ID

22842

Description

AMC-061 Missed Visit Form (F35) Sunitinib Malate in Treating HIV-Positive Patients With Cancer Undergoing Highly Active Antiretroviral Therapy https://clinicaltrials.gov/ct2/show/NCT00890747

Link

https://clinicaltrials.gov/ct2/show/NCT00890747

Keywords

Versions (2)
  1. 8/26/12 8/26/12 -
  2. 6/12/17 6/12/17 - Martin Dugas
Uploaded on

June 12, 2017

DOI

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License

Creative Commons BY 4.0
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HIV Cancer Sunitinib NCT00890747 AMC-061

English

No Instruction available.

1 forms  
  1. StudyEvent: AMC-061 Missed Visit Form (F35)
    1. No Instruction available.
Header Module
Description

Header Module

Alias
UMLS CUI-1
C1320722
Visit number
Description

Hospital Admission Ordinal Number

Data type

integer

Alias
NCI Thesaurus ValueDomain
C25337
NCI Thesaurus ObjectClass
C16696
NCI Thesaurus Property
C25385
UMLS CUI [1]
C1549755
Research Comments Text
Description

Research Comments

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
UMLS CUI [1]
C0947611
Missed Visit Information
Description

Missed Visit Information

Alias
UMLS CUI-1
C1705492
UMLS CUI-2
C2216340
Missed Visit Date
Description

Patient Absent Visit Date

Data type

date

Measurement units
  • mm/dd/yyyy
Alias
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C48190
NCI Thesaurus Property-2
C25716
UMLS CUI [1,1]
C1705492
UMLS CUI [1,2]
C1320303
mm/dd/yyyy
Reason patient missed visit
Description

Patient Absent Visit Reason

Data type

integer

Alias
NCI Thesaurus ValueDomain
C25638
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C48190
NCI Thesaurus Property-2
C25716
UMLS CUI [1,1]
C1705492
UMLS CUI [1,2]
C1512346
UMLS CUI [1,3]
C0566251
Other, specify
Description

Patient Absent Visit Specify

Data type

text

Alias
NCI Thesaurus ValueDomain
C25685
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C48190
NCI Thesaurus Property-2
C25716
UMLS CUI [1]
C1521902
Next visit scheduled (Items missed will be made up at the new visit.)
Description

Patient Schedule Next Visit

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C53286
NCI Thesaurus Property-2
C25211
NCI Thesaurus Property-3
C25716
NCI Thesaurus ValueDomain
C38147
UMLS CUI [1,1]
C0332282
UMLS CUI [1,2]
C1512346
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Similar models

No Instruction available.

1 forms
  1. StudyEvent: AMC-061 Missed Visit Form (F35)
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Header Module
C1320722 (UMLS CUI-1)
Hospital Admission Ordinal Number
Item
Visit number
integer
C25337 (NCI Thesaurus ValueDomain)
C16696 (NCI Thesaurus ObjectClass)
C25385 (NCI Thesaurus Property)
C1549755 (UMLS CUI [1])
Research Comments
Item
Research Comments Text
text
C25704 (NCI Thesaurus ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0947611 (UMLS CUI [1])
Item Group
Missed Visit Information
C1705492 (UMLS CUI-1)
C2216340 (UMLS CUI-2)
Patient Absent Visit Date
Item
Missed Visit Date
date
C25164 (NCI Thesaurus ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C48190 (NCI Thesaurus Property)
C25716 (NCI Thesaurus Property-2)
C1705492 (UMLS CUI [1,1])
C1320303 (UMLS CUI [1,2])
Item
Reason patient missed visit
integer
C25638 (NCI Thesaurus ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C48190 (NCI Thesaurus Property)
C25716 (NCI Thesaurus Property-2)
C1705492 (UMLS CUI [1,1])
C1512346 (UMLS CUI [1,2])
C0566251 (UMLS CUI [1,3])
CL.1
Code List
Reason patient missed visit
CL Item
Patient Forgot (1)
CL Item
Health Reasons (2)
CL Item
Patient Could Not Get Off Work (3)
CL Item
Patient Unable To Obtain Dependent Care (4)
CL Item
Patient Had Transportation Problems (5)
C3830421 (UMLS CUI-1)
CL Item
Patient Unhappy With Frequency Of Visits (6)
CL Item
Scheduling Difficulties (7)
CL Item
Patient Decided To Discontinue Study (8)
CL Item
Patient Experienced An Adverse Event (9)
CL Item
Other (10)
C0205394 (UMLS CUI-1)
Patient Absent Visit Specify
Item
Other, specify
text
C25685 (NCI Thesaurus ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C48190 (NCI Thesaurus Property)
C25716 (NCI Thesaurus Property-2)
C1521902 (UMLS CUI [1])
Patient Schedule Next Visit
Item
Next visit scheduled (Items missed will be made up at the new visit.)
boolean
C16960 (NCI Thesaurus ObjectClass)
C53286 (NCI Thesaurus Property)
C25211 (NCI Thesaurus Property-2)
C25716 (NCI Thesaurus Property-3)
C38147 (NCI Thesaurus ValueDomain)
C0332282 (UMLS CUI [1,1])
C1512346 (UMLS CUI [1,2])
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