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ID

23849

Beschrijving

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

Trefwoorden

  1. 19-09-12 19-09-12 -
  2. 15-07-17 15-07-17 - Martin Dugas
Geüploaded op

15 juli 2017

DOI

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Licentie

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
    Beschrijving

    Follow-up

    Alias
    UMLS CUI-1
    C1522577 (follow-up)
    Date form originally completed
    Beschrijving

    Form Completion Date

    Datatype

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164 (undefined)
    NCI Thesaurus ObjectClass
    C40988 (undefined)
    NCI Thesaurus Property
    C25250 (undefined)
    UMLS CUI [1]
    C1549507 (Report completion date/time)
    Last Contact Date
    Beschrijving

    Last Contact Date

    Datatype

    date

    Alias
    NCI Thesaurus Property
    C25164 (undefined)
    NCI Thesaurus ValueDomain
    C25164 (undefined)
    NCI Thesaurus ObjectClass
    C47954 (undefined)
    NCI Thesaurus ObjectClass
    C25551 (undefined)
    UMLS CUI [1]
    C0585085 (Appointment date)
    SNOMED
    185353001
    Type of Contact
    Beschrijving

    (Select how the information was obtained:)

    Datatype

    integer

    Alias
    NCI Thesaurus ValueDomain
    C25284 (undefined)
    NCI Thesaurus ObjectClass
    C16960 (undefined)
    NCI Thesaurus Property
    C25461 (undefined)
    UMLS CUI [1,1]
    C1512346 (Patient Visit)
    UMLS CUI [1,2]
    C0332307 (Type - attribute)
    SNOMED
    261664005
    Received Treatment Since Last Contact?
    Beschrijving

    (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.)

    Datatype

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C25180 (undefined)
    NCI Thesaurus ObjectClass
    C15368 (undefined)
    NCI Thesaurus Property
    C25461 (undefined)
    NCI Thesaurus ObjectClass
    C25551 (undefined)
    UMLS CUI [1,1]
    C0087111 (Therapeutic procedure)
    SNOMED
    277132007
    LOINC
    LP21090-3
    UMLS CUI [1,2]
    C0205314 (New)
    SNOMED
    7147002
    LOINC
    LA9039-4
    Patient Status
    Beschrijving

    (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.)

    Datatype

    integer

    Alias
    NCI Thesaurus ValueDomain
    C25162 (undefined)
    NCI Thesaurus ObjectClass
    C16960 (undefined)
    NCI Thesaurus Property
    C25688 (undefined)
    UMLS CUI [1,1]
    C0805701 (Code)
    UMLS CUI [1,2]
    C0030705 (Patients)
    SNOMED
    116154003
    UMLS CUI [1,3]
    C0449438 (Status)
    SNOMED
    263490005
    LOINC
    LP73412-6
    Explain 'Unknown' Patient Status
    Beschrijving

    (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.)

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960 (undefined)
    NCI Thesaurus Property
    C25688 (undefined)
    NCI Thesaurus ValueDomain
    C45255 (undefined)
    NCI Thesaurus ValueDomain
    C42614 (undefined)
    NCI Thesaurus ValueDomain
    C68805 (undefined)
    UMLS CUI [1,1]
    C1148433 (Vital Status)
    UMLS CUI [1,2]
    C0439673 (Unknown)
    SNOMED
    261665006
    LOINC
    LA4489-6

    Similar models

    No Instruction available.

    1. StudyEvent: Follow-up
      1. No Instruction available.
    Name
    Type
    Description | Question | Decode (Coded Value)
    Datatype
    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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