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ID

24296

Descrizione

Multiple Myeloma and Plasma Cell Neoplasm NCT00644228 Registration - Southwest Oncology Group S0777 Registration Worksheet (Step 2) - Not for OPEN - 2697459v1.0 Southwest Oncology Group S0777 Registration Worksheet (Step 2) - Not for OPEN Lenalidomide and Dexamethasone With or Without Bortezomib in Treating Patients With Previously Untreated Multiple Myeloma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=3EFE9110-F3B6-20FE-E044-0003BA3F9857

collegamento

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=3EFE9110-F3B6-20FE-E044-0003BA3F9857

Keywords

  1. 19/09/12 19/09/12 -
  2. 29/07/17 29/07/17 - Martin Dugas
Caricato su

29 luglio 2017

DOI

Per favore, per richiedere un accesso.

Licenza

Creative Commons BY-NC 3.0

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    Multiple Myeloma Lenalidomide Bortezomib NCT00644228 SWOG S0777

    No Instruction available.

    1. StudyEvent: Southwest Oncology Group S0777 Registration Worksheet (Step 2) - Not for OPEN
      1. No Instruction available.
    Protocol Information
    Descrizione

    Protocol Information

    Alias
    UMLS CUI-1
    C1507394
    Activation Date
    Descrizione

    ClinicalStudyProtocolAmendmentActivationDate

    Tipo di dati

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    NCI Thesaurus ObjectClass
    C25320
    NCI Thesaurus Property
    C64382
    NCI Thesaurus Property-2
    C41200
    UMLS CUI [1]
    C1515882
    Last Amended Date
    Descrizione

    DataAmendedLastDate

    Tipo di dati

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    NCI Thesaurus ObjectClass
    C25474
    NCI Thesaurus Property
    C25416
    NCI Thesaurus ValueDomain-2
    C25551
    UMLS CUI [1,1]
    C0680532
    UMLS CUI [1,2]
    C0011008
    Registration Step
    Descrizione

    RegistrationStepNumber

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    NCI Thesaurus ObjectClass
    C25646
    NCI Thesaurus Property
    C16154
    NCI Thesaurus ValueDomain-2
    C16154
    UMLS CUI [1]
    C1514821
    For SWOG Institutions
    Descrizione

    For SWOG Institutions

    Alias
    UMLS CUI-1
    C1519429
    Registrar's SWOG Roster ID Number
    Descrizione

    RegistrarSouthwestOncologyGroupIdentifierNumber

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    NCI Thesaurus Property
    C25364
    NCI Thesaurus Property-2
    C25699
    NCI Thesaurus ObjectClass
    C25357
    UMLS CUI [1,1]
    C1519429
    UMLS CUI [1,2]
    C0600091
    SWOG Investigator Number
    Descrizione

    SouthwestOncologyGroupInvestigatorIdentifierNumber

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    NCI Thesaurus Property
    C25364
    NCI Thesaurus ObjectClass
    C25699
    NCI Thesaurus ObjectClass-2
    C17089
    UMLS CUI [1]
    C2986286
    SWOG Treating Institution Number
    Descrizione

    SouthwestOncologyGroupTreatingInstitutionIdentifierNumber

    Tipo di dati

    text

    Alias
    NCI Thesaurus ObjectClass
    C25699
    NCI Thesaurus ObjectClass-2
    C25705
    NCI Thesaurus ObjectClass-3
    C41206
    NCI Thesaurus Property
    C25364
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI [1]
    C0489558
    For Non-Swog Institutions
    Descrizione

    For Non-Swog Institutions

    Alias
    UMLS CUI-1
    C1519429
    UMLS CUI-2
    C2828389
    Registering Group Name
    Descrizione

    Study Group

    Tipo di dati

    text

    Alias
    NCI Thesaurus ObjectClass
    C25646
    NCI Thesaurus Property
    C43359
    NCI Thesaurus ValueDomain
    C42614
    UMLS CUI [1]
    C1320290
    Investigator Name
    Descrizione

    Investigator Name

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    NCI Thesaurus Property
    C25364
    NCI Thesaurus ObjectClass
    C17089
    UMLS CUI [1]
    C2826892
    Institution Name
    Descrizione

    InstitutionName

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    NCI Thesaurus ObjectClass
    C21541
    NCI Thesaurus ValueDomain-2
    C21541
    NCI Thesaurus Property
    C25364
    UMLS CUI [1,1]
    C1301943
    NCI Institution Number
    Descrizione

