English

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.

1 forms  
Ccrr Module For Miscellaneous Pages Shuttle (mps)
Description

Ccrr Module For Miscellaneous Pages Shuttle (mps)

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

Pt.ID

Data type

text

Institution ID:
Description

InstitutionNo.

Data type

text

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

InstitutionName

Data type

text

Back to the top of the page

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.

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Ccrr Module For Miscellaneous Pages Shuttle (mps)
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
Back to the top of the page