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2511

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Southwest Oncology Group Medical Conditions Questionnaire Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A4CF6FCD-888E-36E1-E034-080020C9C0E0

Länk

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A4CF6FCD-888E-36E1-E034-080020C9C0E0

Nyckelord

Versioner (3)
  1. 19/9/12 19/9/12 -
  2. 9/1/15 9/1/15 - Martin Dugas
  3. 3/7/15 3/7/15 -
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19 de septiembre de 2012

DOI

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Creative Commons BY-NC 3.0 Legacy
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    Lung Cancer null Pre-Study - Southwest Oncology Group Medical Conditions Questionnaire - 2040524v3.0

    Engelsk

    No Instruction available.

    1 Formulär  
    1. StudyEvent: Southwest Oncology Group Medical Conditions Questionnaire
      1. No Instruction available.
    Unnamed 1
    Beskrivning

    Unnamed 1

    SWOG Patient ID
    Beskrivning

    SWOGPatientID

    Datatyp

    text

    SWOG Study No.
    Beskrivning

    SWOGStudyNo.

    Datatyp

    text

    Registration Step
    Beskrivning

    RegistrationStep

    Datatyp

    text

    Patient Initials (L, F M)
    Beskrivning

    PatientInitialsName

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191 (undefined)
    UMLS 2011AA ValueDomain
    C1547383 (Person Name)
    SNOMED
    734006007
    NCI Thesaurus ObjectClass
    C16960 (undefined)
    UMLS 2011AA ObjectClass
    C0030705 (Patients)
    SNOMED
    116154003
    NCI Thesaurus Property
    C25536 (undefined)
    UMLS 2011AA Property
    C1555582 (Initial (abbreviation))
    Date
    Beskrivning

    Date

    Datatyp

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164 (undefined)
    UMLS 2011AA ValueDomain
    C0011008 (Date in time)
    SNOMED
    410671006
    Institution/Affiliate
    Beskrivning

    MainMemberInstitution/Affiliate

    Datatyp

    text

    Physician
    Beskrivning

    RegisteredInvestigator

    Datatyp

    text

    Unnamed 2
    Beskrivning

    Unnamed 2

    Unnamed 3
    Beskrivning

    Unnamed 3

    Have you ever had a heart attack?
    Beskrivning

    Haveyoueverhadaheartattack?

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180 (undefined)
    UMLS 2011AA ValueDomain
    C1522602 (Indicator)
    Have you ever been treated for heart failure? (You may have been short of breath and the doctor may have told you that you had fluid in your lungs or that your heart was not pumping well.)
    Beskrivning

    Haveyoueverbeentreatedforheartfailure?

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180 (undefined)
    UMLS 2011AA ValueDomain
    C1522602 (Indicator)
    Have you had an operation to unclog or bypass the arteries in your legs?
    Beskrivning

    LowerExtremityPatientArteryBypassPersonalMedicalHistoryInd-2

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960 (undefined)
    UMLS 2011AA ObjectClass
    C0030705 (Patients)
    SNOMED
    116154003
    NCI Metathesaurus ObjectClass
    C0023216 (Lower Extremity)
    SNOMED
    61685007
    LOINC
    LP207495-5
    NCI Thesaurus Property
    C12372 (undefined)
    UMLS 2011AA Property
    C0003842 (Arteries)
    SNOMED
    51114001
    NCI Thesaurus Property
    C18772 (undefined)
    UMLS 2011AA Property
    C0262926 (Medical History)
    SNOMED
    392521001
    LOINC
    LP6817-3
    NCI Thesaurus Property
    C15723 (undefined)
    UMLS 2011AA Property
    C0741847 (Bypass)
    SNOMED
    88834003
    NCI Thesaurus ValueDomain
    C38147 (undefined)
    UMLS 2011AA ValueDomain
    C1512698 (Yes or No Response)
    Have you had an operation or procedure to unclog or bypass the arteries in your heart?
    Beskrivning

