ID

23828

Beschrijving

Information concerning the patient's off study date and reason. Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AD006CC7-CCBA-B0A3-E040-BB89AD437A16

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AD006CC7-CCBA-B0A3-E040-BB89AD437A16

Trefwoorden

Versies (2)
  1. 19-09-12 19-09-12 -
  2. 14-07-17 14-07-17 - Martin Dugas
Geüploaded op

14 juli 2017

DOI

Voor een aanvraag inloggen.

Licentie

Creative Commons BY-NC 3.0
Model Commentaren :

Hier kunt u commentaar leveren op het model. U kunt de tekstballonnen bij de itemgroepen en items gebruiken om er specifiek commentaar op te geven.

Terug naar het model Commentaren
Itemgroep Commentaren voor :

Item Commentaren voor :

U moet ingelogd zijn om formulieren te downloaden. AUB inloggen of schrijf u gratis in.

CCR 2011 Template

Engels

No Instruction available.

1 Formulieren  
  1. StudyEvent: Off Study
    1. No Instruction available.
Off Study
Beschrijving

Off Study

Alias
UMLS CUI-1
C1518546
Visit Date
Beschrijving

(Enter the date the form is being completed.)

Datatype

date

Alias
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ObjectClass
C40988
NCI Thesaurus Property
C25250
UMLS CUI [1]
C1115437
Date Off Study
Beschrijving

(For protocols with a specific follow-up period, enter the date that corresponds to the date when all protocol specific follow-up has been completed.)

Datatype

date

Alias
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ObjectClass
C15206
NCI Thesaurus Property
C25275
UMLS CUI [1]
C2985813
Reason off study
Beschrijving

(For protocols without a protocol specific follow-up, use the same 'Reason Off Treatment' entered on the Off Treatment case report form.)

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25162
NCI Thesaurus Property
C25638
NCI Thesaurus ObjectClass
C15206
NCI Thesaurus ObjectClass
C40450
UMLS CUI [1]
C2985814
Explain ´Other´ Reason
Beschrijving

Off Study Reason, other

Datatype

text

Alias
NCI Thesaurus ObjectClass
C15206
NCI Thesaurus ObjectClass
C40450
NCI Thesaurus Property
C25638
NCI Thesaurus ValueDomain
C45255
NCI Thesaurus ValueDomain
C42614
NCI Thesaurus ValueDomain
C68805
UMLS CUI [1,1]
C1518544
UMLS CUI [1,2]
C0566251
Date of Disease Progression
Beschrijving

Progression Date

Datatype

date

Alias
NCI Thesaurus Property
C25164
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ObjectClass
C17747
UMLS CUI [1,1]
C0242656
UMLS CUI [1,2]
C0011008
Terug naar het begin van de pagina

Similar models

No Instruction available.

1 Formulieren
  1. StudyEvent: Off Study
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Off Study
C1518546 (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])
Off Study Date
Item
Date Off Study
date
C25164 (NCI Thesaurus ValueDomain)
C15206 (NCI Thesaurus ObjectClass)
C25275 (NCI Thesaurus Property)
C2985813 (UMLS CUI [1])
Item
Reason off study
text
C25162 (NCI Thesaurus ValueDomain)
C25638 (NCI Thesaurus Property)
C15206 (NCI Thesaurus ObjectClass)
C40450 (NCI Thesaurus ObjectClass)
C2985814 (UMLS CUI [1])
CL.1
Code List
Reason off study
CL Item
Patient Noncompliance (2)
C0376405 (NCI Metathesaurus)
C0457432 (UMLS CUI-1)
CL Item
Withdrawal Of Informed Consent (3)
C0021430 (UMLS CUI-1)
C1710677 (UMLS CUI-2)
CL Item
Alternative Medicine (A)
C19936 (NCI Thesaurus)
C1515928 (UMLS CUI-1)
CL Item
Disease Progression Before Treatment (B)
CL Item
Study Complete (C)
C2348577 (UMLS CUI-1)
CL Item
Death (D)
C26554 (NCI Thesaurus)
C1306577 (UMLS CUI-1)
CL Item
Late Adverse Events/side Effects (E)
C0877248 (UMLS CUI-1)
C0205087 (UMLS CUI-2)
CL Item
Cytogenetic Resistance (G)
CL Item
Follow-up Period Completed (H)
CL Item
Ineligible (I)
C40412 (NCI Thesaurus)
C1512714 (UMLS CUI-1)
CL Item
Lost To Follow-up (L)
C48227 (NCI Thesaurus)
C1302313 (UMLS CUI-1)
CL Item
Death During Follow-up Period (M)
CL Item
Not Treated (N)
C0746919 (UMLS CUI-1)
CL Item
Other (O)
C17649 (NCI Thesaurus)
C0205394 (UMLS CUI-1)
CL Item
Disease Progression (P)
C17747 (NCI Thesaurus)
C0242656 (UMLS CUI-1)
CL Item
Refused Further Treatment (R)
CL Item
Complicating Disease (S)
C16457 (NCI Thesaurus)
C0009488 (UMLS CUI-1)
CL Item
Toxicity (T)
C27990 (NCI Thesaurus)
C0600688 (UMLS CUI-1)
CL Item
Not Treated - Other Reasons (U)
CL Item
Protocol Violation (V)
C48251 (NCI Thesaurus)
C1709750 (UMLS CUI-1)
CL Item
Refused Further Follow-up (W)
CL Item
Declined To Participate (X)
C0679823 (UMLS CUI-1)
C1705116 (UMLS CUI-2)
CL Item
No Treatment, Per Protocol Criteria (Z)
Off Study Reason, other
Item
Explain ´Other´ Reason
text
C15206 (NCI Thesaurus ObjectClass)
C40450 (NCI Thesaurus ObjectClass)
C25638 (NCI Thesaurus Property)
C45255 (NCI Thesaurus ValueDomain)
C42614 (NCI Thesaurus ValueDomain)
C68805 (NCI Thesaurus ValueDomain)
C1518544 (UMLS CUI [1,1])
C0566251 (UMLS CUI [1,2])
Progression Date
Item
Date of Disease Progression
date
C25164 (NCI Thesaurus Property)
C25164 (NCI Thesaurus ValueDomain)
C17747 (NCI Thesaurus ObjectClass)
C0242656 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Terug naar het begin van de pagina 

Contact

Gebruik dit formulier voor feedback, vragen en verbeteringsvoorstellen.

Velden gemarkeerd met een * zijn verplicht.

Help

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial