ID
2206
Description
Supplemental Laboratory Report Form Gefitinib in Treating Patients With Non-Small Cell Lung Cancer That Has Been Surgically Removed Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A7039E38-F4C1-1898-E034-0003BA0B1A09
Link
Keywords
Versions (2)
- 9/19/12 9/19/12 -
- 1/9/15 1/9/15 - Martin Dugas
Uploaded on
September 19, 2012
DOI
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License
Creative Commons BY-NC 3.0 Legacy
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Lung Cancer NCT00049543 Lab - Supplemental Laboratory Report Form - 2036656v3.0
No Instruction available.
- StudyEvent: Supplemental Laboratory Report Form
Description
Month Of Report
Description
VisitReportMonthCount
Data type
text
Alias
- NCI Thesaurus Property
- C29846
- UMLS 2011AA Property
- C0439231
- NCI Thesaurus ObjectClass
- C25375
- UMLS 2011AA ObjectClass
- C0684224
- NCI Thesaurus ValueDomain
- C25463
- UMLS 2011AA ValueDomain
- C0750480
- NCI Thesaurus ObjectClass
- C25716
- UMLS 2011AA ObjectClass
- C0545082
Description
VisitReportMonthSpecify
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
- NCI Thesaurus Property
- C29846
- UMLS 2011AA Property
- C0439231
- NCI Thesaurus ObjectClass
- C25375
- UMLS 2011AA ObjectClass
- C0684224
- NCI Thesaurus ObjectClass
- C25716
- UMLS 2011AA ObjectClass
- C0545082
Description
Biochemistry
Description
SpecimenCollectionDate
Data type
date
Description
Lab,UnitsofMeasure
Data type
text
Description
Lab,Hepatic,Bilirubin
Data type
double
Description
HepaticBilirubinLabUpperLimitNormalValue
Data type
double
Alias
- NCI Thesaurus ObjectClass
- C25294
- UMLS 2011AA ObjectClass
- C0022885
- NCI Thesaurus Property
- C20200
- UMLS 2011AA Property
- C1274040
- NCI Thesaurus Property
- C305
- UMLS 2011AA Property
- C0005437
- NCI Thesaurus ValueDomain
- C25712
- UMLS 2011AA ValueDomain
- C1522609
- NCI Thesaurus ValueDomain
- C25706
- UMLS 2011AA ValueDomain
- C1519815
Description
Lab,Hepatic,SGOT
Data type
double
Description
SGOTLabUpperLimitNormalValue
Data type
double
Alias
- NCI Thesaurus ValueDomain
- C25712
- UMLS 2011AA ValueDomain
- C1522609
- NCI Thesaurus ValueDomain
- C25706
- UMLS 2011AA ValueDomain
- C1519815
Description
Lab,Hepatic,SGPT
Data type
double
Description
SGPTLabUpperLimitNormalValue
Data type
double
Alias
- NCI Thesaurus ValueDomain
- C25712
- UMLS 2011AA ValueDomain
- C1522609
- NCI Thesaurus ValueDomain
- C25706
- UMLS 2011AA ValueDomain
- C1519815
Description
Lab,Hepatic,AlkalinePhosphatase
Data type
double
Description
LaboratoryProcedureAlkalinePhosphataseResultUpperLimitNormalValue
Data type
double
Alias
- NCI Thesaurus ObjectClass
- C25294
- UMLS 2011AA ObjectClass
- C0022885
- NCI Thesaurus Property
- C20200
- UMLS 2011AA Property
- C1274040
- NCI Thesaurus Property
- C16276
- UMLS 2011AA Property
- C0002059
- NCI Thesaurus ValueDomain
- C25712
- UMLS 2011AA ValueDomain
- C1522609
- NCI Thesaurus ValueDomain
- C25706
- UMLS 2011AA ValueDomain
- C1519815
Description
Lab,Chemistry,LactateDehydrogenase
Data type
double
Description
Lab,Chemistry,LactateDehydrogenase,ULN
Data type
double
Description
Lab,Renal,Creatinine
Data type
double
Description
LaboratoryProcedureCreatinineResultUpperLimitNormalValue
Data type
double
Alias
