ID

24485

Descripción

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

Palabras clave

Versiones (3)
  1. 19/9/12 19/9/12 -
  2. 2/8/17 2/8/17 - Martin Dugas
  3. 2/8/17 2/8/17 - Martin Dugas
Subido en

2 de agosto de 2017

DOI

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Licencia

Creative Commons BY-NC 3.0
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SWOG

Inglés

No Instruction available.

1 formularios  
  1. StudyEvent: S0100 Registration Form-3
    1. No Instruction available.
Registration Form S0100
Descripción

Registration Form S0100

Alias
UMLS CUI-1
C1320722
SWOG Study No.
Descripción

SWOG Study Number

Tipo de datos

text

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

Registration Step

Tipo de datos

text

Alias
UMLS CUI-1
C1514821
Assigned Treatment Arm
Descripción

Protocol Treatment Arm

Tipo de datos

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
Descripción

Activation Date

Tipo de datos

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
Descripción

DataAmendedLastDate

Tipo de datos

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
Descripción

Patient'sName

Tipo de datos

text

Alias
UMLS CUI [1]
C1299487
SWOG Patient ID
Descripción

SWOG Patient ID

Tipo de datos

text

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

RegistrarSouthwestOncologyGroupIdentifierNumber

Tipo de datos

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
Descripción

SouthwestOncologyGroupTreatingInstitutionIdentifierNumber

Tipo de datos

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
Descripción

Informed Consent Date Signed

Tipo de datos

date

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

SWOG Investigator Number

Tipo de datos

text

Alias
UMLS CUI [1]
C2986286
IRB Approval Date
Descripción

IRB Approval Date

Tipo de datos

date

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

Treatment Begin Date

Tipo de datos

date

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

induction therapy

Tipo de datos

boolean

Alias
UMLS CUI [1]
C3179010
Comments
Descripción

Comments

Tipo de datos

text

Alias
UMLS CUI [1]
C0947611
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Similar models

No Instruction available.

1 formularios
  1. StudyEvent: S0100 Registration Form-3
    1. No Instruction available.
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
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])
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