ID

22697

Description

AMC-046 Off-Study Summary Form (F50) Cidofovir in Treating HIV-Infected Patients With High-Grade Squamous Intraepithelial Lesions of the Skin Near the Anus https://clinicaltrials.gov/ct2/show/NCT00550589

Link

https://clinicaltrials.gov/ct2/show/NCT00550589

Keywords

  1. 8/26/12 8/26/12 -
  2. 6/9/17 6/9/17 - Martin Dugas
Uploaded on

June 9, 2017

DOI

To request one please log in.

License

Creative Commons BY 4.0

Model comments :

You can comment on the data model here. Via the speech bubbles at the itemgroups and items you can add comments to those specificially.

Itemgroup comments for :

Item comments for :

In order to download data models you must be logged in. Please log in or register for free.

HIV Cidovir High-Grade Squamous Intraepithelial Lesions NCT00550589 AMC-046

Please submit this form if the subject has (at least one of the following): 1) completed the post treatment follow-up period per protocol 2) been lost to follow-up 3) has refused follow-up 4) withdrew consent 5) has died. (Note: If all follow-up for a subject has been completed, all subjects (except those never initiating protocol therapy) must have both an Off Protocol Treatment Summary form and Off Study Summary form submitted.)

Ccrr Module For Off Study Summary - Rf50
Description

Ccrr Module For Off Study Summary - Rf50

Alias
UMLS CUI-1
C1518546
UMLS CUI-2
C1706244
Off Study Date
Description

Off-Study Follow-Up End Date

Data type

date

Measurement units
  • mm/dd/yyyy
Alias
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ObjectClass
C25601
NCI Thesaurus ObjectClass
C15206
NCI Thesaurus Property
C25275
UMLS CUI [1]
C2985813
mm/dd/yyyy
Off Study Reason (select the primary reason)
Description

Off-Study Follow-Up Reason

Data type

integer

Alias
NCI Thesaurus ValueDomain
C25638
NCI Thesaurus Property
C16033
NCI Thesaurus ObjectClass
C25601
NCI Thesaurus ObjectClass
C15206
UMLS CUI [1]
C2985814
Other, specify
Description

Off-Study Follow-Up

Data type

text

Alias
NCI Thesaurus ValueDomain
C25685
NCI Thesaurus Property
C16033
NCI Thesaurus ObjectClass
C25601
NCI Thesaurus ObjectClass
C15206
UMLS CUI [1,1]
C1518544
UMLS CUI [1,2]
C1521902
Comments
Description

Research Comments

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
UMLS CUI [1]
C0947611

Similar models

Please submit this form if the subject has (at least one of the following): 1) completed the post treatment follow-up period per protocol 2) been lost to follow-up 3) has refused follow-up 4) withdrew consent 5) has died. (Note: If all follow-up for a subject has been completed, all subjects (except those never initiating protocol therapy) must have both an Off Protocol Treatment Summary form and Off Study Summary form submitted.)

Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Ccrr Module For Off Study Summary - Rf50
C1518546 (UMLS CUI-1)
C1706244 (UMLS CUI-2)
Off-Study Follow-Up End Date
Item
Off Study Date
date
C25164 (NCI Thesaurus ValueDomain)
C25601 (NCI Thesaurus ObjectClass)
C15206 (NCI Thesaurus ObjectClass)
C25275 (NCI Thesaurus Property)
C2985813 (UMLS CUI [1])
Item
Off Study Reason (select the primary reason)
integer
C25638 (NCI Thesaurus ValueDomain)
C16033 (NCI Thesaurus Property)
C25601 (NCI Thesaurus ObjectClass)
C15206 (NCI Thesaurus ObjectClass)
C2985814 (UMLS CUI [1])
Code List
Off Study Reason (select the primary reason)
CL Item
Protocol-defined follow-up completed (1)
C1522577 (UMLS CUI-1)
C0205197 (UMLS CUI-2)
CL Item
Patient lost to follow-up (2)
C2348579 (UMLS CUI-1)
CL Item
Patient refused follow-up (3)
C0580699 (UMLS CUI-1)
CL Item
Death (4)
C0011065 (UMLS CUI-1)
CL Item
Adverse Event/Side Effects/Complications (5)
C0877248 (UMLS CUI-1)
CL Item
Other (6)
C0205394 (UMLS CUI-1)
Off-Study Follow-Up
Item
Other, specify
text
C25685 (NCI Thesaurus ValueDomain)
C16033 (NCI Thesaurus Property)
C25601 (NCI Thesaurus ObjectClass)
C15206 (NCI Thesaurus ObjectClass)
C1518544 (UMLS CUI [1,1])
C1521902 (UMLS CUI [1,2])
Research Comments
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0947611 (UMLS CUI [1])

Please use this form for feedback, questions and suggestions for improvements.

Fields marked with * are required.

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