- NCI Thesaurus ObjectClass
- C25294
- UMLS 2011AA ObjectClass
- C0022885
- NCI Thesaurus Property
- C20200
- UMLS 2011AA Property
- C1274040
- NCI Thesaurus Property
- C399
- UMLS 2011AA Property
- C0010294
- NCI Thesaurus ValueDomain
- C25712
- UMLS 2011AA ValueDomain
- C1522609
- NCI Thesaurus ValueDomain
- C25706
- UMLS 2011AA ValueDomain
- C1519815
Description
Lab,Renal,BUN
Data type
double
Description
LaboratoryProcedureBloodUreaNitrogenResultUpperLimitNormalValue
Data type
double
Alias
- NCI Thesaurus ObjectClass
- C25294
- UMLS 2011AA ObjectClass
- C0022885
- NCI Thesaurus Property
- C20200
- UMLS 2011AA Property
- C1274040
- NCI Thesaurus Property
- C61019
- UMLS 2011AA Property
- C0005845
- NCI Thesaurus ValueDomain
- C25712
- UMLS 2011AA ValueDomain
- C1522609
- NCI Thesaurus ValueDomain
- C25706
- UMLS 2011AA ValueDomain
- C1519815
Description
Lab,Electrolytes,Potassium
Data type
double
Description
LaboratoryProcedurePotassiumElectrolytesOutcomeLowerLimitNormalValue
Data type
double
Alias
- NCI Thesaurus ObjectClass
- C25294
- UMLS 2011AA ObjectClass
- C0022885
- NCI Thesaurus Property
- C20200
- UMLS 2011AA Property
- C1274040
- NCI Thesaurus Property
- C464
- UMLS 2011AA Property
- C0013832
- NCI Thesaurus Property
- C765
- UMLS 2011AA Property
- C0032821
- NCI Thesaurus ValueDomain
- C25712
- UMLS 2011AA ValueDomain
- C1522609
- NCI Thesaurus ValueDomain
- C25555
- UMLS 2011AA ValueDomain
- C1518030
Description
LaboratoryProcedurePotassiumElectrolytesOutcomeUpperLimitNormalValue
Data type
double
Alias
- NCI Thesaurus ObjectClass
- C25294
- UMLS 2011AA ObjectClass
- C0022885
- NCI Thesaurus Property
- C20200
- UMLS 2011AA Property
- C1274040
- NCI Thesaurus Property
- C464
- UMLS 2011AA Property
- C0013832
- NCI Thesaurus Property
- C765
- UMLS 2011AA Property
- C0032821
- NCI Thesaurus ValueDomain
- C25712
- UMLS 2011AA ValueDomain
- C1522609
- NCI Thesaurus ValueDomain
- C25706
- UMLS 2011AA ValueDomain
- C1519815
Description
Lab,Electrolytes,Sodium
Data type
double
Description
LaboratoryProcedureSodiumElectrolytesOutcomeLowerLimitofNormalValue
Data type
double
Alias
- NCI Thesaurus ObjectClass
- C25294
- UMLS 2011AA ObjectClass
- C0022885
- NCI Thesaurus Property
- C20200
- UMLS 2011AA Property
- C1274040
- NCI Thesaurus Property
- C830
- UMLS 2011AA Property
- C0037473
- NCI Thesaurus Property
- C464
- UMLS 2011AA Property
- C0013832
- NCI Thesaurus ValueDomain
- C25712
- UMLS 2011AA ValueDomain
- C1522609
- NCI Thesaurus ValueDomain
- C25555
- UMLS 2011AA ValueDomain
- C1518030
Description
LaboratoryProcedureSodiumElectrolytesOutcomeUpperLimitofNormalValue
Data type
double
Alias
- NCI Thesaurus ObjectClass
- C25294
- UMLS 2011AA ObjectClass
- C0022885
- NCI Thesaurus Property
- C20200
- UMLS 2011AA Property
- C1274040
- NCI Thesaurus Property
- C830
- UMLS 2011AA Property
- C0037473
- NCI Thesaurus Property
- C464
- UMLS 2011AA Property
- C0013832
- NCI Thesaurus ValueDomain
- C25712
- UMLS 2011AA ValueDomain
- C1522609
- NCI Thesaurus ValueDomain
- C25706
- UMLS 2011AA ValueDomain
- C1519815
Description
Lab,Electrolytes,Chloride
Data type
double
Description
LaboratoryProcedureChlorideIonElectrolytesOutcomeLowerLimitofNormalValue
Data type
double
Alias
- NCI Thesaurus ObjectClass
