ID

24240

Beskrivning

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

Länk

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B229FEB2-6C43-5155-E034-0003BA12F5E7

Nyckelord

Versioner (2)
  1. 2012-09-19 2012-09-19 -
  2. 2017-07-27 2017-07-27 - Martin Dugas
Uppladdad den

27 juli 2017

DOI

För en begäran logga in.

Licens

Creative Commons BY-NC 3.0
Modellkommentarer :

Här kan du kommentera modellen. Med hjälp av pratbubblor i Item-grupperna och Item kan du lägga in specifika kommentarer.

Tillbaka till modellkommentarer
Itemgroup-kommentar för :

Item-kommentar för :

Du måste vara inloggad för att kunna ladda ner formulär. Var vänlig logga in eller registrera dig utan kostnad.

Leukemia Daunorubicin Cytarabine Oblimersen NCT00085124 CALGB

Engelsk

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.

1 Formulär  
New Primary Cancer Form CALGB C-1001
Beskrivning

New Primary Cancer Form CALGB C-1001

Alias
UMLS CUI-1
C0751623
CALGB Form
Beskrivning

CALGB Form

Datatyp

text

Alias
UMLS CUI [1,1]
C1516238
UMLS CUI [1,2]
C0348078
CALGB Study No
Beskrivning

CALGB Protocol Number

Datatyp

text

Alias
UMLS CUI [1,1]
C1516238
UMLS CUI [1,2]
C2603343
CALGB Patient ID
Beskrivning

CALGB Patient ID

Datatyp

text

Alias
UMLS CUI [1,1]
C2348585
UMLS CUI [1,2]
C1516238
Are data amended
Beskrivning

Amended Data

Datatyp

boolean

Alias
NCI Thesaurus ObjectClass
C25474
NCI Thesaurus Property
C25416
UMLS CUI [1,1]
C1511726
UMLS CUI [1,2]
C1691222
Patient's Name
Beskrivning

Patient Name

Datatyp

text

Alias
UMLS CUI [1]
C1299487
Patient Hospital Number
Beskrivning

Hospital Number

Datatyp

text

Alias
UMLS CUI [1]
C0806432
Main Member Institution/Adjunct
Beskrivning

Main Member Institution

Datatyp

text

Alias
UMLS CUI [1]
C1301943
Participating Group
Beskrivning

Participating Group Name

Datatyp

text

Alias
UMLS CUI [1]
C2347449
Participating Group Protocol No.
Beskrivning

Participating Group Protocol No

Datatyp

text

Alias
UMLS CUI [1,1]
C3274381
UMLS CUI [1,2]
C2347449
Participating Group Patient No.
Beskrivning

Participating Group Patient ID

Datatyp

text

Alias
UMLS CUI [1,1]
C2348585
UMLS CUI [1,2]
C2347449
Site(s) of New Primary
Beskrivning

New Cancer Site

Datatyp

text

Alias
NCI Thesaurus ValueDomain
C25704
NCI Thesaurus ObjectClass
C25586
NCI Thesaurus Property
C25341
NCI Thesaurus ObjectClass-2
C9305
UMLS CUI [1,1]
C0751623
UMLS CUI [1,2]
C1515974
New Primary, Histologic Type
Beskrivning

Histologic Type New Primary

Datatyp

text

Alias
UMLS CUI [1,1]
C0449574
UMLS CUI [1,2]
C0751623
Date of Diagnosis
Beskrivning

New Cancer Diagnosis Date

Datatyp

date

Alias
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ObjectClass
C9305
NCI Thesaurus Property
C15220
UMLS CUI [1,1]
C2316983
UMLS CUI [1,2]
C0751623
Comments
Beskrivning

Research Comments

Datatyp

text

Alias
NCI Thesaurus ValueDomain
C25704
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
UMLS CUI [1]
C0947611
Completed by (First Name. Last Name)
Beskrivning

Completed By

Datatyp

text

Alias
UMLS CUI [1]
C1550483
Date Completed
Beskrivning

Form Original Complete Date

Datatyp

date

Alias
NCI Thesaurus ObjectClass
C19464
NCI Thesaurus Property
C25250
NCI Thesaurus Property-2
C25604
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ValueDomain-2
C25367
UMLS CUI [1]
C1549507
Tillbaka till toppen

Similar models

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.

1 Formulär
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
New Primary Cancer Form CALGB C-1001
C0751623 (UMLS CUI-1)
CALGB Form
Item
CALGB Form
text
C1516238 (UMLS CUI [1,1])
C0348078 (UMLS CUI [1,2])
CALGB Protocol Number
Item
CALGB Study No
text
C1516238 (UMLS CUI [1,1])
C2603343 (UMLS CUI [1,2])
CALGB Patient ID
Item
CALGB Patient ID
text
C2348585 (UMLS CUI [1,1])
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])
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])
Participating Group Patient ID
Item
Participating Group Patient No.
text
C2348585 (UMLS CUI [1,1])
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])
Histologic Type New Primary
Item
New Primary, Histologic Type
text
C0449574 (UMLS CUI [1,1])
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])
Research Comments
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
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])
Tillbaka till toppen 

Kontakt

Använd detta formulär för feedback, frågor och förslag på förbättringar.

Fält markerade med * är obligatoriska.

Hjälp

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