ID

23855

Description

Follow-Up form for C3D 3.12 Adopters Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=015F32CE-0D72-1F20-E044-0003BA3F9857

Lien

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=015F32CE-0D72-1F20-E044-0003BA3F9857

Mots-clés

Versions (2)
  1. 19/09/2012 19/09/2012 -
  2. 15/07/2017 15/07/2017 - Martin Dugas
Téléchargé le

15 juillet 2017

DOI

Pour une demande vous connecter.

Licence

Creative Commons BY-NC 3.0
Modèle Commentaires :

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C3D Adopter Template Forms

Anglais

Dates will appear as 'DD-MON-YYYY'

1 Formulaires  
Follow-up
Description

Follow-up

Alias
UMLS CUI-1
C1522577
Last Contact Date
Description

Last Contact Date

Type de données

date

Alias
NCI Thesaurus Property
C25164
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ObjectClass
C47954
NCI Thesaurus ObjectClass
C25551
UMLS CUI [1]
C0805839
Patient Contact Type
Description

Patient Contact Type

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25284
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25461
UMLS CUI [1,1]
C0030705
UMLS CUI [1,2]
C0337611
UMLS CUI [1,3]
C0332307
Treatment Since Last Contact
Description

Treatment Since Last Contact

Type de données

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 Survival Status
Description

Patient Survival Status

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25162
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25688
UMLS CUI [1]
C1148433
Survival Status, unknown explanation
Description

Survival Status, unknown

Type de données

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]
C1148433
Comments
Description

Comments

Alias
UMLS CUI-1
C0947611
Note Date
Description

Note Date

Type de données

date

Alias
NCI Thesaurus Property
C25164
NCI Thesaurus ValueDomain
C25164
NCI Metathesaurus ObjectClass
C1317574
UMLS CUI [1,1]
C1317574
UMLS CUI [1,2]
C0011008
Research Comments
Description

Research Comments Text

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25704
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
UMLS CUI [1]
C0947611
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Similar models

Dates will appear as 'DD-MON-YYYY'

1 Formulaires
Name
Type
Description | Question | Decode (Coded Value)
Type de données
Alias
Item Group
Follow-up
C1522577 (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)
C0805839 (UMLS CUI [1])
Item
Patient Contact Type
text
C25284 (NCI Thesaurus ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C25461 (NCI Thesaurus Property)
C0030705 (UMLS CUI [1,1])
C0337611 (UMLS CUI [1,2])
C0332307 (UMLS CUI [1,3])
CL.1
Code List
Patient Contact Type
CL Item
Clinic Appointment (Clinic Appointment)
CL Item
Email Contact With Patient (Email Contact w/Patient)
CL Item
Mail Contact With Patient (Mail Contact w/Patient)
CL Item
Telephone Contact With Patient (Telephone Contact w/Patient)
CL Item
Telephone Contact With Patient's Family (Telephone Contact w/Patient's Family)
CL Item
Telephone Contact With Patient's Local Physician (Telephone Contact w/Patient's Local Physician)
CL Item
Social Security Death Index (ssdi) (Social Security Death Index (SSDI)
Treatment Since Last Contact
Item
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 Survival Status
text
C25162 (NCI Thesaurus ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C25688 (NCI Thesaurus Property)
C1148433 (UMLS CUI [1])
CL.3
Code List
Patient Survival Status
CL Item
Alive With Disease (1)
CL Item
Alive With No Evidence Of Disease (2)
CL Item
Alive Disease Status Unknown (3)
CL Item
Unknown (4)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
CL Item
Died (5)
Survival Status, unknown
Item
Survival Status, unknown explanation
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])
Item Group
Comments
C0947611 (UMLS CUI-1)
Note Date
Item
Note Date
date
C25164 (NCI Thesaurus Property)
C25164 (NCI Thesaurus ValueDomain)
C1317574 (NCI Metathesaurus ObjectClass)
C1317574 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Research Comments Text
Item
Research Comments
text
C25704 (NCI Thesaurus ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0947611 (UMLS CUI [1])
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