- C25294
- UMLS 2011AA ObjectClass
- C0022885
- NCI Thesaurus Property
- C20200
- UMLS 2011AA Property
- C1274040
- NCI Thesaurus Property
- C464
- UMLS 2011AA Property
- C0013832
- NCI Thesaurus Property
- C1741
- UMLS 2011AA Property
- C0596019
- NCI Thesaurus ValueDomain
- C25712
- UMLS 2011AA ValueDomain
- C1522609
- NCI Thesaurus ValueDomain
- C25555
- UMLS 2011AA ValueDomain
- C1518030
Description
LaboratoryProcedureChlorideIonElectrolytesOutcomeUpperLimitofNormalValue
Data type
double
Alias
- NCI Thesaurus ObjectClass
- C25294
- UMLS 2011AA ObjectClass
- C0022885
- NCI Thesaurus Property
- C20200
- UMLS 2011AA Property
- C1274040
- NCI Thesaurus Property
- C464
- UMLS 2011AA Property
- C0013832
- NCI Thesaurus Property
- C1741
- UMLS 2011AA Property
- C0596019
- NCI Thesaurus ValueDomain
- C25712
- UMLS 2011AA ValueDomain
- C1522609
- NCI Thesaurus ValueDomain
- C25706
- UMLS 2011AA ValueDomain
- C1519815
Description
Lab,Electrolytes,Calcium
Data type
double
Description
LaboratoryProcedureCalciumElectrolytesOutcomeLowerLimitofNormalValue
Data type
double
Alias
- NCI Thesaurus ObjectClass
- C25294
- UMLS 2011AA ObjectClass
- C0022885
- NCI Thesaurus Property
- C331
- UMLS 2011AA Property
- C0006675
- NCI Thesaurus Property
- C20200
- UMLS 2011AA Property
- C1274040
- NCI Thesaurus Property
- C464
- UMLS 2011AA Property
- C0013832
- NCI Thesaurus ValueDomain
- C25712
- UMLS 2011AA ValueDomain
- C1522609
- NCI Thesaurus ValueDomain
- C25555
- UMLS 2011AA ValueDomain
- C1518030
Description
LaboratoryProcedureCalciumElectrolytesOutcomeUpperLimitofNormalValue
Data type
double
Alias
- NCI Thesaurus ObjectClass
- C25294
- UMLS 2011AA ObjectClass
- C0022885
- NCI Thesaurus Property
- C331
- UMLS 2011AA Property
- C0006675
- NCI Thesaurus Property
- C20200
- UMLS 2011AA Property
- C1274040
- NCI Thesaurus Property
- C464
- UMLS 2011AA Property
- C0013832
- NCI Thesaurus ValueDomain
- C25712
- UMLS 2011AA ValueDomain
- C1522609
- NCI Thesaurus ValueDomain
- C25706
- UMLS 2011AA ValueDomain
- C1519815
Description
Chemistry,BloodAlbumin
Data type
double
Description
LaboratoryProcedureAlbuminResultLowerLimitofNormalValue
Data type
double
Alias
- NCI Thesaurus ObjectClass
- C25294
- UMLS 2011AA ObjectClass
- C0022885
- NCI Thesaurus Property
- C20200
- UMLS 2011AA Property
- C1274040
- NCI Thesaurus Property
- C214
- UMLS 2011AA Property
- C0001924
- NCI Thesaurus ValueDomain
- C25712
- UMLS 2011AA ValueDomain
- C1522609
- NCI Thesaurus ValueDomain
- C25555
- UMLS 2011AA ValueDomain
- C1518030
Description
LaboratoryProcedureAlbuminResultUpperLimitNormalValue
Data type
double
Alias
- NCI Thesaurus ObjectClass
- C25294
- UMLS 2011AA ObjectClass
- C0022885
- NCI Thesaurus Property
- C20200
- UMLS 2011AA Property
- C1274040
- NCI Thesaurus Property
- C214
- UMLS 2011AA Property
- C0001924
- NCI Thesaurus ValueDomain
- C25712
- UMLS 2011AA ValueDomain
- C1522609
- NCI Thesaurus ValueDomain
- C25706
- UMLS 2011AA ValueDomain
- C1519815
Description
Ncic Ctg Use Only
Description
LoggedEntryInitials
Data type
text
Description
LoggedEntryDate
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Description
RegulatoryAffairsReviewInitials
Data type
text
Description
RegulatoryAffairsReviewDate