    NCIInstitutionIdentifierCode

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25162
    NCI Thesaurus ObjectClass
    C21541
    NCI Thesaurus Property
    C25364
    NCI Thesaurus ObjectClass-2
    C19202
    UMLS CUI [1]
    C0489558
    Participating Group Patient ID
    Descrizione

    PatientParticipatingIdentifierNumber

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25608
    NCI Thesaurus Property-2
    C25364
    UMLS CUI [1,1]
    C2348585
    UMLS CUI [1,2]
    C2347449
    Patient Information
    Descrizione

    Patient Information

    Alias
    UMLS CUI-1
    C1955348
    SWOG Patient ID Status
    Descrizione

    PatientSouthwestOncologyGroupIdentifierStatus

    Tipo di dati

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25364
    NCI Thesaurus Property-2
    C25699
    NCI Thesaurus ValueDomain
    C25688
    UMLS CUI [1,1]
    C1519429
    UMLS CUI [1,2]
    C0449438
    SWOG Patient ID
    Descrizione

    PatientSouthwestOncologyGroupIdentifierNumber

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25364
    NCI Thesaurus Property-2
    C25699
    UMLS CUI [1,1]
    C2348585
    UMLS CUI [1,2]
    C1519429
    Projected Start Date of Treatment
    Descrizione

    TreatmentProjectedBeginDate

    Tipo di dati

    date

    Alias
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus ObjectClass-2
    C25631
    NCI Thesaurus Property
    C25431
    NCI Thesaurus Property-2
    C25275
    NCI Thesaurus ValueDomain
    C25164
    NCI Thesaurus ValueDomain-2
    C25431
    UMLS CUI [1,1]
    C3173309
    Method of Payment
    Descrizione

    Patient Payment Type

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25371
    UMLS CUI [1]
    C0680264
    Other, specify
    Descrizione

    Patient Payment

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25371
    UMLS CUI [1]
    C0680264
    Patient Eligibility
    Descrizione

    Patient Eligibility

    Alias
    UMLS CUI-1
    C1302261
    Has the Southwest Oncology Group Registration Worksheet been completed entirely and is the patient eligible according to the current version of protocol section 5.0
    Descrizione

    SouthwestOncologyGroupPatientRegistrationEligibilityDeterminationInd-2

    Tipo di dati

    boolean

    Alias
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus ObjectClass-2
    C25699
    NCI Thesaurus Property
    C25646
    NCI Thesaurus Property-2
    C25171
    NCI Thesaurus ValueDomain
    C38147
    UMLS CUI [1]
    C1302261
    Comments
    Descrizione

    Comments

    Alias
    UMLS CUI-1
    C0947611
    Assigned Treatment Arm
    Descrizione

    Treatment Arm

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    NCI Thesaurus Property
    C32141
    NCI Thesaurus ObjectClass
    C15368
    UMLS CUI [1]
    C1522541
    Treatment name
    Descrizione

    ClinicalTrialProtocolTherapeuticProcedureName

    Tipo di dati

    text

    Alias
    NCI Thesaurus ObjectClass
    C25320
    NCI Thesaurus Property
    C25364
    NCI Thesaurus ObjectClass-2
    C49236
    NCI Thesaurus ValueDomain
    C42614
    UMLS CUI [1,1]
    C2826274
    Other Notes
    Descrizione

    SouthwestOncologyGroupRegistrationConfirmationOtherText

    Tipo di dati

    text

    Alias
    NCI Thesaurus ObjectClass
    C25646
    NCI Thesaurus ObjectClass-2
    C25699
    NCI Thesaurus Property
    C25458
    NCI Thesaurus ValueDomain
    C25704
    NCI Thesaurus ValueDomain-2
    C17649
    UMLS CUI [1]
    C1534847

    Similar models

    No Instruction available.

