ID

2336

Descripción

Termination of Patient Follow-up (TPFU) Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B1243BAC-D9BC-4E9B-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B1243BAC-D9BC-4E9B-E034-0003BA12F5E7

Palabras clave

Versiones (2)
  1. 19/9/12 19/9/12 -
  2. 9/1/15 9/1/15 - Martin Dugas
Subido en

19 de septiembre de 2012

DOI

Para solicitar uno, por favor iniciar sesión.

Licencia

Creative Commons BY-NC 3.0 Legacy
Comentarios del modelo :

Puede comentar sobre el modelo de datos aquí. A través de las burbujas de diálogo en los grupos de elementos y elementos, puede agregar comentarios específicos.

Volver a los comentarios del modelo
Comentarios de grupo de elementos para :

Comentarios del elemento para :

Para descargar modelos de datos, debe haber iniciado sesión. Por favor iniciar sesión o Registrate gratis.

Melanoma (Skin) null Follow-Up - Termination of Patient Follow-up (TPFU) - 2074808v3.0

Inglés

No Instruction available.

1 formularios  
  1. StudyEvent: Termination of Patient Follow-up (TPFU)
    1. No Instruction available.
Ccrr Module For Termination Of Patient Follow-up (tpfu)
Descripción

Ccrr Module For Termination Of Patient Follow-up (tpfu)

Patient ID (Pt. ID issued during registration or previously issued patient ID)
Descripción

Pt.ID

Tipo de datos

text

Institution ID:
Descripción

InstitutionNo.

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
Patient Initials: (F ML)
Descripción

PatientInitialsName

Tipo de datos

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
Institution:
Descripción

InstitutionName

Tipo de datos

text

Date of Study Completion or Early Follow-up Terminiation (Year Month Day)
Descripción

PatientEndFollow-upDate

Tipo de datos

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C16033
UMLS 2011AA Property
C1522577
NCI Thesaurus Property
C25496
UMLS 2011AA Property
C2746065
Did the Patient complete the study per protocol
Descripción

Follow-UpPatientCompleteStudyInd-2

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C16033
UMLS 2011AA Property
C1522577
NCI Thesaurus Property
C25496
UMLS 2011AA Property
C2746065
Reason for early termination of patient follow-up (mark x only one:)
Descripción

Off-TreatmentACOSOGReason

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25638
UMLS 2011AA ValueDomain
C0392360
NCI Thesaurus Property
C19712
UMLS 2011AA Property
C1515944
NCI Thesaurus ObjectClass
C25601
UMLS 2011AA ObjectClass
C1518544
NCI Thesaurus Property
C25365
UMLS 2011AA Property
C0678257
Adverse event, (specify)
Descripción

Adverseevent,

Tipo de datos

text

Patient declared ineligible (specify)
Descripción

Patientdeclaredineligible

Tipo de datos

text

Other, (specify)
Descripción

Other,

Tipo de datos

text

Early follow-up termination authorization number:
Descripción

Off-TreatmentACOSOGDescriptionNumber

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus Property
C19712
UMLS 2011AA Property
C1515944
NCI Thesaurus ObjectClass
C25601
UMLS 2011AA ObjectClass
C1518544
NCI Thesaurus Property
C25365
UMLS 2011AA Property
C0678257
Completed by:
Descripción

CompletedBy

Tipo de datos

text

Date:
Descripción

FormCompletionDate,Original

Tipo de datos

date

Year Month Day
Descripción

YearMonthDay

Tipo de datos

text

Volver a la parte superior de la página

Similar models

No Instruction available.

1 formularios
  1. StudyEvent: Termination of Patient Follow-up (TPFU)
    1. No Instruction available.
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
Ccrr Module For Termination Of Patient Follow-up (tpfu)
Pt.ID
Item
Patient ID (Pt. ID issued during registration or previously issued patient ID)
text
InstitutionNo.
Item
Institution ID:
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
PatientInitialsName
Item
Patient Initials: (F ML)
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25536 (NCI Thesaurus Property)
C1555582 (UMLS 2011AA Property)
InstitutionName
Item
Institution:
text
PatientEndFollow-upDate
Item
Date of Study Completion or Early Follow-up Terminiation (Year Month Day)
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C16033 (NCI Thesaurus Property)
C1522577 (UMLS 2011AA Property)
C25496 (NCI Thesaurus Property)
C2746065 (UMLS 2011AA Property)
Item
Did the Patient complete the study per protocol
text
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C16033 (NCI Thesaurus Property)
C1522577 (UMLS 2011AA Property)
C25496 (NCI Thesaurus Property)
C2746065 (UMLS 2011AA Property)
CL.1
Code List
Did the Patient complete the study per protocol
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item
Reason for early termination of patient follow-up (mark x only one:)
text
C25638 (NCI Thesaurus ValueDomain)
C0392360 (UMLS 2011AA ValueDomain)
C19712 (NCI Thesaurus Property)
C1515944 (UMLS 2011AA Property)
C25601 (NCI Thesaurus ObjectClass)
C1518544 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
CL.2
Code List
Reason for early termination of patient follow-up (mark x only one:)
CL Item
Adverse Event (Adverse event, specify)
C41331 (NCI Thesaurus)
C0877248 (UMLS 2011AA)
CL Item
Patient Follow-up Terminated For Other Complicating Disease. (Patient follow-up terminated for other complicating disease.)
CL Item
Patient Withdrew Consent. (Patient withdrew consent.)
CL Item
Patient Declared Ineligible (Patient declared ineligible, specify)
CL Item
Death (Death)
C28554 (NCI Thesaurus)
C0011065 (UMLS 2011AA)
CL Item
Other (Other, specify)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
Adverseevent,
Item
Adverse event, (specify)
text
Patientdeclaredineligible
Item
Patient declared ineligible (specify)
text
Other,
Item
Other, (specify)
text
Off-TreatmentACOSOGDescriptionNumber
Item
Early follow-up termination authorization number:
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C19712 (NCI Thesaurus Property)
C1515944 (UMLS 2011AA Property)
C25601 (NCI Thesaurus ObjectClass)
C1518544 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
CompletedBy
Item
Completed by:
text
FormCompletionDate,Original
Item
Date:
date
YearMonthDay
Item
Year Month Day
text
Volver a la parte superior de la página 

Contacto

Utilice este formulario para comentarios, preguntas y sugerencias.

Los campos marcados con * son obligatorios.

Ayuda

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