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ID
24240
Beschrijving
CALGB: C-1001 NEW PRIMARY CANCER FORM Leukemia NCT00085124 Follow-Up - CALGB: C-1001 NEW PRIMARY CANCER FORM - 2076934v3.0 Daunorubicin and Cytarabine With or Without Oblimersen in Treating Older Patients With Previously Untreated Acute Myeloid Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B229FEB2-6C43-5155-E034-0003BA12F5E7
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- 19-09-12 19-09-12 -
- 27-07-17 27-07-17 - Martin Dugas
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27 juli 2017
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Creative Commons BY-NC 3.0
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Leukemia Daunorubicin Cytarabine Oblimersen NCT00085124 CALGB
Instructions: This form is to be completed and submitted with each bone marrow or blood sample drawn for evaluation. Unless otherwise indicated use ?-1? to indicate that and answer is ?unknown,? ?unobtainable,? ?not applicable? or ?not done.? Make 2 copies, send original to reference laboratory with sample; send one copy to CALGB Statistical Center, Data Operations and keep a copy for your records.
- StudyEvent: CALGB: C-1001 NEW PRIMARY CANCER FORM
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Instructions: This form is to be completed and submitted with each bone marrow or blood sample drawn for evaluation. Unless otherwise indicated use ?-1? to indicate that and answer is ?unknown,? ?unobtainable,? ?not applicable? or ?not done.? Make 2 copies, send original to reference laboratory with sample; send one copy to CALGB Statistical Center, Data Operations and keep a copy for your records.
- StudyEvent: CALGB: C-1001 NEW PRIMARY CANCER FORM
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
CALGB Form
Item
CALGB Form
text
C1516238 (UMLS CUI [1,1])
C0348078 (UMLS CUI [1,2])
C0348078 (UMLS CUI [1,2])
CALGB Protocol Number
Item
CALGB Study No
text
C1516238 (UMLS CUI [1,1])
C2603343 (UMLS CUI [1,2])
C2603343 (UMLS CUI [1,2])
CALGB Patient ID
Item
CALGB Patient ID
text
C2348585 (UMLS CUI [1,1])
C1516238 (UMLS CUI [1,2])
C1516238 (UMLS CUI [1,2])
Amended Data
Item
Are data amended
boolean
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)
C1511726 (UMLS CUI [1,1])
C1691222 (UMLS CUI [1,2])
C25416 (NCI Thesaurus Property)
C1511726 (UMLS CUI [1,1])
C1691222 (UMLS CUI [1,2])
Patient Name
Item
Patient's Name
text
C1299487 (UMLS CUI [1])
Hospital Number
Item
Patient Hospital Number
text
C0806432 (UMLS CUI [1])
Main Member Institution
Item
Main Member Institution/Adjunct
text
C1301943 (UMLS CUI [1])
Participating Group Name
Item
Participating Group
text
C2347449 (UMLS CUI [1])
Participating Group Protocol No
Item
Participating Group Protocol No.
text
C3274381 (UMLS CUI [1,1])
C2347449 (UMLS CUI [1,2])
C2347449 (UMLS CUI [1,2])
Participating Group Patient ID
Item
Participating Group Patient No.
text
C2348585 (UMLS CUI [1,1])
C2347449 (UMLS CUI [1,2])
C2347449 (UMLS CUI [1,2])
New Cancer Site
Item
Site(s) of New Primary
text
C25704 (NCI Thesaurus ValueDomain)
C25586 (NCI Thesaurus ObjectClass)
C25341 (NCI Thesaurus Property)
C9305 (NCI Thesaurus ObjectClass-2)
C0751623 (UMLS CUI [1,1])
C1515974 (UMLS CUI [1,2])
C25586 (NCI Thesaurus ObjectClass)
C25341 (NCI Thesaurus Property)
C9305 (NCI Thesaurus ObjectClass-2)
C0751623 (UMLS CUI [1,1])
C1515974 (UMLS CUI [1,2])
Histologic Type New Primary
Item
New Primary, Histologic Type
text
C0449574 (UMLS CUI [1,1])
C0751623 (UMLS CUI [1,2])
C0751623 (UMLS CUI [1,2])
New Cancer Diagnosis Date
Item
Date of Diagnosis
date
C25164 (NCI Thesaurus ValueDomain)
C9305 (NCI Thesaurus ObjectClass)
C15220 (NCI Thesaurus Property)
C2316983 (UMLS CUI [1,1])
C0751623 (UMLS CUI [1,2])
C9305 (NCI Thesaurus ObjectClass)
C15220 (NCI Thesaurus Property)
C2316983 (UMLS CUI [1,1])
C0751623 (UMLS CUI [1,2])
Research Comments
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0947611 (UMLS CUI [1])
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0947611 (UMLS CUI [1])
Completed By
Item
Completed by (First Name. Last Name)
text
C1550483 (UMLS CUI [1])
Form Original Complete Date
Item
Date Completed
date
C19464 (NCI Thesaurus ObjectClass)
C25250 (NCI Thesaurus Property)
C25604 (NCI Thesaurus Property-2)
C25164 (NCI Thesaurus ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
C1549507 (UMLS CUI [1])
C25250 (NCI Thesaurus Property)
C25604 (NCI Thesaurus Property-2)
C25164 (NCI Thesaurus ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
C1549507 (UMLS CUI [1])