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ID

23849

Beschreibung

Follow-up contact as identified in the protocol. Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=ACFF3AFA-BEEC-470F-E040-BB89AD43497B

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=ACFF3AFA-BEEC-470F-E040-BB89AD43497B

Stichworte

  1. 19.09.12 19.09.12 -
  2. 15.07.17 15.07.17 - Martin Dugas
Hochgeladen am

15. Juli 2017

DOI

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Lizenz

Creative Commons BY-NC 3.0

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    CCR 2011 Template

    No Instruction available.

    1. StudyEvent: Follow-up
      1. No Instruction available.
    Follow-up
    Beschreibung

    Follow-up

    Alias
    UMLS CUI-1
    C1522577
    Date form originally completed
    Beschreibung

    Form Completion Date

    Datentyp

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    NCI Thesaurus ObjectClass
    C40988
    NCI Thesaurus Property
    C25250
    UMLS CUI [1]
    C1549507
    Last Contact Date
    Beschreibung

    Last Contact Date

    Datentyp

    date

    Alias
    NCI Thesaurus Property
    C25164
    NCI Thesaurus ValueDomain
    C25164
    NCI Thesaurus ObjectClass
    C47954
    NCI Thesaurus ObjectClass
    C25551
    UMLS CUI [1]
    C0585085
    Type of Contact
    Beschreibung

    (Select how the information was obtained:)

    Datentyp

    integer

    Alias
    NCI Thesaurus ValueDomain
    C25284
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25461
    UMLS CUI [1,1]
    C1512346
    UMLS CUI [1,2]
    C0332307
    Received Treatment Since Last Contact?
    Beschreibung

    (Note: When answering 'Yes' and the patient has died during the follow-up period, only the Date of Death, entered on the Survival case report form, is sent to CTMS.)

    Datentyp

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C25180
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus Property
    C25461
    NCI Thesaurus ObjectClass
    C25551
    UMLS CUI [1,1]
    C0087111
    UMLS CUI [1,2]
    C0205314
    Patient Status
    Beschreibung

    (Select one of the options below that indicates the patient's last known status. If the patient has died, enter the date in the Date of Death field.)

    Datentyp

    integer

    Alias
    NCI Thesaurus ValueDomain
    C25162
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25688
    UMLS CUI [1,1]
    C0805701
    UMLS CUI [1,2]
    C0030705
    UMLS CUI [1,3]
    C0449438
    Explain 'Unknown' Patient Status
    Beschreibung

    (If Patient Status is unknown, enter some explanation here. Include what attempts were made and how many attempts where made in order to obtain the patient's status i.e.: no response to 5 messages left.)

    Datentyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25688
    NCI Thesaurus ValueDomain
    C45255
    NCI Thesaurus ValueDomain
    C42614
    NCI Thesaurus ValueDomain
    C68805
    UMLS CUI [1,1]
    C1148433
    UMLS CUI [1,2]
    C0439673

    Ähnliche Modelle

    No Instruction available.

    1. StudyEvent: Follow-up
      1. No Instruction available.
    Name
    Typ
    Description | Question | Decode (Coded Value)
    Datentyp
    Alias
    Item Group
    Follow-up
    C1522577 (UMLS CUI-1)
    Form Completion Date
    Item
    Date form originally completed
    date
    C25164 (NCI Thesaurus ValueDomain)
    C40988 (NCI Thesaurus ObjectClass)
    C25250 (NCI Thesaurus Property)
    C1549507 (UMLS CUI [1])
    Last Contact Date
    Item
    Last Contact Date
    date
    C25164 (NCI Thesaurus Property)
    C25164 (NCI Thesaurus ValueDomain)
    C47954 (NCI Thesaurus ObjectClass)
    C25551 (NCI Thesaurus ObjectClass)
    C0585085 (UMLS CUI [1])
    Item
    Type of Contact
    integer
    C25284 (NCI Thesaurus ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C25461 (NCI Thesaurus Property)
    C1512346 (UMLS CUI [1,1])
    C0332307 (UMLS CUI [1,2])
    Code List
    Type of Contact
    CL Item
    Telephone Contact With Patient/participant (1)
    CL Item
    Telephone contact with Patient/Participant Family (2)
    CL Item
    Telephone contact with Patient/Participant Local Physician (3)
    CL Item
    Social Security Death Index (SSDI (4)
    CL Item
    Clinic Appointment (5)
    CL Item
    Mail contact with Patient/Participant (6)
    CL Item
    Email contact with Patient/Participant (7)
    Treatment Since Last Contact
    Item
    Received Treatment Since Last Contact?
    boolean
    C25180 (NCI Thesaurus ValueDomain)
    C15368 (NCI Thesaurus ObjectClass)
    C25461 (NCI Thesaurus Property)
    C25551 (NCI Thesaurus ObjectClass)
    C0087111 (UMLS CUI [1,1])
    C0205314 (UMLS CUI [1,2])
    Item
    Patient Status
    integer
    C25162 (NCI Thesaurus ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C25688 (NCI Thesaurus Property)
    C0805701 (UMLS CUI [1,1])
    C0030705 (UMLS CUI [1,2])
    C0449438 (UMLS CUI [1,3])
    Code List
    Patient Status
    CL Item
    Alive With Disease (1)
    C2584946 (UMLS CUI-1)
    C0012634 (UMLS CUI-2)
    CL Item
    Alive With No Evidence Of Disease (2)
    C2584946 (UMLS CUI-1)
    C0497153 (UMLS CUI-2)
    CL Item
    Alive Disease Status Unknown (3)
    C2584946 (UMLS CUI-1)
    C3898906 (UMLS CUI-2)
    CL Item
    Unknown (4)
    C17998 (NCI Thesaurus)
    C0439673 (UMLS CUI-1)
    CL Item
    Died (5)
    C0011065 (UMLS CUI-1)
    Survival Status, unknown
    Item
    Explain 'Unknown' Patient Status
    text
    C16960 (NCI Thesaurus ObjectClass)
    C25688 (NCI Thesaurus Property)
    C45255 (NCI Thesaurus ValueDomain)
    C42614 (NCI Thesaurus ValueDomain)
    C68805 (NCI Thesaurus ValueDomain)
    C1148433 (UMLS CUI [1,1])
    C0439673 (UMLS CUI [1,2])

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