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1 forms  
  1. StudyEvent: CALGB: HOSPITALIZATION FORM
    1. No Instruction available.
Hospitalization Form
Description

Hospitalization Form

Alias
UMLS CUI-1
C1320722
Patient Initials
Description

Patient Initials

Data type

text

Alias
UMLS CUI [1]
C2986440
Patient Hospital No.
Description

Patient Hospital Number

Data type

text

Alias
UMLS CUI [1]
C0421459
Institution/Affiliate
Description

Institution/Affiliate

Data type

text

Alias
UMLS CUI [1]
C1301943
Participating Group
Description

Participating Group

Data type

text

Alias
UMLS CUI [1]
C2347449
Participating Group Protocol No.
Description

Participating Group Protocol Number

Data type

text

Alias
UMLS CUI [1,1]
C3274381
UMLS CUI [1,2]
C2347449
Participating Group Patient ID
Description

Participating Group Patient ID

Data type

text

Alias
UMLS CUI [1,1]
C2348585
UMLS CUI [1,2]
C2347449
CALGB Study No.
Description

CALGB Study Number

Data type

text

Alias
UMLS CUI [1,1]
C3274381
UMLS CUI [1,2]
C1516238
CALGB Patient ID
Description

CALGB Patient ID

Data type

text

Alias
UMLS CUI [1,1]
C2348585
UMLS CUI [1,2]
C1516238
Hospital admit date
Description

Hospital admit date

Data type

date

Alias
UMLS CUI [1]
C0806429
Hospital discharge date
Description

Hospital discharge date

Data type

date

Alias
UMLS CUI [1]
C2361123
Reason for hospitalization
Description

Reason for hospitalization

Data type

integer

Alias
UMLS CUI [1]
C1830395
Other, specify
Description

Other,specify

Data type

text

Alias
UMLS CUI [1]
C3845569
Completed by
Description

Completed by

Data type

text

Alias
UMLS CUI [1]
C1550483
Date form originally completed
Description

Form completion date

Data type

date

Alias
UMLS CUI [1]
C1115437
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Similar models

No Instruction available.

1 forms
  1. StudyEvent: CALGB: HOSPITALIZATION FORM
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Hospitalization Form
C1320722 (UMLS CUI-1)
Patient Initials
Item
Patient Initials
text
C2986440 (UMLS CUI [1])
Patient Hospital Number
Item
Patient Hospital No.
text
C0421459 (UMLS CUI [1])
Institution/Affiliate
Item
Institution/Affiliate
text
C1301943 (UMLS CUI [1])
Participating Group
Item
Participating Group
text
C2347449 (UMLS CUI [1])
Participating Group Protocol Number
Item
Participating Group Protocol No.
text
C3274381 (UMLS CUI [1,1])
C2347449 (UMLS CUI [1,2])
Participating Group Patient ID
Item
Participating Group Patient ID
text
C2348585 (UMLS CUI [1,1])
C2347449 (UMLS CUI [1,2])
CALGB Study Number
Item
CALGB Study No.
text
C3274381 (UMLS CUI [1,1])
C1516238 (UMLS CUI [1,2])
CALGB Patient ID
Item
CALGB Patient ID
text
C2348585 (UMLS CUI [1,1])
C1516238 (UMLS CUI [1,2])
Hospital admit date
Item
Hospital admit date
date
C0806429 (UMLS CUI [1])
Hospital discharge date
Item
Hospital discharge date
date
C2361123 (UMLS CUI [1])
Item
Reason for hospitalization
integer
C1830395 (UMLS CUI [1])
CL.1
Code List
Reason for hospitalization
CL Item
Treatment of disease related complications (1)
CL Item
Treatment of complications related to protocol therapy (2)
CL Item
Non-study indication (3)
CL Item
Other, specify (4)
C3845569 (UMLS CUI-1)
Other,specify
Item
Other, specify
text
C3845569 (UMLS CUI [1])
Completed by
Item
Completed by
text
C1550483 (UMLS CUI [1])
Form completion date
Item
Date form originally completed
date
C1115437 (UMLS CUI [1])
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