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Description
CoordinatorReviewInitials
Data type
text
Description
CoordinatorReviewDate
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Description
PhysicianReviewInitials
Data type
text
Description
DataEntryInitials
Data type
text
Description
DataVerificationInitials
Data type
text
Description
Unnamed1
Description
PatientStudyID,CoordinatingGroup
Data type
text
Description
PatientInitialsName
Data type
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
Description
Hematology
Description
Lab,Hematology,SampleCollectionDate
Data type
date
Description
Lab,UnitsofMeasure
Data type
text
Description
Lab,Hematology,Hemoglobin
Data type
double
Description
Lab,Hematology,Platelets
Data type
double
Description
Lab,Hematology,WBC
Data type
double
Description
Lab,Hematology,Neutrophils,CellPercentage
Data type
double
Description
Comments
Description
Investigator Signature
Description
InvestigatorSignature
Data type
text
Alias
- NCI Thesaurus Property
- C25678
- UMLS 2011AA Property
- C1519316
- NCI Thesaurus ObjectClass
- C17089
- UMLS 2011AA ObjectClass
- C0035173
Description
PersonCompletingForm,LastName
Data type
text
Description
PersonCompletingForm,FirstName
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
Description
FormCompletionDate,Original
Data type
date
Description
Ccrr Module For Supplemental Laboratory Report Form
Similar models
No Instruction available.
- StudyEvent: Supplemental Laboratory Report Form
C1547383 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25536 (NCI Thesaurus Property)
C1555582 (UMLS 2011AA Property)
C0439231 (UMLS 2011AA Property)
C25375 (NCI Thesaurus ObjectClass)
C0684224 (UMLS 2011AA ObjectClass)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C25716 (NCI Thesaurus ObjectClass)
C0545082 (UMLS 2011AA ObjectClass)
C1521902 (UMLS 2011AA ValueDomain)
C29846 (NCI Thesaurus Property)
C0439231 (UMLS 2011AA Property)
C25375 (NCI Thesaurus ObjectClass)
C0684224 (UMLS 2011AA ObjectClass)
C25716 (NCI Thesaurus ObjectClass)
C0545082 (UMLS 2011AA ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C305 (NCI Thesaurus Property)
C0005437 (UMLS 2011AA Property)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C25706 (NCI Thesaurus ValueDomain)
C1519815 (UMLS 2011AA ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C25706 (NCI Thesaurus ValueDomain)
C1519815 (UMLS 2011AA ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C25706 (NCI Thesaurus ValueDomain)
C1519815 (UMLS 2011AA ValueDomain)
C0022885 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C16276 (NCI Thesaurus Property)
C0002059 (UMLS 2011AA Property)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C25706 (NCI Thesaurus ValueDomain)
C1519815 (UMLS 2011AA ValueDomain)
C0022885 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C399 (NCI Thesaurus Property)
C0010294 (UMLS 2011AA Property)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C25706 (NCI Thesaurus ValueDomain)
C1519815 (UMLS 2011AA ValueDomain)
C0022885 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C61019 (NCI Thesaurus Property)
C0005845 (UMLS 2011AA Property)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C25706 (NCI Thesaurus ValueDomain)
C1519815 (UMLS 2011AA ValueDomain)