    HeartPatientArteryBypassPersonalMedicalHistoryInd-3

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960 (undefined)
    UMLS 2011AA ObjectClass
    C0030705 (Patients)
    SNOMED
    116154003
    NCI Thesaurus ObjectClass
    C12727 (undefined)
    UMLS 2011AA ObjectClass
    C0018787 (Heart)
    SNOMED
    80891009
    LOINC
    LP7289-4
    NCI Thesaurus Property
    C12372 (undefined)
    UMLS 2011AA Property
    C0003842 (Arteries)
    SNOMED
    51114001
    NCI Thesaurus Property
    C18772 (undefined)
    UMLS 2011AA Property
    C0262926 (Medical History)
    SNOMED
    392521001
    LOINC
    LP6817-3
    NCI Thesaurus Property
    C15723 (undefined)
    UMLS 2011AA Property
    C0741847 (Bypass)
    SNOMED
    88834003
    NCI Thesaurus ValueDomain
    C38148 (undefined)
    UMLS 2011AA ValueDomain
    C1512699 (Yes, No, or Unknown Response)
    Have you had a stroke, cerebrovascular accident, blood clot or bleeding in the brain, or transient ischemic attack (TIA)?
    Beskrivning

    Haveyouhadastroke,cerebrovascularaccident,bloodclotorbleedinginthebrain,ortransientischemicattack(TIA)?

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180 (undefined)
    UMLS 2011AA ValueDomain
    C1522602 (Indicator)
    If you have had any of these problems, do you have difficulty moving an arm or leg as a result of the stroke or cerebrovascular accident?
    Beskrivning

    Ifyouhavehadanyoftheseproblems,doyouhavedifficultymovinganarmorlegasaresultofthestrokeorcerebrovascularaccident?

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180 (undefined)
    UMLS 2011AA ValueDomain
    C1522602 (Indicator)
    Do you have asthma?
    Beskrivning

    Doyouhaveasthma?

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180 (undefined)
    UMLS 2011AA ValueDomain
    C1522602 (Indicator)
    If you have asthma, do you take medicines for your asthma?
    Beskrivning

    Ifyouhaveasthma,doyoutakemedicinesforyourasthma?

    Datatyp

    text

    Do you have emphysema, chronic bronchitis, or chronic obstructive lung disease?
    Beskrivning

    Doyouhaveemphysema,chronicbronchitis,orchronicobstructivelungdisease?

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180 (undefined)
    UMLS 2011AA ValueDomain
    C1522602 (Indicator)
    If you have any of these lung diseases, do you take medicines for your condition?
    Beskrivning

    Ifyouhaveanyoftheselungdiseases,doyoutakemedicinesforyourcondition?

    Datatyp

    text

    Do you have stomach ulcers, or peptic ulcer disease?
    Beskrivning

    Doyouhavestomachulcers,orpepticulcerdisease?

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180 (undefined)
    UMLS 2011AA ValueDomain
    C1522602 (Indicator)
    NCI Thesaurus ObjectClass
    C16960 (undefined)
    UMLS 2011AA ObjectClass
    C0030705 (Patients)
    SNOMED
    116154003
    NCI Thesaurus Property
    C18772 (undefined)
    UMLS 2011AA Property
    C0262926 (Medical History)
    SNOMED
    392521001
    LOINC
    LP6817-3
    NCI Thesaurus Property
    C25757 (undefined)
    UMLS 2011AA Property
    C0041582 (Ulcer)
    SNOMED
    429040005
    LOINC
    MTHU022920
    If you have any of these conditions, has it been diagnosed by a doctor looking into your stomach through a scope, or by asking you to swallow a chalky dye and then having x-rays taken?
    Beskrivning

    Ifyouhaveanyoftheseconditions,hasitbeendiagnosedbyadoctorlookingintoyourstomachthroughascope,orbyaskingyoutoswallowachalkydyeandthenhavingx-raystaken?

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180 (undefined)
    UMLS 2011AA ValueDomain
    C1522602 (Indicator)
    Do you have diabetes (high blood sugar)?
    Beskrivning

    Doyouhavediabetes(highbloodsugar)?

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180 (undefined)
    UMLS 2011AA ValueDomain
    C1522602 (Indicator)
    If you have diabetes, are you being treated for it?
    Beskrivning

    Ifyouhavediabetes,areyoubeingtreatedforit?

