ID

2410

Descripción

ECOG 4599 Registration Form (RECIST) Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A16F5E81-8438-5E56-E034-080020C9C0E0

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A16F5E81-8438-5E56-E034-080020C9C0E0

Palabras clave

Versiones (2)
  1. 19/9/12 19/9/12 -
  2. 28/5/15 28/5/15 -
Subido en

19 de septiembre de 2012

DOI

Para solicitar uno, por favor iniciar sesión.

Licencia

Creative Commons BY-NC 3.0 Legacy
Comentarios del modelo :

Puede comentar sobre el modelo de datos aquí. A través de las burbujas de diálogo en los grupos de elementos y elementos, puede agregar comentarios específicos.

Volver a los comentarios del modelo
Comentarios de grupo de elementos para :

Comentarios del elemento para :

Para descargar modelos de datos, debe haber iniciado sesión. Por favor iniciar sesión o Registrate gratis.

Lung Cancer null Registration - ECOG 4599 Registration Form - 2036190v3.0

Inglés

No Instruction available.

1 formularios  
  1. StudyEvent: ECOG 4599 Registration Form
    1. No Instruction available.
Unnamed1
Descripción

Unnamed1

Cooperative Group Name
Descripción

CooperativeGroupName

Tipo de datos

text

Coordinating Group Protocol Number
Descripción

CoordinatingGroupProtocolNumber

Tipo de datos

text

Person Completing Form, First Name
Descripción

PersonCompletingForm,FirstName

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Person Completing Form, Last Name
Descripción

PersonCompletingForm,LastName

Tipo de datos

text

Person Completing Form, Phone
Descripción

PersonCompletingForm,Phone

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
Person Completing Form, Fax
Descripción

PersonCompletingForm,Fax

Tipo de datos

double

Institution Name
Descripción

InstitutionName

Tipo de datos

text

Institution City
Descripción

InstitutionCity

Tipo de datos

text

Institution State
Descripción

InstitutionState

Tipo de datos

text

Institution NCI Code
Descripción

InstitutionNCICode

Tipo de datos

text

Investigator Name
Descripción

InvestigatorName

Tipo de datos

text

Affiliate Name
Descripción

AffiliateName

Tipo de datos

text

IRB Approval Date
Descripción

IRBApprovalDate

Tipo de datos

date

Alias
NCI Thesaurus ObjectClass
C25320
UMLS 2011AA ObjectClass
C1507394
NCI Thesaurus Property
C25425
UMLS 2011AA Property
C0205540
Informed Consent Date Signed
Descripción

InformedConsentDateSigned

Tipo de datos

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
Patient enrolled on any other CG trial
Descripción

PatientenrolledonanyotherCGtrial

Tipo de datos

text

Other Cooperative Group Trial-Group Name
Descripción

OtherCooperativeGroupTrial-GroupName

Tipo de datos

text

Other Cooperative Group Trial-Protocol #
Descripción

OtherCooperativeGroupTrial-Protocol#

Tipo de datos

text

Other Cooperative Group Trial-Specify
Descripción

OtherCooperativeGroupTrial-Specify

Tipo de datos

text

Patient Identifier
Descripción

PatientIdentifier

Tipo de datos

text

NCI Investigator Number
Descripción

NCIInvestigatorNumber

Tipo de datos

text

Investigator Status
Descripción

InvestigatorStatus

Tipo de datos

text

Patient Study ID, Coordinating Group
Descripción

PatientStudyID,CoordinatingGroup

Tipo de datos

text

Treatment Arm Number
Descripción

TreatmentArmNumber

Tipo de datos

text

Registration Date
Descripción

RegistrationDate

Tipo de datos

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
CTSU Patient Registrar
Descripción

CTSUPatientRegistrar

Tipo de datos

text

Is Treating Institution a CCOP of a Coop
Descripción

IsTreatingInstitutionaCCOPofaCoop

Tipo de datos

text

U10
Descripción

U10

Tipo de datos

text

Patient Gender
Descripción

PatientGender

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25372
UMLS 2011AA ValueDomain
C0683312
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C17357
UMLS 2011AA Property
C0079399
Patient Race/Ethnicity
Descripción

PatientRace

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C17049
UMLS 2011AA Property
C0034510
Comments1
Descripción

Comments1

Tipo de datos

text

Comments2
Descripción

Comments2

Tipo de datos

text

Investigator Code
Descripción

InvestigatorCode

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
Volver a la parte superior de la página

Similar models

No Instruction available.

1 formularios
  1. StudyEvent: ECOG 4599 Registration Form
    1. No Instruction available.
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
Unnamed1
CooperativeGroupName
Item
Cooperative Group Name
text
CoordinatingGroupProtocolNumber
Item
Coordinating Group Protocol Number
text
PersonCompletingForm,FirstName
Item
Person Completing Form, First Name
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
PersonCompletingForm,LastName
Item
Person Completing Form, Last Name
text
PersonCompletingForm,Phone
Item
Person Completing Form, Phone
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
PersonCompletingForm,Fax
Item
Person Completing Form, Fax
double
InstitutionName
Item
Institution Name
text
InstitutionCity
Item
Institution City
text
InstitutionState
Item
Institution State
text
InstitutionNCICode
Item
Institution NCI Code
text
InvestigatorName
Item
Investigator Name
text
AffiliateName
Item
Affiliate Name
text
IRBApprovalDate
Item
IRB Approval Date
date
C25320 (NCI Thesaurus ObjectClass)
C1507394 (UMLS 2011AA ObjectClass)
C25425 (NCI Thesaurus Property)
C0205540 (UMLS 2011AA Property)
InformedConsentDateSigned
Item
Informed Consent Date Signed
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
PatientenrolledonanyotherCGtrial
Item
Patient enrolled on any other CG trial
text
OtherCooperativeGroupTrial-GroupName
Item
Other Cooperative Group Trial-Group Name
text
OtherCooperativeGroupTrial-Protocol#
Item
Other Cooperative Group Trial-Protocol #
text
OtherCooperativeGroupTrial-Specify
Item
Other Cooperative Group Trial-Specify
text
PatientIdentifier
Item
Patient Identifier
text
NCIInvestigatorNumber
Item
NCI Investigator Number
text
InvestigatorStatus
Item
Investigator Status
text
PatientStudyID,CoordinatingGroup
Item
Patient Study ID, Coordinating Group
text
TreatmentArmNumber
Item
Treatment Arm Number
text
RegistrationDate
Item
Registration Date
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
CTSUPatientRegistrar
Item
CTSU Patient Registrar
text
IsTreatingInstitutionaCCOPofaCoop
Item
Is Treating Institution a CCOP of a Coop
text
U10
Item
U10
text
PatientGender
Item
Patient Gender
text
C25372 (NCI Thesaurus ValueDomain)
C0683312 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C17357 (NCI Thesaurus Property)
C0079399 (UMLS 2011AA Property)
PatientRace
Item
Patient Race/Ethnicity
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C17049 (NCI Thesaurus Property)
C0034510 (UMLS 2011AA Property)
Comments1
Item
Comments1
text
Comments2
Item
Comments2
text
InvestigatorCode
Item
Investigator Code
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
Volver a la parte superior de la página 

Contacto

Utilice este formulario para comentarios, preguntas y sugerencias.

Los campos marcados con * son obligatorios.

Ayuda

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial