ID

2384

Beskrivning

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

Länk

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

Nyckelord

Versioner (2)
  1. 2012-09-19 2012-09-19 -
  2. 2015-01-09 2015-01-09 - Martin Dugas
Uppladdad den

19 september 2012

DOI

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Licens

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

Engelsk

No Instruction available.

1 Formulär  
  1. StudyEvent: Surgical Report (SR)
    1. No Instruction available.
Type Of Procedure
Beskrivning

Type Of Procedure

Excision/Sentinel Node Biopsy
Beskrivning

SentinelNodeBiopsyInd

Datatyp

text

Completion Lymphadenectomy
Beskrivning

LymphNodeSamplingInd

Datatyp

text

Location(s) of basin(s):
Beskrivning

DiseaseSite,LymphNodes

Datatyp

text

Re-excision
Beskrivning

Re-excision

Datatyp

text

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

Indication:

Datatyp

text

Other, specify (Other, specify)
Beskrivning

Other,specify

Datatyp

text

Adjunctive Procedure: (Mark only one)
Beskrivning

AdjunctiveProcedure:

Datatyp

text

Name of surgeon responsible for case:
Beskrivning

SurgeonName

Datatyp

text

Signature of surgeon/PI:
Beskrivning

SurgeonSignature

Datatyp

text

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

CompletedBy

Datatyp

text

Date: (Year Month Day)
Beskrivning

FormCompletionDate,Original

Datatyp

date

Date: (Year Month Day)
Beskrivning

FormCompletionDate,Original

Datatyp

date

Ccrr Module For Surgical Report (sr)
Beskrivning

Ccrr Module For Surgical Report (sr)

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

PatientIdentifier

Datatyp

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:
Beskrivning

InstitutionNo.

Datatyp

text

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

PatientInitialsName

Datatyp

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:
Beskrivning

InstitutionName

Datatyp

text

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

SurgeryDate

Datatyp

date

Type of Surgery:
Beskrivning

TypeofSurgery:

Datatyp

text

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Similar models

No Instruction available.

1 Formulär
  1. StudyEvent: Surgical Report (SR)
    1. No Instruction available.
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
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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