    Datatyp

    text

    If you have diabetes, has it caused problems with your kidneys?
    Beskrivning

    Ifyouhavediabetes,hasitcausedproblemswithyourkidneys?

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180 (undefined)
    UMLS 2011AA ValueDomain
    C1522602 (Indicator)
    If you have diabetes, has it caused problems with your eyes, treated by an ophthalmologist?
    Beskrivning

    Ifyouhavediabetes,hasitcausedproblemswithyoureyes,treatedbyanophthalmologist?

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180 (undefined)
    UMLS 2011AA ValueDomain
    C1522602 (Indicator)
    Have you ever had poor kidney function (blood tests show high creatinine)?
    Beskrivning

    Haveyoueverhadpoorkidneyfunction(bloodtestsshowhighcreatinine)?

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180 (undefined)
    UMLS 2011AA ValueDomain
    C1522602 (Indicator)
    Have you have used hemodialysis or peritoneal dialysis?
    Beskrivning

    Haveyouhaveusedhemodialysisorperitonealdialysis?

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180 (undefined)
    UMLS 2011AA ValueDomain
    C1522602 (Indicator)
    Have you ever received a kidney transplantation?
    Beskrivning

    Haveyoueverreceivedakidneytransplantation?

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180 (undefined)
    UMLS 2011AA ValueDomain
    C1522602 (Indicator)
    Do you have rheumatoid arthritis?
    Beskrivning

    Doyouhaverheumatoidarthritis?

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180 (undefined)
    UMLS 2011AA ValueDomain
    C1522602 (Indicator)
    If you have rheumatoid arthritis, do you take medications for it regularly?
    Beskrivning

    Ifyouhaverheumatoidarthritis,doyoutakemedicationsforitregularly?

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180 (undefined)
    UMLS 2011AA ValueDomain
    C1522602 (Indicator)
    Do you have lupus (systemic lupus erythematosus)?
    Beskrivning

    Doyouhavelupus(systemiclupuserythematosus)?

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180 (undefined)
    UMLS 2011AA ValueDomain
    C1522602 (Indicator)
    Do you have polymyalgia rheumatica (inflammatory disorder causing joint and muscle pain)?
    Beskrivning

    Doyouhavepolymyalgiarheumatica(inflammatorydisordercausingjointandmusclepain)?

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180 (undefined)
    UMLS 2011AA ValueDomain
    C1522602 (Indicator)
    Do you have Alzheimer's Disease, or another form of dementia?
    Beskrivning

    DoyouhaveAlzheimer'sDisease,oranotherformofdementia?

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180 (undefined)
    UMLS 2011AA ValueDomain
    C1522602 (Indicator)
    Do you have cirrhosis, or serious liver damage?
    Beskrivning

    Doyouhavecirrhosis,orseriousliverdamage?

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180 (undefined)
    UMLS 2011AA ValueDomain
    C1522602 (Indicator)
    Have you had any type of cancer (other than common skin cancer such as basal or squamous cell skin cancer) that was successfully treated more than 5 years ago?
    Beskrivning

    Haveyouhadanytypeofcancer(otherthancommonskincancersuchasbasalorsquamouscellskincancer)thatwassuccessfullytreatedmorethan5yearsago?

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180 (undefined)
    UMLS 2011AA ValueDomain
    C1522602 (Indicator)
    If you were treated for cancer more than 5 years ago had the cancer spread, or metastasized, to other parts of your body?
    Beskrivning

    Ifyouweretreatedforcancermorethan5yearsagohadthecancerspread,ormetastasized,tootherpartsofyourbody?

