatype

text

Unnamed 2
Beschrijving

Unnamed 2

If not completed by patient, by whom and why? (Self Care Activities)
Beschrijving

Ifnotcompletedbypatient,bywhomandwhy?

Datatype

text

Eating
Beschrijving

Eating

Datatype

text

Dressing
Beschrijving

Dressing

Datatype

text

Bathing
Beschrijving

Bathing

Datatype

text

Elimination
Beschrijving

Elimination

Datatype

text

Mobility in home
Beschrijving

Mobilityinhome

Datatype

text

Comments
Beschrijving

Comments

Datatype

text

Patient Initials
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
Date completed
Beschrijving

DateCompleted

Datatype

date

Ccrr Module For Radiation Therapy Oncology Group Phase Iii Lung Prophylactic Cranial Rt Activities Of Daily Living Scale
Beschrijving

Ccrr Module For Radiation Therapy Oncology Group Phase Iii Lung Prophylactic Cranial Rt Activities Of Daily Living Scale

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Similar models

No Instruction available.

1 Formulieren
  1. StudyEvent: Radiation Therapy Oncology Group Phase III Lung Prophylactic Cranial RT Activities of Daily Living Scale
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Unnamed 1
Case#
Item
Case #
text
Institution
Item
Institution
text
InstitutionNo.
Item
Institution No.
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
Patient'sName
Item
Patient's Name
text
Patient'sI.D.No.
Item
Patient's I.D. No.
text
Ifthisisarevisedorcorrectedform,indicatebycheckingbox.
Item
If this is a revised or corrected form, indicate by checking box.
text
Item Group
Unnamed 2
Ifnotcompletedbypatient,bywhomandwhy?
Item
If not completed by patient, by whom and why? (Self Care Activities)
text
Item
Eating
text
CL.1
Code List
Eating
CL Item
No Problem (No problem)
CL Item
Independent, But Slow Or Some Spills (Independent, but slow or some spills)
CL Item
Need Help To Cut Or Pour; Spills Often (Need help to cut or pour; spills often)
CL Item
Must Be Fed Most Foods (Must be fed most foods)
CL Item
Don't Know (Don't know)
Item
Dressing
text
CL.2
Code List
Dressing
CL Item
No Problem (No problem)
CL Item
Independent, But Slow Or Clumsy (Independent, but slow or clumsy)
CL Item
Wrong Sequence, Forget Items (Wrong sequence, forget items)
CL Item
Need Help With Dressing (Need help with dressing)
CL Item
Don't Know (Don't know)
Item
Bathing
text
CL.3
Code List
Bathing
CL Item
No Problem (No problem)
CL Item
Bathe Self, But Needs To Be Reminded (Bathe self, but needs to be reminded)
CL Item
Bathe Self With Assistance (Bathe self with assistance)
CL Item
Must Be Bathed By Others (Must be bathed by others)
CL Item
Don't Know (Don't know)
Item
Elimination
text
CL.4
Code List
Elimination
CL Item
Go To The Bathroom Independently (Go to the bathroom independently)
CL Item
Got To The Bathroom When Reminded; Some Accidents (Got to the bathroom when reminded; some accidents)
CL Item
Needs Assistance For Elimination (Needs assistance for elimination)
CL Item
Have No Control Over Either Bowel Or Bladder (Have no control over either bowel or bladder)
CL Item
Don't Know (Don't know)
Item
Mobility in home
text
CL.5
Code List
Mobility in home
CL Item
No Problems (No problems)
CL Item
Move Into And Out Of Bed Or Chair Independently (may Use A Cane Or Walker For Support) (Move into and out of bed or chair independently (may use a cane or walker for support))
CL Item
Move Into And Out Of Bed Or Chair With Assistance (Move into and out of bed or chair with assistance)
CL Item
Do Not Get Out Of Bed (Do not get out of bed)
CL Item
Don't Know (Don't know)
Comments
Item
Comments
text
PatientInitialsName
Item
Patient Initials
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)
DateCompleted
Item
Date completed
date
Item Group
Ccrr Module For Radiation Therapy Oncology Group Phase Iii Lung Prophylactic Cranial Rt Activities Of Daily Living Scale
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