ID

24485

Beschreibung

Registration - S0100 Registration Form-3 - 2031484v3.0 S0100 Registration Form-3 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AEB40849-88C2-417E-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AEB40849-88C2-417E-E034-0003BA12F5E7

Stichworte

Versionen (3)
  1. 19.09.12 19.09.12 -
  2. 02.08.17 02.08.17 - Martin Dugas
  3. 02.08.17 02.08.17 - Martin Dugas
Hochgeladen am

2. August 2017

DOI

Für eine Beantragung loggen Sie sich ein.

Lizenz

Creative Commons BY-NC 3.0
Modell Kommentare :

Hier können Sie das Modell kommentieren. Über die Sprechblasen an den Itemgruppen und Items können Sie diese spezifisch kommentieren.

Zurück zu Modell Kommentaren
Itemgroup Kommentare für :

Item Kommentare für :

Um Formulare herunterzuladen müssen Sie angemeldet sein. Bitte loggen Sie sich ein oder registrieren Sie sich kostenlos.

SWOG

Englisch

No Instruction available.

1 Formulare  
  1. StudyEvent: S0100 Registration Form-3
    1. No Instruction available.
Registration Form S0100
Beschreibung

Registration Form S0100

Alias
UMLS CUI-1
C1320722
SWOG Study No.
Beschreibung

SWOG Study Number

Datentyp

text

Alias
UMLS CUI [1,1]
C3274381
UMLS CUI [1,2]
C1519429
Registration Step
Beschreibung

Registration Step

Datentyp

text

Alias
UMLS CUI-1
C1514821
Assigned Treatment Arm
Beschreibung

Protocol Treatment Arm

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C15368
NCI Thesaurus ObjectClass-2
C42651
NCI Thesaurus Property
C32141
NCI Thesaurus Property-2
C25426
NCI Thesaurus ValueDomain
C25704
UMLS CUI-1
C1522541
Activation Date
Beschreibung

Activation Date

Datentyp

date

Alias
NCI Thesaurus ObjectClass
C25320
NCI Thesaurus Property
C64382
NCI Thesaurus Property-2
C41200
UMLS CUI [1,1]
C1879547
UMLS CUI [1,2]
C0011008
Last Amended Date
Beschreibung

DataAmendedLastDate

Datentyp

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
Patient's Name
Beschreibung

Patient'sName

Datentyp

text

Alias
UMLS CUI [1]
C1299487
SWOG Patient ID
Beschreibung

SWOG Patient ID

Datentyp

text

Alias
UMLS CUI [1,1]
C2348585
UMLS CUI [1,2]
C1519429
Caller's SWOG Roster ID
Beschreibung

RegistrarSouthwestOncologyGroupIdentifierNumber

Datentyp

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 Treating Institution Number
Beschreibung

SouthwestOncologyGroupTreatingInstitutionIdentifierNumber

Datentyp

float

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
Date Informed Consent Signed
Beschreibung

Informed Consent Date Signed

Datentyp

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0009797
SWOG Investigator Number
Beschreibung

SWOG Investigator Number

Datentyp

text

Alias
UMLS CUI [1]
C2986286
IRB Approval Date
Beschreibung

IRB Approval Date

Datentyp

date

Alias
NCI Thesaurus ObjectClass
C25320
NCI Thesaurus Property
C25425
UMLS CUI [1]
C2346500
Projected Start Date of Treatment
Beschreibung

Treatment Begin Date

Datentyp

date

Alias
UMLS CUI [1]
C3173309
Did patient receive induction regimen 1 as either initial or crossover induction therapy?
Beschreibung

induction therapy

Datentyp

boolean

Alias
UMLS CUI [1]
C3179010
Comments
Beschreibung

Comments

Datentyp

text

Alias
UMLS CUI [1]
C0947611
Zum Seitenanfang zurückkehren

Ähnliche Modelle

No Instruction available.

1 Formulare
  1. StudyEvent: S0100 Registration Form-3
    1. No Instruction available.
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Registration Form S0100
C1320722 (UMLS CUI-1)
SWOG Study Number
Item
SWOG Study No.
text
C3274381 (UMLS CUI [1,1])
C1519429 (UMLS CUI [1,2])
Registration Step
Item
Registration Step
text
C1514821 (UMLS CUI-1)
Protocol Treatment Arm
Item
Assigned Treatment Arm
text
C15368 (NCI Thesaurus ObjectClass)
C42651 (NCI Thesaurus ObjectClass-2)
C32141 (NCI Thesaurus Property)
C25426 (NCI Thesaurus Property-2)
C25704 (NCI Thesaurus ValueDomain)
C1522541 (UMLS CUI-1)
Activation Date
Item
Activation Date
date
C25320 (NCI Thesaurus ObjectClass)
C64382 (NCI Thesaurus Property)
C41200 (NCI Thesaurus Property-2)
C1879547 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Last 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])
Patient'sName
Item
Patient's Name
text
C1299487 (UMLS CUI [1])
SWOG Patient ID
Item
SWOG Patient ID
text
C2348585 (UMLS CUI [1,1])
C1519429 (UMLS CUI [1,2])
SWOG Roster ID
Item
Caller's SWOG Roster ID
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])
Treating Institution Number
Item
SWOG Treating Institution Number
float
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])
Informed Consent Date Signed
Item
Date Informed Consent Signed
date
C0011008 (UMLS CUI [1,1])
C0009797 (UMLS CUI [1,2])
SWOG Investigator Number
Item
SWOG Investigator Number
text
C2986286 (UMLS CUI [1])
IRB Approval Date
Item
IRB Approval Date
date
C25320 (NCI Thesaurus ObjectClass)
C25425 (NCI Thesaurus Property)
C2346500 (UMLS CUI [1])
Treatment Begin Date
Item
Projected Start Date of Treatment
date
C3173309 (UMLS CUI [1])
induction therapy
Item
Did patient receive induction regimen 1 as either initial or crossover induction therapy?
boolean
C3179010 (UMLS CUI [1])
Comments
Item
Comments
text
C0947611 (UMLS CUI [1])
Zum Seitenanfang zurückkehren 

Kontakt

Benutzen Sie dieses Formular für Rückmeldungen, Fragen und Verbesserungsvorschläge.

Mit * gekennzeichnete Felder sind notwendig.

Hilfe

Benötigen Sie Hilfe bei der Suche? Um mehr Details zu erfahren und die Suche effektiver nutzen zu können schauen Sie sich doch das entsprechende Video auf unserer Tutorial Seite an.

Zum Video