ID

24882

Description

S0100 Registration Form-4 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AEB40AD7-35D8-4185-E034-0003BA12F5E7

Lien

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AEB40AD7-35D8-4185-E034-0003BA12F5E7

Mots-clés

Versions (2)
  1. 19/09/2012 19/09/2012 -
  2. 22/08/2017 22/08/2017 -
Téléchargé le

22 août 2017

DOI

Pour une demande vous connecter.

Licence

Creative Commons BY-NC 3.0 Legacy
Modèle Commentaires :

Ici, vous pouvez faire des commentaires sur le modèle. À partir des bulles de texte, vous pouvez laisser des commentaires spécifiques sur les groupes Item et les Item.

Retour au modèle Commentaires
Groupe Item commentaires pour :

Item commentaires pour :

Vous devez être connecté pour pouvoir télécharger des formulaires. Veuillez vous connecter ou s’inscrire gratuitement.

S0100 Registration Form-4

Anglais

No Instruction available.

1 Formulaires  
  1. StudyEvent: S0100 Registration Form-4
    1. No Instruction available.
Ccrr Module For S0100 Registration Form-4
Description

Ccrr Module For S0100 Registration Form-4

Alias
UMLS CUI-1
C1514821
SWOG Study No.
Description

Study Number

Type de données

text

Alias
UMLS CUI [1,1]
C0008976
UMLS CUI [1,2]
C0600091
Registration Step
Description

Registration Step

Type de données

text

Alias
UMLS CUI [1]
C1514821
Assigned Treatment Arm
Description

Protocol Treatment Arm

Type de données

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
Description

Activation Date

Type de données

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
Description

DataAmendedLastDate

Type de données

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
Description

Patient's Name

Type de données

text

Alias
UMLS CUI [1]
C1299487
SWOG Patient ID
Description

Patient ID

Type de données

text

Alias
UMLS CUI [1]
C2348585
Caller's SWOG Roster ID
Description

RegistrarSouthwestOncologyGroupIdentifierNumber

Type de données

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]
C0237753
UMLS CUI [1,3]
C0600091
SWOG Treating Institution Number
Description

SouthwestOncologyGroupTreatingInstitutionIdentifierNumber

Type de données

integer

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 [1,1]
C1519429
UMLS CUI [1,2]
C1272753
UMLS CUI [1,3]
C0600091
Date Informed Consent Signed
Description

Date Informed Consent Signed

Type de données

date

Alias
UMLS CUI [1,1]
C0021430
UMLS CUI [1,2]
C0011008
SWOG Investigator Number
Description

Investigator Number

Type de données

text

Alias
UMLS CUI [1]
C2826689
IRB Approval Date
Description

IRB Approval Date

Type de données

date

Alias
NCI Thesaurus ObjectClass
C25320
NCI Thesaurus Property
C25425
UMLS CUI [1,1]
C1507394
UMLS CUI [1,2]
C0205540
UMLS CUI [1,3]
C0011008
Projected Start Date of Treatment
Description

Start Date of Treatment

Type de données

date

Alias
UMLS CUI [1,1]
C0087111
UMLS CUI [1,2]
C0808070
Candidate for allogeneic PBSCT?
Description

allogeneic PBSCT

Type de données

boolean

Alias
NCI Thesaurus ValueDomain
C25180
UMLS CUI [1]
C2242529
Comments
Description

Comments

Type de données

text

Alias
UMLS CUI [1]
C0947611
Retour au début de la page

Similar models

No Instruction available.

1 Formulaires
  1. StudyEvent: S0100 Registration Form-4
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Type de données
Alias
Item Group
Ccrr Module For S0100 Registration Form-4
C1514821 (UMLS CUI-1)
Study Number
Item
SWOG Study No.
text
C0008976 (UMLS CUI [1,1])
C0600091 (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's Name
Item
Patient's Name
text
C1299487 (UMLS CUI [1])
Patient ID
Item
SWOG Patient ID
text
C2348585 (UMLS CUI [1])
Caller's 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])
C0237753 (UMLS CUI [1,2])
C0600091 (UMLS CUI [1,3])
SWOG Treating Institution Number
Item
SWOG Treating Institution Number
integer
C25699 (NCI Thesaurus ObjectClass)
C25705 (NCI Thesaurus ObjectClass-2)
C41206 (NCI Thesaurus ObjectClass-3)
C25364 (NCI Thesaurus Property)
C25337 (NCI Thesaurus ValueDomain)
C1519429 (UMLS CUI [1,1])
C1272753 (UMLS CUI [1,2])
C0600091 (UMLS CUI [1,3])
Date Informed Consent Signed
Item
Date Informed Consent Signed
date
C0021430 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Investigator Number
Item
SWOG Investigator Number
text
C2826689 (UMLS CUI [1])
IRB Approval Date
Item
IRB Approval Date
date
C25320 (NCI Thesaurus ObjectClass)
C25425 (NCI Thesaurus Property)
C1507394 (UMLS CUI [1,1])
C0205540 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
Start Date of Treatment
Item
Projected Start Date of Treatment
date
C0087111 (UMLS CUI [1,1])
C0808070 (UMLS CUI [1,2])
allogeneic PBSCT
Item
Candidate for allogeneic PBSCT?
boolean
C25180 (NCI Thesaurus ValueDomain)
C2242529 (UMLS CUI [1])
Comments
Item
Comments
text
C0947611 (UMLS CUI [1])
Retour au début de la page 

Contact

Utilisez ce formulaire pour les retours, les questions et les améliorations suggérées.

Les champs marqués d’un * sont obligatoires.

Aide

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