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180 (undefined)
    UMLS 2011AA ValueDomain
    C1522602 (Indicator)
    Do you have AIDS (acquired immunodeficiency syndrome)?
    Beskrivning

    PatientAcquiredImmunodeficiencySyndromeAssessmentInd-3

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C38148 (undefined)
    UMLS 2011AA ValueDomain
    C1512699 (Yes, No, or Unknown Response)
    NCI Thesaurus ObjectClass
    C16960 (undefined)
    UMLS 2011AA ObjectClass
    C0030705 (Patients)
    SNOMED
    116154003
    NCI Thesaurus Property
    C20989 (undefined)
    UMLS 2011AA Property
    C0031809 (Physical Examination)
    SNOMED
    5880005
    LOINC
    MTHU028014
    NCI Thesaurus Property
    C2851 (undefined)
    UMLS 2011AA Property
    C0001175 (Acquired Immunodeficiency Syndrome)
    SNOMED
    62479008
    LOINC
    LA10430-9
    Have you had weight loss that required medical treatment?
    Beskrivning

    Haveyouhadweightlossthatrequiredmedicaltreatment?

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180 (undefined)
    UMLS 2011AA ValueDomain
    C1522602 (Indicator)
    Ccrr Module For Southwest Oncology Group Medical Conditions Questionnaire
    Beskrivning

    Ccrr Module For Southwest Oncology Group Medical Conditions Questionnaire

    Tillbaka till toppen

    Similar models

    No Instruction available.

