ID

22019

Beskrivning

Study part: Medical History. A phase III multinational, randomized, single-blind study of recombinant humanized anti-p185HER2 monoclonal antibody (rhuMAb HER2) in patients with HER2/neu overexpression who have not received prior cytotoxic chemotherapy for metastatic breast cancer. "Terms of use: You may not use this document or the information contained herein to a regulatory authority in connection with an application for a marketing authorization or any other regulatory submission without the express written consent of Roche"

Nyckelord

Versioner (1)
  1. 2017-05-14 2017-05-14 -
Rättsinnehavare

Roche

Uppladdad den

14 maj 2017

DOI

För en begäran logga in.

Licens

Creative Commons BY-NC 3.0
Modellkommentarer :

Här kan du kommentera modellen. Med hjälp av pratbubblor i Item-grupperna och Item kan du lägga in specifika kommentarer.

Tillbaka till modellkommentarer
Itemgroup-kommentar för :

Item-kommentar för :

Du måste vara inloggad för att kunna ladda ner formulär. Var vänlig logga in eller registrera dig utan kostnad.

MEDICAL HISTORY Roche H0650g Breast Cancer

Engelsk

MEDICAL HISTORY

1 Formulär  
  1. StudyEvent: ODM
    1. MEDICAL HISTORY
MEDICAL HISTORY (OTHER THAN BREAST CANCER)
Beskrivning

MEDICAL HISTORY (OTHER THAN BREAST CANCER)

Alias
UMLS CUI-1
C0262926
PATIENT INT.
Beskrivning

Patient initial

Datatyp

text

Alias
UMLS CUI [1]
C2986440
PATIENT NUMBER
Beskrivning

Patient id

Datatyp

integer

Alias
UMLS CUI [1]
C2348585
IS PATIENT ALLERGIC TO ANY MEDICATION?
Beskrivning

Hypersensitivity drugs

Datatyp

text

Alias
UMLS CUI [1,1]
C0020517
UMLS CUI [1,2]
C0013227
IF YES, LIST MEDICATION(S).
Beskrivning

Medication name

Datatyp

text

Alias
UMLS CUI [1]
C2360065
ACTIVE INTERCURRENT ILLNESSES (other than breast cancer)
Beskrivning

ACTIVE INTERCURRENT ILLNESSES (other than breast cancer)

Alias
UMLS CUI-1
C0012634
ACTIVE INTERCURRENT ILLNESSES (other than breast cancer) -NONE
Beskrivning

disease present

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0012634
UMLS CUI [1,2]
C0150312
ACTIVE INTERCURRENT ILLNESSES (other than breast cancer)
Beskrivning

disease present

Datatyp

text

Alias
UMLS CUI [1,1]
C0012634
UMLS CUI [1,2]
C0150312
DATE OF DIAGNOSIS
Beskrivning

date of diagnosis

Datatyp

date

Alias
UMLS CUI [1]
C2316983
PAST MAJOR SURGERIES AND PAST MAJOR ILLNESSES
Beskrivning

PAST MAJOR SURGERIES AND PAST MAJOR ILLNESSES

Alias
UMLS CUI-1
C0744961
UMLS CUI-2
C0012634
UMLS CUI-3
C0205156
PAST MAJOR SURGERIES AND PAST MAJOR ILLNESSES
Beskrivning

history of prior surgery; disease Previous

Datatyp

text

Alias
UMLS CUI [1,1]
C0744961
UMLS CUI [1,2]
C0012634
UMLS CUI [1,3]
C0205156
PAST MAJOR SURGERIES AND PAST MAJOR ILLNESSES
Beskrivning

history of prior surgery; disease Previous

Datatyp

text

Alias
UMLS CUI [1,1]
C0744961
UMLS CUI [1,2]
C0012634
UMLS CUI [1,3]
C0205156
DATE OF SURGERY/ILLNESS
Beskrivning

date surgery; date of diagnosis

Datatyp

date

Alias
UMLS CUI [1]
C1628561
UMLS CUI [2]
C2316983
Tillbaka till toppen

Similar models

MEDICAL HISTORY

1 Formulär
  1. StudyEvent: ODM
    1. MEDICAL HISTORY
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
MEDICAL HISTORY (OTHER THAN BREAST CANCER)
C0262926 (UMLS CUI-1)
Patient initial
Item
PATIENT INT.
text
C2986440 (UMLS CUI [1])
Patient id
Item
PATIENT NUMBER
integer
C2348585 (UMLS CUI [1])
Item
IS PATIENT ALLERGIC TO ANY MEDICATION?
text
C0020517 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
Hypersensitivity drugs
Code List
IS PATIENT ALLERGIC TO ANY MEDICATION?
CL Item
YES (YES)
CL Item
NO (NO)
CL Item
UNKNOWN (UNKNOWN)
Medication name
Item
IF YES, LIST MEDICATION(S).
text
C2360065 (UMLS CUI [1])
Item Group
ACTIVE INTERCURRENT ILLNESSES (other than breast cancer)
C0012634 (UMLS CUI-1)
disease present
Item
ACTIVE INTERCURRENT ILLNESSES (other than breast cancer) -NONE
boolean
C0012634 (UMLS CUI [1,1])
C0150312 (UMLS CUI [1,2])
disease present
Item
ACTIVE INTERCURRENT ILLNESSES (other than breast cancer)
text
C0012634 (UMLS CUI [1,1])
C0150312 (UMLS CUI [1,2])
date of diagnosis
Item
DATE OF DIAGNOSIS
date
C2316983 (UMLS CUI [1])
Item Group
PAST MAJOR SURGERIES AND PAST MAJOR ILLNESSES
C0744961 (UMLS CUI-1)
C0012634 (UMLS CUI-2)
C0205156 (UMLS CUI-3)
Item
PAST MAJOR SURGERIES AND PAST MAJOR ILLNESSES
text
C0744961 (UMLS CUI [1,1])
C0012634 (UMLS CUI [1,2])
C0205156 (UMLS CUI [1,3])
history of prior surgery; disease Previous
Code List
PAST MAJOR SURGERIES AND PAST MAJOR ILLNESSES
CL Item
NONE  (NONE )
CL Item
UNKNOWN (UNKNOWN)
history of prior surgery; disease Previous
Item
PAST MAJOR SURGERIES AND PAST MAJOR ILLNESSES
text
C0744961 (UMLS CUI [1,1])
C0012634 (UMLS CUI [1,2])
C0205156 (UMLS CUI [1,3])
date surgery; date of diagnosis
Item
DATE OF SURGERY/ILLNESS
date
C1628561 (UMLS CUI [1])
C2316983 (UMLS CUI [2])
Tillbaka till toppen 

Kontakt

Använd detta formulär för feedback, frågor och förslag på förbättringar.

Fält markerade med * är obligatoriska.

Hjälp

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial