ID

2355

Description

Southwest Oncology Group S0201 Pathology Submission Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A8BA7D80-B069-121E-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A8BA7D80-B069-121E-E034-0003BA12F5E7

Keywords

Versions (3)
  1. 9/19/12 9/19/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
  3. 7/3/15 7/3/15 -
Uploaded on

September 19, 2012

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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Melanoma (Skin) null Pathology - Southwest Oncology Group S0201 Pathology Submission Form - 2055787v3.0

English

No Instruction available.

1 forms  
  1. StudyEvent: Southwest Oncology Group S0201 Pathology Submission Form
    1. No Instruction available.
Unnamed 1
Description

Unnamed 1

SWOG Patient ID
Description

SWOGPatientID

Data type

text

Patient Initials (L, F M)
Description

PatientInitialsName

Data type

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
Disease
Description

Disease

Data type

text

Institution/Member
Description

MainMemberInstitution/Affiliate

Data type

text

Physician (Groups other than SWOG)
Description

TreatingPhysician

Data type

text

Alias
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ObjectClass
C25741
UMLS 2011AA ObjectClass
C0031831
NCI Thesaurus ObjectClass
C25705
UMLS 2011AA ObjectClass
C1522326
Group Name
Description

GroupName

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C17005
UMLS 2011AA ObjectClass
C1257890
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Study No.
Description

StudyNo.

Data type

text

Pt. No
Description

Pt.ID

Data type

text

Unnamed1
Description

Unnamed1

No. of slides
Description

SpecimenSlideCount

Data type

text

No. of blocks
Description

SpecimenBlockSubmissionCount

Data type

text

Alias
NCI Thesaurus ValueDomain
C25463
UMLS 2011AA ValueDomain
C0750480
NCI Thesaurus Property
C25436
UMLS 2011AA Property
C1533157
NCI Thesaurus ObjectClass
C19157
UMLS 2011AA ObjectClass
C0370003
NCI Thesaurus Property
C25694
UMLS 2011AA Property
C1515022
Date sample obtained
Description

SpecimenCollectionDate

Data type

date

One representative H&E stained section from each block of the primary tumor
Description

OnerepresentativeH&Estainedsectionfromeachblockoftheprimarytumor

Data type

text

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Section of sentinel regional lymph node(s) (ind)
Description

Sectionofsentinelregionallymphnode(s)(ind)

Data type

text

Sections of non-sentinel lymph node(s) (Ind)
Description

Sectionsofnon-sentinellymphnode(s)(Ind)

Data type

text

Operative reports (ind)
Description

Operativereports(ind)

Data type

text

Pathology reports (ind)
Description

Pathologyreports(ind)

Data type

text

Specimen Number
Description

SpecimenID

Data type

double

Comments
Description

Comments

Data type

text

Ccrr Module For Southwest Oncology Group S0201 Pathology Submission Form
Description

Ccrr Module For Southwest Oncology Group S0201 Pathology Submission Form

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Similar models

No Instruction available.

1 forms
  1. StudyEvent: Southwest Oncology Group S0201 Pathology Submission Form
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Unnamed 1
SWOGPatientID
Item
SWOG Patient ID
text
PatientInitialsName
Item
Patient Initials (L, F M)
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)
Disease
Item
Disease
text
MainMemberInstitution/Affiliate
Item
Institution/Member
text
TreatingPhysician
Item
Physician (Groups other than SWOG)
text
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25741 (NCI Thesaurus ObjectClass)
C0031831 (UMLS 2011AA ObjectClass)
C25705 (NCI Thesaurus ObjectClass)
C1522326 (UMLS 2011AA ObjectClass)
GroupName
Item
Group Name
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C17005 (NCI Thesaurus ObjectClass)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
StudyNo.
Item
Study No.
text
Pt.ID
Item
Pt. No
text
Item Group
Unnamed1
SpecimenSlideCount
Item
No. of slides
text
SpecimenBlockSubmissionCount
Item
No. of blocks
text
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C25436 (NCI Thesaurus Property)
C1533157 (UMLS 2011AA Property)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C25694 (NCI Thesaurus Property)
C1515022 (UMLS 2011AA Property)
SpecimenCollectionDate
Item
Date sample obtained
date
Item
One representative H&E stained section from each block of the primary tumor
text
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
CL.1
Code List
One representative H&E stained section from each block of the primary tumor
CL Item
Yes (yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (no)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item
Section of sentinel regional lymph node(s) (ind)
text
CL.2
Code List
Section of sentinel regional lymph node(s) (ind)
CL Item
Yes (yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (no)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item
Sections of non-sentinel lymph node(s) (Ind)
text
CL.3
Code List
Sections of non-sentinel lymph node(s) (Ind)
CL Item
Yes (yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (no)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item
Operative reports (ind)
text
CL.4
Code List
Operative reports (ind)
CL Item
Yes (yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (no)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item
Pathology reports (ind)
text
CL.5
Code List
Pathology reports (ind)
CL Item
Yes (yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (no)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
SpecimenID
Item
Specimen Number
double
Comments
Item
Comments
text
Item Group
Ccrr Module For Southwest Oncology Group S0201 Pathology Submission Form
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