    1 Formulär
    1. StudyEvent: Southwest Oncology Group Medical Conditions Questionnaire
      1. No Instruction available.
    Name
    Typ
    Description | Question | Decode (Coded Value)
    Datatyp
    Alias
    Item Group
    Unnamed 1
    SWOGPatientID
    Item
    SWOG Patient ID
    text
    SWOGStudyNo.
    Item
    SWOG Study No.
    text
    RegistrationStep
    Item
    Registration Step
    text
    PatientInitialsName
    Item
    Patient Initials (L, F M)
    text
    C25191 (NCI Thesaurus ValueDomain)
    C1547383 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25536 (NCI Thesaurus Property)
    C1555582 (UMLS 2011AA Property)
    Date
    Item
    Date
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    MainMemberInstitution/Affiliate
    Item
    Institution/Affiliate
    text
    RegisteredInvestigator
    Item
    Physician
    text
    Item Group
    Unnamed 2
    Item Group
    Unnamed 3
    Item
    Have you ever had a heart attack?
    text
    C25180 (NCI Thesaurus ValueDomain)
    C1522602 (UMLS 2011AA ValueDomain)
    CL.1
    Code List
    Have you ever had a heart attack?
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    Item
    Have you ever been treated for heart failure? (You may have been short of breath and the doctor may have told you that you had fluid in your lungs or that your heart was not pumping well.)
    text
    C25180 (NCI Thesaurus ValueDomain)
    C1522602 (UMLS 2011AA ValueDomain)
    CL.2
    Code List
    Have you ever been treated for heart failure? (You may have been short of breath and the doctor may have told you that you had fluid in your lungs or that your heart was not pumping well.)
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    Item
    Have you had an operation to unclog or bypass the arteries in your legs?
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C0023216 (NCI Metathesaurus ObjectClass)
    C12372 (NCI Thesaurus Property)
    C0003842 (UMLS 2011AA Property)
    C18772 (NCI Thesaurus Property)
    C0262926 (UMLS 2011AA Property)
    C15723 (NCI Thesaurus Property)
    C0741847 (UMLS 2011AA Property)
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    CL.3
    Code List
    Have you had an operation to unclog or bypass the arteries in your legs?
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    Item
    Have you had an operation or procedure to unclog or bypass the arteries in your heart?
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C12727 (NCI Thesaurus ObjectClass)
    C0018787 (UMLS 2011AA ObjectClass)
    C12372 (NCI Thesaurus Property)
    C0003842 (UMLS 2011AA Property)
    C18772 (NCI Thesaurus Property)
    C0262926 (UMLS 2011AA Property)
    C15723 (NCI Thesaurus Property)
    C0741847 (UMLS 2011AA Property)
    C38148 (NCI Thesaurus ValueDomain)
    C1512699 (UMLS 2011AA ValueDomain)
    CL.4
    Code List
    Have you had an operation or procedure to unclog or bypass the arteries in your heart?
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    Item
    Have you had a stroke, cerebrovascular accident, blood clot or bleeding in the brain, or transient ischemic attack (TIA)?
    text
    C25180 (NCI Thesaurus ValueDomain)
    C1522602 (UMLS 2011AA ValueDomain)
    CL.5
    Code List
    Have you had a stroke, cerebrovascular accident, blood clot or bleeding in the brain, or transient ischemic attack (TIA)?
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    Item
    If you have had any of these problems, do you have difficulty moving an arm or leg as a result of the stroke or cerebrovascular accident?
    text
    C25180 (NCI Thesaurus ValueDomain)
    C1522602 (UMLS 2011AA ValueDomain)
    CL.6
    Code List
    If you have had any of these problems, do you have difficulty moving an arm or leg as a result of the stroke or cerebrovascular accident?
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    Item
    Do you have asthma?
    text
    C25180 (NCI Thesaurus ValueDomain)
    C1522602 (UMLS 2011AA ValueDomain)
    CL.7
    Code List
    Do you have asthma?
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    Item
    If you have asthma, do you take medicines for your asthma?
    text
    CL.8
    Code List
    If you have asthma, do you take medicines for your asthma?
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes, Only With Flare-ups Of My Asthma (Yes, only with flare-ups of my asthma)
    CL Item
    Yes, I Take Medicines Regularly, Even When I'm Not Having A Flare-up (Yes, I take medicines regularly, even when I'm not having a flare-up)
    Item
    Do you have emphysema, chronic bronchitis, or chronic obstructive lung disease?
    text
    C25180 (NCI Thesaurus ValueDomain)
    C1522602 (UMLS 2011AA ValueDomain)
    CL.9
    Code List
    Do you have emphysema, chronic bronchitis, or chronic obstructive lung disease?
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    Item
    If you have any of these lung diseases, do you take medicines for your condition?
    text
    CL.10
    Code List
    If you have any of these lung diseases, do you take medicines for your condition?
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes, Only With Flare-ups Of My Asthma (Yes, only with flare-ups of my asthma)
    CL Item
    Yes, I Take Medicines Regularly, Even When I'm Not Having A Flare-up (Yes, I take medicines regularly, even when I'm not having a flare-up)
    Item
    Do you have stomach ulcers, or peptic ulcer disease?
    text
    C25180 (NCI Thesaurus ValueDomain)
    C1522602 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C18772 (NCI Thesaurus Property)
    C0262926 (UMLS 2011AA Property)
    C25757 (NCI Thesaurus Property)
    C0041582 (UMLS 2011AA Property)
    CL.11
    Code List
    Do you have stomach ulcers, or peptic ulcer disease?
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    Item
    If you have any of these conditions, has it been diagnosed by a doctor looking into your stomach through a scope, or by asking you to swallow a chalky dye and then having x-rays taken?
    text
    C25180 (NCI Thesaurus ValueDomain)
    C1522602 (UMLS 2011AA ValueDomain)
