ID

23816

Description

The patient's status for each item of the eligibility checklist. Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=ACFB66E7-BD58-6D16-E040-BB89AD4363C3

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=ACFB66E7-BD58-6D16-E040-BB89AD4363C3

Keywords

Versions (2)
  1. 8/27/12 8/27/12 -
  2. 7/14/17 7/14/17 - Martin Dugas
Uploaded on

July 14, 2017

DOI

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License

Creative Commons BY-NC 3.0
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Eligibility Checklist

English

No Instruction available.

1 forms  
  1. StudyEvent: Eligibility Checklist
    1. No Instruction available.
Eligibility Checklist
Description

Eligibility Checklist

Alias
UMLS CUI-1
C0013893
Visit Date
Description

Enter the date the form was completed i.e. the date information was gathered.

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ObjectClass
C40988
NCI Thesaurus Property
C25250
UMLS CUI [1]
C1115437
Checklist Number
Description

Note: This field cannot be modified by the user.

Data type

text

Alias
NCI Thesaurus Property
C25337
NCI Thesaurus ValueDomain
C25337
NCI Thesaurus ObjectClass
C16112
NCI Thesaurus ValueDomain-2
C49073
UMLS CUI [1,1]
C1707357
UMLS CUI [1,2]
C1516637
UMLS CUI [1,3]
C0237753
Effective Date
Description

Note: This field cannot be modified by the user.

Data type

date

Alias
NCI Thesaurus Property
C25164
NCI Thesaurus ValueDomain
C25164
NCI Metathesaurus ObjectClass
CL067459
UMLS CUI [1]
C0011008
Waiver Number
Description

Waiver Number

Data type

text

Alias
NCI Thesaurus Property
C25337
NCI Thesaurus ObjectClass
C42580
UMLS CUI [1,1]
C1707901
UMLS CUI [1,2]
C0237753
Criterion Response
Description

Select the patient's status relative to the eligibility inclusion criterion.

Data type

text

Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus ObjectClass-2
C25171
NCI Metathesaurus Property
C0750484
NCI Thesaurus ValueDomain
C25162
NCI Thesaurus ValueDomain-2
C25180
NCI Thesaurus ValueDomain-3
C49488
NCI Thesaurus ValueDomain-4
C49487
NCI Thesaurus ValueDomain-5
C48660
UMLS CUI [1]
C1302261
Sequence
Description

Question Display Sequence

Data type

text

Alias
NCI Thesaurus ObjectClass
C21153
NCI Thesaurus Property
C25673
NCI Thesaurus Property-2
C25485
UMLS CUI [1]
C1519249
Eligibility Waiver Reason
Description

Eligibility Waiver Reason

Data type

text

Alias
NCI Thesaurus Property
C25638
NCI Thesaurus ValueDomain
C25638
NCI Thesaurus ObjectClass
C42580
NCI Thesaurus ValueDomain-2
C42580
UMLS CUI [1,1]
C1707901
UMLS CUI [1,2]
C0566251
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Similar models

No Instruction available.

1 forms
  1. StudyEvent: Eligibility Checklist
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Eligibility Checklist
C0013893 (UMLS CUI-1)
Form Completion Date
Item
Visit Date
date
C25164 (NCI Thesaurus ValueDomain)
C40988 (NCI Thesaurus ObjectClass)
C25250 (NCI Thesaurus Property)
C1115437 (UMLS CUI [1])
Checklist Number
Item
Checklist Number
text
C25337 (NCI Thesaurus Property)
C25337 (NCI Thesaurus ValueDomain)
C16112 (NCI Thesaurus ObjectClass)
C49073 (NCI Thesaurus ValueDomain-2)
C1707357 (UMLS CUI [1,1])
C1516637 (UMLS CUI [1,2])
C0237753 (UMLS CUI [1,3])
Effective Date
Item
Effective Date
date
C25164 (NCI Thesaurus Property)
C25164 (NCI Thesaurus ValueDomain)
CL067459 (NCI Metathesaurus ObjectClass)
C0011008 (UMLS CUI [1])
Waiver Number
Item
Waiver Number
text
C25337 (NCI Thesaurus Property)
C42580 (NCI Thesaurus ObjectClass)
C1707901 (UMLS CUI [1,1])
C0237753 (UMLS CUI [1,2])
Item
Criterion Response
text
C16960 (NCI Thesaurus ObjectClass)
C25171 (NCI Thesaurus ObjectClass-2)
C0750484 (NCI Metathesaurus Property)
C25162 (NCI Thesaurus ValueDomain)
C25180 (NCI Thesaurus ValueDomain-2)
C49488 (NCI Thesaurus ValueDomain-3)
C49487 (NCI Thesaurus ValueDomain-4)
C48660 (NCI Thesaurus ValueDomain-5)
C1302261 (UMLS CUI [1])
CL.1
Code List
Criterion Response
CL Item
Yes, All (Y)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (N)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Not Applicable (X)
C48660 (NCI Thesaurus)
C1272460 (UMLS 2011AA)
Question Display Sequence
Item
Sequence
text
C21153 (NCI Thesaurus ObjectClass)
C25673 (NCI Thesaurus Property)
C25485 (NCI Thesaurus Property-2)
C1519249 (UMLS CUI [1])
Eligibility Waiver Reason
Item
Eligibility Waiver Reason
text
C25638 (NCI Thesaurus Property)
C25638 (NCI Thesaurus ValueDomain)
C42580 (NCI Thesaurus ObjectClass)
C42580 (NCI Thesaurus ValueDomain-2)
C1707901 (UMLS CUI [1,1])
C0566251 (UMLS CUI [1,2])
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