    1. StudyEvent: Southwest Oncology Group S0777 Registration Worksheet (Step 2) - Not for OPEN
      1. No Instruction available.
    Name
    genere
    Description | Question | Decode (Coded Value)
    Tipo di dati
    Alias
    Item Group
    Protocol Information
    C1507394 (UMLS CUI-1)
    Activation Date
    Item
    Activation Date
    date
    C25164 (NCI Thesaurus ValueDomain)
    C25320 (NCI Thesaurus ObjectClass)
    C64382 (NCI Thesaurus Property)
    C41200 (NCI Thesaurus Property-2)
    C1515882 (UMLS CUI [1])
    Amended Date
    Item
    Last Amended Date
    date
    C25164 (NCI Thesaurus ValueDomain)
    C25474 (NCI Thesaurus ObjectClass)
    C25416 (NCI Thesaurus Property)
    C25551 (NCI Thesaurus ValueDomain-2)
    C0680532 (UMLS CUI [1,1])
    C0011008 (UMLS CUI [1,2])
    Registration Step
    Item
    Registration Step
    text
    C25337 (NCI Thesaurus ValueDomain)
    C25646 (NCI Thesaurus ObjectClass)
    C16154 (NCI Thesaurus Property)
    C16154 (NCI Thesaurus ValueDomain-2)
    C1514821 (UMLS CUI [1])
    Item Group
    For SWOG Institutions
    C1519429 (UMLS CUI-1)
    SWOG Roster ID
    Item
    Registrar's SWOG Roster ID Number
    text
    C25337 (NCI Thesaurus ValueDomain)
    C25364 (NCI Thesaurus Property)
    C25699 (NCI Thesaurus Property-2)
    C25357 (NCI Thesaurus ObjectClass)
    C1519429 (UMLS CUI [1,1])
    C0600091 (UMLS CUI [1,2])
    SWOG Investigator Number
    Item
    SWOG Investigator Number
    text
    C25337 (NCI Thesaurus ValueDomain)
    C25364 (NCI Thesaurus Property)
    C25699 (NCI Thesaurus ObjectClass)
    C17089 (NCI Thesaurus ObjectClass-2)
    C2986286 (UMLS CUI [1])
    Institution Number
    Item
    SWOG Treating Institution Number
    text
    C25699 (NCI Thesaurus ObjectClass)
    C25705 (NCI Thesaurus ObjectClass-2)
    C41206 (NCI Thesaurus ObjectClass-3)
    C25364 (NCI Thesaurus Property)
    C25337 (NCI Thesaurus ValueDomain)
    C0489558 (UMLS CUI [1])
    Item Group
    For Non-Swog Institutions
    C1519429 (UMLS CUI-1)
    C2828389 (UMLS CUI-2)
    Study Group
    Item
    Registering Group Name
    text
    C25646 (NCI Thesaurus ObjectClass)
    C43359 (NCI Thesaurus Property)
    C42614 (NCI Thesaurus ValueDomain)
    C1320290 (UMLS CUI [1])
    Investigator Name
    Item
    Investigator Name
    text
    C25191 (NCI Thesaurus ValueDomain)
    C25364 (NCI Thesaurus Property)
    C17089 (NCI Thesaurus ObjectClass)
    C2826892 (UMLS CUI [1])
    Institution Name
    Item
    Institution Name
    text
    C25191 (NCI Thesaurus ValueDomain)
    C21541 (NCI Thesaurus ObjectClass)
    C21541 (NCI Thesaurus ValueDomain-2)
    C25364 (NCI Thesaurus Property)
    C1301943 (UMLS CUI [1,1])
    Institution Number
    Item
    NCI Institution Number
    text
    C25162 (NCI Thesaurus ValueDomain)
    C21541 (NCI Thesaurus ObjectClass)
    C25364 (NCI Thesaurus Property)
    C19202 (NCI Thesaurus ObjectClass-2)
    C0489558 (UMLS CUI [1])
    Participating Group Patient ID
    Item
    Participating Group Patient ID
    text
    C25337 (NCI Thesaurus ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C25608 (NCI Thesaurus Property)
    C25364 (NCI Thesaurus Property-2)
    C2348585 (UMLS CUI [1,1])
    C2347449 (UMLS CUI [1,2])
    Item Group
    Patient Information
    C1955348 (UMLS CUI-1)
    Item
    SWOG Patient ID Status
    text
    C16960 (NCI Thesaurus ObjectClass)
    C25364 (NCI Thesaurus Property)
    C25699 (NCI Thesaurus Property-2)
    C25688 (NCI Thesaurus ValueDomain)
    C1519429 (UMLS CUI [1,1])
    C0449438 (UMLS CUI [1,2])
    Code List
    SWOG Patient ID Status
    CL Item
    New Patient (New patient)
    C1313868 (UMLS CUI-1)
    (Comment:en)
    CL Item
