Item
Excision/Sentinel Node Biopsy
text
Code List
Excision/Sentinel Node Biopsy
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item
Completion Lymphadenectomy
text
Code List
Completion Lymphadenectomy
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
DiseaseSite,LymphNodes
Item
Location(s) of basin(s):
text
Item
Re-excision
text
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Invasive Primary Tumor Present Within 1 Mm Of Any Margin (Invasive primary tumor present within 1 mm of any margin)
CL Item
Microsatellite Tumor Present Within 1mm Of Any Margin (Microsatellite tumor present within 1mm of any margin)
CL Item
In Situ Tumor Present At Any Margin (In Situ tumor present at any margin)
CL Item
Other, Specify (Other, specify)
Other,specify
Item
Other, specify (Other, specify)
text
Item
Adjunctive Procedure: (Mark only one)
text
Code List
Adjunctive Procedure: (Mark only one)
CL Item
Primary Closure With Or Without Undermining (Primary closure with or without undermining)
CL Item
Reconstructive Flap And/or Skin Graft (Reconstructive flap and/or skin graft)
SurgeonName
Item
Name of surgeon responsible for case:
text
SurgeonSignature
Item
Signature of surgeon/PI:
text
C25678 (NCI Thesaurus Property)
C1519316 (UMLS 2011AA Property)
C18071 (NCI Thesaurus ObjectClass)
C0582175 (UMLS 2011AA ObjectClass)
CompletedBy
Item
Completed by:
text
FormCompletionDate,Original
Item
Date: (Year Month Day)
date
FormCompletionDate,Original
Item
Date: (Year Month Day)
date
PatientIdentifier
Item
Patient ID (Pt. ID issued during registration or previously issued patient ID)
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25364 (NCI Thesaurus ValueDomain)
C0600091 (UMLS 2011AA ValueDomain)
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
SurgeryDate
Item
Date of Surgery: (within 30 days of randomization)
date
TypeofSurgery:
Item
Type of Surgery:
text