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ID
2316
Description
ECOG 4599 Toxicity Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A16E9046-8508-5FB4-E034-080020C9C0E0
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Versions (2)
- 9/19/12 9/19/12 -
- 5/28/15 5/28/15 -
Uploaded on
September 19, 2012
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License
Creative Commons BY-NC 3.0 Legacy
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Lung Cancer null Toxicity - ECOG 4599 Toxicity Form - 2036233v3.0
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- StudyEvent: ECOG 4599 Toxicity Form
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- StudyEvent: ECOG 4599 Toxicity Form
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Dateofdatatransfer
Item
Date of data transfer
text
TransferMethod
Item
Transfer Method
text
Specifyothertransfermethod
Item
Specify other transfer method
text
PatientName
Item
Patient Name
text
Particip.GroupProtocolNumber
Item
Particip. Group Protocol Number
double
PatientStudyID,ParticipatingGroup
Item
Patient Study ID, Participating Group
text
InstitutionName
Item
Institution Name
text
AffiliateName
Item
Affiliate Name
text
AdverseEventReportBeginDate
Item
Adverse Event Report Begin Date
text
AdverseEventReportEndDate
Item
Adverse Event Report End Date
text
AmendedDataInd
Item
Amended Data Ind
text
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
AmendedDataInd
Item
Amended Data Ind
text
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
CTCAdverseEventTerm
Item
CTC Adverse Event Term
text
CTCAdverseEventTerm
Item
CTC Adverse Event Term
text
CTCAdverseEventTerm
Item
CTC Adverse Event Term
text
CTCAdverseEventTerm
Item
CTC Adverse Event Term
text
CTCAdverseEventGrade
Item
CTC Adverse Event Grade
text
CTCAdverseEventGrade
Item
CTC Adverse Event Grade
text
CTCAdverseEventGrade
Item
CTC Adverse Event Grade
text
CTCAdverseEventGrade
Item
CTC Adverse Event Grade
text
TreatmentRelation
Item
Treatment Relation
text
TreatmentRelation
Item
Treatment Relation
text
TreatmentRelation
Item
Treatment Relation
text
TreatmentRelation
Item
Treatment Relation
text
Comments1
Item
Comments1
text
Comments2
Item
Comments2
text
CTCCode
Item
CTC Code
text