ID

2384

Descrizione

Surgical Report (SR) Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B1229F05-2708-4D58-E034-0003BA12F5E7

collegamento

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B1229F05-2708-4D58-E034-0003BA12F5E7

Keywords

versioni (2)
  1. 19/09/12 19/09/12 -
  2. 09/01/15 09/01/15 - Martin Dugas
Caricato su

19 settembre 2012

DOI

Per favore, per richiedere un accesso.

Licenza

Creative Commons BY-NC 3.0 Legacy
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Melanoma (Skin) null Treatment - Surgical Report (SR) - 2074581v3.0

Inglese

No Instruction available.

1 moduli  
  1. StudyEvent: Surgical Report (SR)
    1. No Instruction available.
Type Of Procedure
Descrizione

Type Of Procedure

Excision/Sentinel Node Biopsy
Descrizione

SentinelNodeBiopsyInd

Tipo di dati

text

Completion Lymphadenectomy
Descrizione

LymphNodeSamplingInd

Tipo di dati

text

Location(s) of basin(s):
Descrizione

DiseaseSite,LymphNodes

Tipo di dati

text

Re-excision
Descrizione

Re-excision

Tipo di dati

text

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Indication:
Descrizione

Indication:

Tipo di dati

text

Other, specify (Other, specify)
Descrizione

Other,specify

Tipo di dati

text

Adjunctive Procedure: (Mark only one)
Descrizione

AdjunctiveProcedure:

Tipo di dati

text

Name of surgeon responsible for case:
Descrizione

SurgeonName

Tipo di dati

text

Signature of surgeon/PI:
Descrizione

SurgeonSignature

Tipo di dati

text

Alias
NCI Thesaurus Property
C25678
UMLS 2011AA Property
C1519316
NCI Thesaurus ObjectClass
C18071
UMLS 2011AA ObjectClass
C0582175
Completed by:
Descrizione

CompletedBy

Tipo di dati

text

Date: (Year Month Day)
Descrizione

FormCompletionDate,Original

Tipo di dati

date

Date: (Year Month Day)
Descrizione

FormCompletionDate,Original

Tipo di dati

date

Ccrr Module For Surgical Report (sr)
Descrizione

Ccrr Module For Surgical Report (sr)

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

PatientIdentifier

Tipo di dati

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ValueDomain
C25364
UMLS 2011AA ValueDomain
C0600091
Institution ID:
Descrizione

InstitutionNo.

Tipo di dati

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
Patient Initials: (F ML)
Descrizione

PatientInitialsName

Tipo di dati

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:
Descrizione

InstitutionName

Tipo di dati

text

Date of Surgery: (within 30 days of randomization)
Descrizione

SurgeryDate

Tipo di dati

date

Type of Surgery:
Descrizione

TypeofSurgery:

Tipo di dati

text

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Similar models

No Instruction available.

1 moduli
  1. StudyEvent: Surgical Report (SR)
    1. No Instruction available.
Name
genere
Description | Question | Decode (Coded Value)
Tipo di dati
Alias
Item Group
Type Of Procedure
Item
Excision/Sentinel Node Biopsy
text
CL.1
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
CL.2
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.3
Code List
Re-excision
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item
Indication:
text
CL.4
Code List
Indication:
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
CL.5
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
Item Group
Ccrr Module For Surgical Report (sr)
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
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