ID

24963

Beskrivning

S0100 Registration Form-2 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AEB405CA-6FD5-4176-E034-0003BA12F5E7

Länk

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AEB405CA-6FD5-4176-E034-0003BA12F5E7

Nyckelord

Versioner (2)
  1. 2012-09-19 2012-09-19 -
  2. 2017-08-23 2017-08-23 -
Uppladdad den

23 augusti 2017

DOI

För en begäran logga in.

Licens

Creative Commons BY-NC 3.0 Legacy
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 null Registration - S0100 Registration Form-2 - 2031499v3.0

Engelsk

No Instruction available.

1 Formulär  
  1. StudyEvent: S0100 Registration Form-2
    1. No Instruction available.
Ccrr Module For S0100 Registration Form-2
Beskrivning

Ccrr Module For S0100 Registration Form-2

Alias
UMLS CUI-1
C1514821
UMLS CUI-2
C0023418
SWOG Study No.
Beskrivning

Study Number

Datatyp

text

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

Registration Step

Datatyp

text

Alias
UMLS CUI-1
C1514821
Assigned Treatment Arm
Beskrivning

Protocol Treatment Arm

Datatyp

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
Beskrivning

Activation Date

Datatyp

date

Alias
NCI Thesaurus ObjectClass
C25320
NCI Thesaurus Property
C64382
NCI Thesaurus Property-2
C41200
UMLS CUI [1,1]
C1879547
UMLS CUI [1,2]
C1507394
UMLS CUI [1,3]
C0011008
Last Amended Date
Beskrivning

Last Amended Date

Datatyp

date

Alias
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ObjectClass
C25474
NCI Thesaurus Property
C25416
NCI Thesaurus ValueDomain-2
C25551
UMLS CUI [1,1]
C1691222
UMLS CUI [1,2]
C1517741
UMLS CUI [1,3]
C0011008
Patient's Name
Beskrivning

Patient's Name

Datatyp

text

Alias
UMLS CUI [1]
C1299487
SWOG Patient ID
Beskrivning

Patient ID

Datatyp

text

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

Caller's SWOG Roster ID

Datatyp

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
Beskrivning

Treating Institution Number

Datatyp

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

Date Informed Consent Signed

Datatyp

date

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

Investigator Number

Datatyp

text

Alias
UMLS CUI [1,1]
C2986286
UMLS CUI [1,2]
C1519429
IRB Approval Date
Beskrivning

IRBApprovalDate

Datatyp

date

Alias
NCI Thesaurus ObjectClass
C25320
UMLS 2011AA ObjectClass
C1507394
NCI Thesaurus Property
C25425
UMLS 2011AA Property
C0205540
Projected Start Date of Treatment
Beskrivning

Start Date of Treatment

Datatyp

date

Alias
UMLS CUI [1,1]
C0087111
UMLS CUI [1,2]
C0808070
Initial induction arm
Beskrivning

Initial induction arm

Datatyp

integer

Alias
UMLS CUI [1,1]
C1522541
UMLS CUI [1,2]
C3179010
Comments
Beskrivning

Notes

Datatyp

text

Alias
UMLS CUI [1]
C0947611
Tillbaka till toppen

Similar models

No Instruction available.

1 Formulär
  1. StudyEvent: S0100 Registration Form-2
    1. No Instruction available.
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
Ccrr Module For S0100 Registration Form-2
C1514821 (UMLS CUI-1)
C0023418 (UMLS CUI-2)
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])
C1507394 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
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)
C1691222 (UMLS CUI [1,1])
C1517741 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
Patient's Name
Item
Patient's Name
text
C1299487 (UMLS CUI [1])
Patient ID
Item
SWOG Patient ID
text
C2348585 (UMLS CUI [1,1])
C1519429 (UMLS CUI [1,2])
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])
Treating 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)
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
C2986286 (UMLS CUI [1,1])
C1519429 (UMLS CUI [1,2])
IRBApprovalDate
Item
IRB Approval Date
date
C25320 (NCI Thesaurus ObjectClass)
C1507394 (UMLS 2011AA ObjectClass)
C25425 (NCI Thesaurus Property)
C0205540 (UMLS 2011AA Property)
Start Date of Treatment
Item
Projected Start Date of Treatment
date
C0087111 (UMLS CUI [1,1])
C0808070 (UMLS CUI [1,2])
Item
Initial induction arm
integer
C1522541 (UMLS CUI [1,1])
C3179010 (UMLS CUI [1,2])
CL.1
Code List
Initial induction arm
CL Item
Daunorubicin/vincristine/prednisone/l-asparaginase (1)
CL Item
High Dose Ara-c/mixoxantrone (2)
Notes
Item
Comments
text
C0947611 (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