ID

23121

Beschrijving

Comparison of Four Combination Chemotherapy Regimens Using Cisplatin in Treating Patients With Stage IVB, Recurrent, or Persistent Cancer of the Cervix GOG Treatment Completion Form 2059221v3.0 https://clinicaltrials.gov/ct2/show/NCT00064077

Link

https://clinicaltrials.gov/ct2/show/NCT00064077

Trefwoorden

Versies (2)
  1. 27/8/12 27/8/12 -
  2. 24/6/17 24/6/17 - Martin Dugas
Geüploaded op

24 de junio de 2017

DOI

Voor een aanvraag inloggen.

Licentie

Creative Commons BY 4.0
Model Commentaren :

Hier kunt u commentaar leveren op het model. U kunt de tekstballonnen bij de itemgroepen en items gebruiken om er specifiek commentaar op te geven.

Terug naar het model Commentaren
Itemgroep Commentaren voor :

Item Commentaren voor :

  • Nieuwste
  • Oudste
  • Populair
  • Nieuwste
    • Nieuwste
    • Oudste
    • Populair

Geen commentaren

U moet ingelogd zijn om formulieren te downloaden. AUB inloggen of schrijf u gratis in.

Cervical Cancer Cisplatin NCT00064077 GOG

Engels

FORM Q0

1 Formulieren  
  1. StudyEvent: GOG Treatment Completion Form
    1. FORM Q0
Header Module
Beschrijving

Header Module

Alias
UMLS CUI-1
C1320722
Date form originally completed
Beschrijving

Form Completion Date

Datatype

date

Maateenheden
  • m d y
Alias
UMLS CUI [1]
C1549507
m d y
Date form amended
Beschrijving

Form Amendment Date

Datatype

date

Maateenheden
  • m d y
Alias
UMLS CUI [1,1]
C0680532
UMLS CUI [1,2]
C0011008
m d y
Patient Name, Last
Beschrijving

Patient Lastname

Datatype

text

Alias
UMLS CUI [1]
C1301584
Patient Name, First
Beschrijving

Patient Firstname

Datatype

text

Alias
UMLS CUI [1]
C0421447
Patient Study ID
Beschrijving

Patient Study ID

Datatype

text

Alias
UMLS CUI [1]
C2348585
Participating Group Code
Beschrijving

Participating Clinical Study Organization

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25162
UMLS CUI [1]
C2347449
Participating Group Protocol Number
Beschrijving

Participating Group Protocol Number

Datatype

text

Alias
UMLS CUI [1,1]
C3274381
UMLS CUI [1,2]
C2347449
Participating Patient Study ID
Beschrijving

Patient Identifier Number

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25337
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25608
NCI Thesaurus Property-2
C25364
UMLS CUI [1,1]
C2348585
UMLS CUI [1,2]
C2347449
Person amending form, last name
Beschrijving

Responsible Person Reporting Change

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25191
NCI Thesaurus ObjectClass
C25190
NCI Thesaurus Property
C25364
UMLS CUI [1,1]
C0680532
UMLS CUI [1,2]
C1547383
Person Completing Form, Last Name
Beschrijving

Person Completing Form

Datatype

text

Alias
UMLS CUI [1]
C3258039
COMMENTS
Beschrijving

Comments

Datatype

text

Alias
UMLS CUI [1]
C0947611
Treatment Schedule
Beschrijving

Treatment Schedule

Alias
UMLS CUI-1
C0040808
Total number of cycles given
Beschrijving

Total Course Number

Datatype

integer

Alias
UMLS CUI [1]
C2045831
Last date (any modality of) protocol therapy was given
Beschrijving

Treatment End Date

Datatype

date

Maateenheden
  • m d y
Alias
UMLS CUI [1]
C1531784
m d y
Off-treatment Reason
Beschrijving

Off-treatment Reason

Alias
UMLS CUI-1
C1518544
UMLS CUI-2
C0566251
Reason treatment ended (check only one)
Beschrijving

Off Treatment Reason

Datatype

integer

Alias
UMLS CUI [1,1]
C1518544
UMLS CUI [1,2]
C0566251
Specify toxicity (unnamed)
Beschrijving

Toxicity

Datatype

text

Alias
UMLS CUI [1]
C0013221
Specify reason (unnamed)
Beschrijving

Reason Off-Treatment

Datatype

text

Alias
NCI Thesaurus ObjectClass
C25638
NCI Thesaurus ObjectClass-2
C25601
NCI Metathesaurus Property
C0030705
NCI Thesaurus Property
C41341
NCI Thesaurus ValueDomain
C25685
UMLS CUI [1,1]
C1518544
UMLS CUI [1,2]
C0566251
Specify disease
Beschrijving