    CL.12
    Code List
    If you have any of these conditions, has it been diagnosed by a doctor looking into your stomach through a scope, or by asking you to swallow a chalky dye and then having x-rays taken?
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    Item
    Do you have diabetes (high blood sugar)?
    text
    C25180 (NCI Thesaurus ValueDomain)
    C1522602 (UMLS 2011AA ValueDomain)
    CL.13
    Code List
    Do you have diabetes (high blood sugar)?
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    Item
    If you have diabetes, are you being treated for it?
    text
    CL.14
    Code List
    If you have diabetes, are you being treated for it?
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes, Treated By Modifying My Diet (Yes, treated by modifying my diet)
    CL Item
    Yes, Treated By Medications Taken By Mouth (Yes, treated by medications taken by mouth)
    CL Item
    Yes, Treated By Insuling Injections (Yes, treated by insuling injections)
    Item
    If you have diabetes, has it caused problems with your kidneys?
    text
    C25180 (NCI Thesaurus ValueDomain)
    C1522602 (UMLS 2011AA ValueDomain)
    CL.15
    Code List
    If you have diabetes, has it caused problems with your kidneys?
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    Item
    If you have diabetes, has it caused problems with your eyes, treated by an ophthalmologist?
    text
    C25180 (NCI Thesaurus ValueDomain)
    C1522602 (UMLS 2011AA ValueDomain)
    CL.16
    Code List
    If you have diabetes, has it caused problems with your eyes, treated by an ophthalmologist?
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    Item
    Have you ever had poor kidney function (blood tests show high creatinine)?
    text
    C25180 (NCI Thesaurus ValueDomain)
    C1522602 (UMLS 2011AA ValueDomain)
    CL.17
    Code List
    Have you ever had poor kidney function (blood tests show high creatinine)?
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    Item
    Have you have used hemodialysis or peritoneal dialysis?
    text
    C25180 (NCI Thesaurus ValueDomain)
    C1522602 (UMLS 2011AA ValueDomain)
    CL.18
    Code List
    Have you have used hemodialysis or peritoneal dialysis?
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    Item
    Have you ever received a kidney transplantation?
    text
    C25180 (NCI Thesaurus ValueDomain)
    C1522602 (UMLS 2011AA ValueDomain)
    CL.19
    Code List
    Have you ever received a kidney transplantation?
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    Item
    Do you have rheumatoid arthritis?
    text
    C25180 (NCI Thesaurus ValueDomain)
    C1522602 (UMLS 2011AA ValueDomain)
    CL.20
    Code List
    Do you have rheumatoid arthritis?
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    Item
    If you have rheumatoid arthritis, do you take medications for it regularly?
    text
    C25180 (NCI Thesaurus ValueDomain)
    C1522602 (UMLS 2011AA ValueDomain)
    CL.21
    Code List
    If you have rheumatoid arthritis, do you take medications for it regularly?
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    Item
    Do you have lupus (systemic lupus erythematosus)?
    text
    C25180 (NCI Thesaurus ValueDomain)
    C1522602 (UMLS 2011AA ValueDomain)
    CL.22
    Code List
    Do you have lupus (systemic lupus erythematosus)?
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    Item
    Do you have polymyalgia rheumatica (inflammatory disorder causing joint and muscle pain)?
    text
    C25180 (NCI Thesaurus ValueDomain)
    C1522602 (UMLS 2011AA ValueDomain)
    CL.23
    Code List
    Do you have polymyalgia rheumatica (inflammatory disorder causing joint and muscle pain)?
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    Item
    Do you have Alzheimer's Disease, or another form of dementia?
    text
    C25180 (NCI Thesaurus ValueDomain)
    C1522602 (UMLS 2011AA ValueDomain)
    CL.24
    Code List
    Do you have Alzheimer's Disease, or another form of dementia?
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    Item
    Do you have cirrhosis, or serious liver damage?
    text
    C25180 (NCI Thesaurus ValueDomain)
    C1522602 (UMLS 2011AA ValueDomain)
    CL.25
    Code List
    Do you have cirrhosis, or serious liver damage?
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    Item
    Have you had any type of cancer (other than common skin cancer such as basal or squamous cell skin cancer) that was successfully treated more than 5 years ago?
    text
    C25180 (NCI Thesaurus ValueDomain)
    C1522602 (UMLS 2011AA ValueDomain)
    CL.26
    Code List
    Have you had any type of cancer (other than common skin cancer such as basal or squamous cell skin cancer) that was successfully treated more than 5 years ago?
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    Item
    If you were treated for cancer more than 5 years ago had the cancer spread, or metastasized, to other parts of your body?
    text
    C25180 (NCI Thesaurus ValueDomain)
    C1522602 (UMLS 2011AA ValueDomain)
    CL.27
    Code List
    If you were treated for cancer more than 5 years ago had the cancer spread, or metastasized, to other parts of your body?
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    Item
    Do you have AIDS (acquired immunodeficiency syndrome)?
    text
    C38148 (NCI Thesaurus ValueDomain)
    C1512699 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C2851 (NCI Thesaurus Property)
    C0001175 (UMLS 2011AA Property)
    CL.28
    Code List
    Do you have AIDS (acquired immunodeficiency syndrome)?
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    Item
    Have you had weight loss that required medical treatment?
    text
    C25180 (NCI Thesaurus ValueDomain)
    C1522602 (UMLS 2011AA ValueDomain)
    CL.29
    Code List
    Have you had weight loss that required medical treatment?
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    Item Group
    Ccrr Module For Southwest Oncology Group Medical Conditions Questionnaire
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