C0022885 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C464 (NCI Thesaurus Property)
C0013832 (UMLS 2011AA Property)
C765 (NCI Thesaurus Property)
C0032821 (UMLS 2011AA Property)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C25555 (NCI Thesaurus ValueDomain)
C1518030 (UMLS 2011AA ValueDomain)
C0022885 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C464 (NCI Thesaurus Property)
C0013832 (UMLS 2011AA Property)
C765 (NCI Thesaurus Property)
C0032821 (UMLS 2011AA Property)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C25706 (NCI Thesaurus ValueDomain)
C1519815 (UMLS 2011AA ValueDomain)
C0022885 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C830 (NCI Thesaurus Property)
C0037473 (UMLS 2011AA Property)
C464 (NCI Thesaurus Property)
C0013832 (UMLS 2011AA Property)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C25555 (NCI Thesaurus ValueDomain)
C1518030 (UMLS 2011AA ValueDomain)
C0022885 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C830 (NCI Thesaurus Property)
C0037473 (UMLS 2011AA Property)
C464 (NCI Thesaurus Property)
C0013832 (UMLS 2011AA Property)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C25706 (NCI Thesaurus ValueDomain)
C1519815 (UMLS 2011AA ValueDomain)
C0022885 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C464 (NCI Thesaurus Property)
C0013832 (UMLS 2011AA Property)
C1741 (NCI Thesaurus Property)
C0596019 (UMLS 2011AA Property)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C25555 (NCI Thesaurus ValueDomain)
C1518030 (UMLS 2011AA ValueDomain)
C0022885 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C464 (NCI Thesaurus Property)
C0013832 (UMLS 2011AA Property)
C1741 (NCI Thesaurus Property)
C0596019 (UMLS 2011AA Property)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C25706 (NCI Thesaurus ValueDomain)
C1519815 (UMLS 2011AA ValueDomain)
C0022885 (UMLS 2011AA ObjectClass)
C331 (NCI Thesaurus Property)
C0006675 (UMLS 2011AA Property)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C464 (NCI Thesaurus Property)
C0013832 (UMLS 2011AA Property)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C25555 (NCI Thesaurus ValueDomain)
C1518030 (UMLS 2011AA ValueDomain)
C0022885 (UMLS 2011AA ObjectClass)
C331 (NCI Thesaurus Property)
C0006675 (UMLS 2011AA Property)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C464 (NCI Thesaurus Property)
C0013832 (UMLS 2011AA Property)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C25706 (NCI Thesaurus ValueDomain)
C1519815 (UMLS 2011AA ValueDomain)
C0022885 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C214 (NCI Thesaurus Property)
C0001924 (UMLS 2011AA Property)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C25555 (NCI Thesaurus ValueDomain)
C1518030 (UMLS 2011AA ValueDomain)
C0022885 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C214 (NCI Thesaurus Property)
C0001924 (UMLS 2011AA Property)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C25706 (NCI Thesaurus ValueDomain)
C1519815 (UMLS 2011AA ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25536 (NCI Thesaurus Property)
C1555582 (UMLS 2011AA Property)
C1519316 (UMLS 2011AA Property)
C17089 (NCI Thesaurus ObjectClass)
C0035173 (UMLS 2011AA ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)