    Previous Patient (Previous patient)
    C0030705 (UMLS CUI-1)
    C0205156 (UMLS CUI-2)
    (Comment:en)
    SWOG Patient ID
    Item
    SWOG Patient ID
    text
    C25337 (NCI Thesaurus ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C25364 (NCI Thesaurus Property)
    C25699 (NCI Thesaurus Property-2)
    C2348585 (UMLS CUI [1,1])
    C1519429 (UMLS CUI [1,2])
    Projected Start Date of Treatment
    Item
    Projected Start Date of Treatment
    date
    C15368 (NCI Thesaurus ObjectClass)
    C25631 (NCI Thesaurus ObjectClass-2)
    C25431 (NCI Thesaurus Property)
    C25275 (NCI Thesaurus Property-2)
    C25164 (NCI Thesaurus ValueDomain)
    C25431 (NCI Thesaurus ValueDomain-2)
    C3173309 (UMLS CUI [1,1])
    Item
    Method of Payment
    text
    C25284 (NCI Thesaurus ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C25371 (NCI Thesaurus Property)
    C0680264 (UMLS CUI [1])
    Code List
    Method of Payment
    CL Item
    Private Insurance (Private Insurance)
    C3845555 (UMLS CUI-1)
    (Comment:en)
    CL Item
    Veterans Sponsored (Veterans Sponsored)
    C0042610 (UMLS CUI-1)
    (Comment:en)
    CL Item
    Medicare (Medicare)
    C16665 (NCI Thesaurus)
    C0018717 (UMLS CUI-1)
    (Comment:en)
    CL Item
    Medicare And Private Insurance (Medicare and Private Insurance)
    C0018717 (UMLS CUI-1)
    C3845555 (UMLS CUI-2)
    (Comment:en)
    CL Item
    Medicaid (Medicaid)
    C0025071 (NCI Metathesaurus)
    C0025071 (UMLS CUI-1)
    (Comment:en)
    CL Item
    Medicaid And Medicare (Medicaid and Medicare)
    C0596896 (UMLS CUI-1)
    (Comment:en)
    CL Item
    Unknown (Unknown)
    C17998 (NCI Thesaurus)
    C0439673 (UMLS CUI-1)
    (Comment:en)
    CL Item
    Other (Other)
    C17649 (NCI Thesaurus)
    C0205394 (UMLS CUI-1)
    (Comment:en)
    CL Item
    Military Or Veterans Sponsored NOS (Military or Veterans)
    C3245458 (UMLS CUI-1)
    C0042610 (UMLS CUI-2)
    (Comment:en)
    CL Item
    Self Pay (no Insurance) (Self Pay)
    C3530213 (UMLS CUI-1)
    (Comment:en)
    CL Item
    No Means Of Payment (no Insurance) (No means of payment)
    C0021682 (UMLS CUI-1)
    C1518422 (UMLS CUI-2)
    (Comment:en)
    Patient Payment
    Item
    Other, specify
    text
    C25685 (NCI Thesaurus ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C25371 (NCI Thesaurus Property)
    C0680264 (UMLS CUI [1])
    Item Group
    Patient Eligibility
    C1302261 (UMLS CUI-1)
    Patient eligible
    Item
    Has the Southwest Oncology Group Registration Worksheet been completed entirely and is the patient eligible according to the current version of protocol section 5.0
    boolean
    C16960 (NCI Thesaurus ObjectClass)
    C25699 (NCI Thesaurus ObjectClass-2)
    C25646 (NCI Thesaurus Property)
    C25171 (NCI Thesaurus Property-2)
    C38147 (NCI Thesaurus ValueDomain)
    C1302261 (UMLS CUI [1])
    Item Group
    Comments
    C0947611 (UMLS CUI-1)
    Treatment Arm
    Item
    Assigned Treatment Arm
    text
    C25337 (NCI Thesaurus ValueDomain)
    C32141 (NCI Thesaurus Property)
    C15368 (NCI Thesaurus ObjectClass)
    C1522541 (UMLS CUI [1])
    Treatment name
    Item
    Treatment name
    text
    C25320 (NCI Thesaurus ObjectClass)
    C25364 (NCI Thesaurus Property)
    C49236 (NCI Thesaurus ObjectClass-2)
    C42614 (NCI Thesaurus ValueDomain)
    C2826274 (UMLS CUI [1,1])
    Other Notes
    Item
    Other Notes
    text
    C25646 (NCI Thesaurus ObjectClass)
    C25699 (NCI Thesaurus ObjectClass-2)
    C25458 (NCI Thesaurus Property)
    C25704 (NCI Thesaurus ValueDomain)
    C17649 (NCI Thesaurus ValueDomain-2)
    C1534847 (UMLS CUI [1])

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