Information:
Error:
ID
9224
Description
Miscellaneous Pages Shuttle (MPS) Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B12410D0-2110-4E41-E034-0003BA12F5E7
Link
Keywords
Versions (2)
- 9/19/12 9/19/12 -
- 1/9/15 1/9/15 - Martin Dugas
Uploaded on
January 9, 2015
DOI
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License
Creative Commons BY-NC 3.0 Legacy
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Melanoma (Skin) Follow-Up - Miscellaneous Pages Shuttle (MPS) - 2074799v3.0
Attach each page of the report to a separate Shuttle form. Align the top edge of each page with the horizontal line below. Fax this Shuttle Form with the attached page to the ACOSOG Coordinating Center at 919-668-8466.
Similar models
Attach each page of the report to a separate Shuttle form. Align the top edge of each page with the horizontal line below. Fax this Shuttle Form with the attached page to the ACOSOG Coordinating Center at 919-668-8466.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
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)
C0237753 (UMLS 2011AA ValueDomain)
Patient Initials
Item
Patient Initials: (F ML)
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
InstitutionName
Item
Institution:
text