ID

2381

Beschreibung

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

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B12410D0-2110-4E41-E034-0003BA12F5E7

Stichworte

19.09.12 19.09.12 -
09.01.15 09.01.15 - Martin Dugas

Hochgeladen am

19. September 2012

DOI

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Lizenz

Creative Commons BY-NC 3.0 Legacy

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Melanoma (Skin) Follow-Up - Miscellaneous Pages Shuttle (MPS) - 2074799v3.0

Modell
Details

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 Formulare

StudyEvent: Miscellaneous Pages Shuttle (MPS)
1. 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.

Ccrr Module For Miscellaneous Pages Shuttle (mps)

Beschreibung

Ccrr Module For Miscellaneous Pages Shuttle (mps)

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

Beschreibung

Pt.ID

Datentyp

text

Institution ID:

Beschreibung

InstitutionNo.

Datentyp

text

Alias

NCI Thesaurus ValueDomain: C25337

UMLS 2011AA ValueDomain: C0237753

Patient Initials: (F ML)

Beschreibung

PatientInitialsName

Datentyp

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:

Beschreibung

InstitutionName

Datentyp

text

Zum Seitenanfang zurückkehren

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 Formulare

StudyEvent: Miscellaneous Pages Shuttle (MPS)
1. 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

Typ

Description | Question | Decode (Coded Value)

Datentyp

Alias

CCRR MODULE

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

Zum Seitenanfang zurückkehren

ID

Beschreibung

Link

Stichworte

Versionen (2)

Hochgeladen am

DOI

Lizenz

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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.

Beschreibung

Beschreibung

Datentyp

Beschreibung

Datentyp

Alias

Beschreibung

Datentyp

Alias

Beschreibung

Datentyp

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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.

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