Complicating Disease

Datatype

text

Alias
UMLS CUI [1]
C0544688
Will patient receive further treatment?
Beschrijving

Further Treatment

Datatype

boolean

Alias
UMLS CUI [1,1]
C0087111
UMLS CUI [1,2]
C1517331
Specify further treatment
Beschrijving

Further Treatment, specify

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25685
NCI Thesaurus ObjectClass
C15368
NCI Thesaurus ObjectClass-2
C25519
NCI Thesaurus Property
C25382
UMLS CUI [1,1]
C0087111
UMLS CUI [1,2]
C1517331
Terug naar het begin van de pagina

Similar models

FORM Q0

1 Formulieren
  1. StudyEvent: GOG Treatment Completion Form
    1. FORM Q0
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Header Module
C1320722 (UMLS CUI-1)
Form Completion Date
Item
Date form originally completed
date
C1549507 (UMLS CUI [1])
Form Amendment Date
Item
Date form amended
date
C0680532 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Patient Lastname
Item
Patient Name, Last
text
C1301584 (UMLS CUI [1])
Patient Firstname
Item
Patient Name, First
text
C0421447 (UMLS CUI [1])
Patient Study ID
Item
Patient Study ID
text
C2348585 (UMLS CUI [1])
Participating Clinical Study Organization
Item
Participating Group Code
text
C25162 (NCI Thesaurus ValueDomain)
C2347449 (UMLS CUI [1])
Participating Group Protocol Number
Item
Participating Group Protocol Number
text
C3274381 (UMLS CUI [1,1])
C2347449 (UMLS CUI [1,2])
Patient Identifier Number
Item
Participating Patient Study ID
text
C25337 (NCI Thesaurus ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
C2348585 (UMLS CUI [1,1])
C2347449 (UMLS CUI [1,2])
Responsible Person Reporting Change
Item
Person amending form, last name
text
C25191 (NCI Thesaurus ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C25364 (NCI Thesaurus Property)
C0680532 (UMLS CUI [1,1])
C1547383 (UMLS CUI [1,2])
Person Completing Form
Item
Person Completing Form, Last Name
text
C3258039 (UMLS CUI [1])
Comments
Item
COMMENTS
text
C0947611 (UMLS CUI [1])
Item Group
Treatment Schedule
C0040808 (UMLS CUI-1)
Total Course Number
Item
Total number of cycles given
integer
C2045831 (UMLS CUI [1])
Treatment End Date
Item
Last date (any modality of) protocol therapy was given
date
C1531784 (UMLS CUI [1])
Item Group
Off-treatment Reason
C1518544 (UMLS CUI-1)
C0566251 (UMLS CUI-2)
Item
Reason treatment ended (check only one)
integer
C1518544 (UMLS CUI [1,1])
C0566251 (UMLS CUI [1,2])
CL.1
Code List
Reason treatment ended (check only one)
CL Item
Routine completion of planned protocol treatment (1)
C0040808 (UMLS CUI-1)
C0205197 (UMLS CUI-2)
CL Item
Disease progression, relapse during active treatment (2)
C0242656 (UMLS CUI-1)
CL Item
Toxicity/side effects/complications (3)
C0877248 (UMLS CUI-1)
CL Item
Patient withdrawal or refusal for reason other than toxicity (4)
C0040809 (UMLS CUI-1)
CL Item
Death after beginning protocol therapy (5)
C0011065 (UMLS CUI-1)
CL Item
Patient off-treatment for other complicating disease (6)
C0009566 (UMLS CUI-1)
CL Item
Other (7)
C0205394 (UMLS CUI-1)
Toxicity
Item
Specify toxicity (unnamed)
text
C0013221 (UMLS CUI [1])
Reason Off-Treatment
Item
Specify reason (unnamed)
text
C25638 (NCI Thesaurus ObjectClass)
C25601 (NCI Thesaurus ObjectClass-2)
C0030705 (NCI Metathesaurus Property)
C41341 (NCI Thesaurus Property)
C25685 (NCI Thesaurus ValueDomain)
C1518544 (UMLS CUI [1,1])
C0566251 (UMLS CUI [1,2])
Complicating Disease
Item
Specify disease
text
C0544688 (UMLS CUI [1])
Further Treatment
Item
Will patient receive further treatment?
boolean
C0087111 (UMLS CUI [1,1])
C1517331 (UMLS CUI [1,2])
Further Treatment, specify
Item
Specify further treatment
text
C25685 (NCI Thesaurus ValueDomain)
C15368 (NCI Thesaurus ObjectClass)
C25519 (NCI Thesaurus ObjectClass-2)
C25382 (NCI Thesaurus Property)
C0087111 (UMLS CUI [1,1])
C1517331 (UMLS CUI [1,2])
Terug naar het begin van de pagina 

Help

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