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ID

2511

Descripción

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

Link

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

Palabras clave

Versiones (3)
  1. 19/9/12 19/9/12 -
  2. 9/1/15 9/1/15 - Martin Dugas
  3. 3/7/15 3/7/15 -
Subido en

19 de septiembre de 2012

DOI

Para solicitar uno, por favor iniciar sesión.

Licencia

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

    Inglés

    No Instruction available.

    1 formularios  
    1. StudyEvent: Southwest Oncology Group Medical Conditions Questionnaire
      1. No Instruction available.
    Unnamed 1
    Descripción

    Unnamed 1

    SWOG Patient ID
    Descripción

    SWOGPatientID

    Tipo de datos

    text

    SWOG Study No.
    Descripción

    SWOGStudyNo.

    Tipo de datos

    text

    Registration Step
    Descripción

    RegistrationStep

    Tipo de datos

    text

    Patient Initials (L, F M)
    Descripción

    PatientInitialsName

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS 2011AA ValueDomain
    C1547383
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25536
    UMLS 2011AA Property
    C1555582
    Date
    Descripción

    Date

    Tipo de datos

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    Institution/Affiliate
    Descripción

    MainMemberInstitution/Affiliate

    Tipo de datos

    text

    Physician
    Descripción

    RegisteredInvestigator

    Tipo de datos

    text

    Unnamed 2
    Descripción

    Unnamed 2

    Unnamed 3
    Descripción

    Unnamed 3

    Have you ever had a heart attack?
    Descripción

    Haveyoueverhadaheartattack?

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180
    UMLS 2011AA ValueDomain
    C1522602
    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.)
    Descripción

    Haveyoueverbeentreatedforheartfailure?

    Tipo de datos

    text

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

    LowerExtremityPatientArteryBypassPersonalMedicalHistoryInd-2

    Tipo de datos

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Metathesaurus ObjectClass
    C0023216
    NCI Thesaurus Property
    C12372
    UMLS 2011AA Property
    C0003842
    NCI Thesaurus Property
    C18772
    UMLS 2011AA Property
    C0262926
    NCI Thesaurus Property
    C15723
    UMLS 2011AA Property
    C0741847
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    Have you had an operation or procedure to unclog or bypass the arteries in your heart?
    Descripción

    HeartPatientArteryBypassPersonalMedicalHistoryInd-3

    Tipo de datos

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus ObjectClass
    C12727
    UMLS 2011AA ObjectClass
    C0018787
    NCI Thesaurus Property
    C12372
    UMLS 2011AA Property
    C0003842
    NCI Thesaurus Property
    C18772
    UMLS 2011AA Property
    C0262926
    NCI Thesaurus Property
    C15723
    UMLS 2011AA Property
    C0741847
    NCI Thesaurus ValueDomain
    C38148
    UMLS 2011AA ValueDomain
    C1512699
    Have you had a stroke, cerebrovascular accident, blood clot or bleeding in the brain, or transient ischemic attack (TIA)?
    Descripción

    Haveyouhadastroke,cerebrovascularaccident,bloodclotorbleedinginthebrain,ortransientischemicattack(TIA)?

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180
    UMLS 2011AA ValueDomain
    C1522602
    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?
    Descripción

    Ifyouhavehadanyoftheseproblems,doyouhavedifficultymovinganarmorlegasaresultofthestrokeorcerebrovascularaccident?

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180
    UMLS 2011AA ValueDomain
    C1522602
    Do you have asthma?
    Descripción

    Doyouhaveasthma?

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180
    UMLS 2011AA ValueDomain
    C1522602
    If you have asthma, do you take medicines for your asthma?
    Descripción

    Ifyouhaveasthma,doyoutakemedicinesforyourasthma?

    Tipo de datos

    text

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

    Doyouhaveemphysema,chronicbronchitis,orchronicobstructivelungdisease?

    Tipo de datos

    text

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

    Ifyouhaveanyoftheselungdiseases,doyoutakemedicinesforyourcondition?

    Tipo de datos

    text

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

    Doyouhavestomachulcers,orpepticulcerdisease?

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180
    UMLS 2011AA ValueDomain
    C1522602
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C18772
    UMLS 2011AA Property
    C0262926
    NCI Thesaurus Property
    C25757
    UMLS 2011AA Property
    C0041582
    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?
    Descripción

    Ifyouhaveanyoftheseconditions,hasitbeendiagnosedbyadoctorlookingintoyourstomachthroughascope,orbyaskingyoutoswallowachalkydyeandthenhavingx-raystaken?

    Tipo de datos

    text

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

    Doyouhavediabetes(highbloodsugar)?

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180
    UMLS 2011AA ValueDomain
    C1522602
    If you have diabetes, are you being treated for it?
    Descripción

    Ifyouhavediabetes,areyoubeingtreatedforit?

    Tipo de datos

    text

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

    Ifyouhavediabetes,hasitcausedproblemswithyourkidneys?

    Tipo de datos

    text

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

    Ifyouhavediabetes,hasitcausedproblemswithyoureyes,treatedbyanophthalmologist?

    Tipo de datos

    text

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

    Haveyoueverhadpoorkidneyfunction(bloodtestsshowhighcreatinine)?

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180
    UMLS 2011AA ValueDomain
    C1522602
    Have you have used hemodialysis or peritoneal dialysis?
    Descripción

    Haveyouhaveusedhemodialysisorperitonealdialysis?

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180
    UMLS 2011AA ValueDomain
    C1522602
    Have you ever received a kidney transplantation?
    Descripción

    Haveyoueverreceivedakidneytransplantation?

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180
    UMLS 2011AA ValueDomain
    C1522602
    Do you have rheumatoid arthritis?
    Descripción

    Doyouhaverheumatoidarthritis?

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180
    UMLS 2011AA ValueDomain
    C1522602
    If you have rheumatoid arthritis, do you take medications for it regularly?
    Descripción

    Ifyouhaverheumatoidarthritis,doyoutakemedicationsforitregularly?

    Tipo de datos

    text

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

    Doyouhavelupus(systemiclupuserythematosus)?

    Tipo de datos

    text

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

    Doyouhavepolymyalgiarheumatica(inflammatorydisordercausingjointandmusclepain)?

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180
    UMLS 2011AA ValueDomain
    C1522602
    Do you have Alzheimer's Disease, or another form of dementia?
    Descripción

    DoyouhaveAlzheimer'sDisease,oranotherformofdementia?

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180
    UMLS 2011AA ValueDomain
    C1522602
    Do you have cirrhosis, or serious liver damage?
    Descripción

    Doyouhavecirrhosis,orseriousliverdamage?

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180
    UMLS 2011AA ValueDomain
    C1522602
    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?
    Descripción

    Haveyouhadanytypeofcancer(otherthancommonskincancersuchasbasalorsquamouscellskincancer)thatwassuccessfullytreatedmorethan5yearsago?

    Tipo de datos

    text

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

    Ifyouweretreatedforcancermorethan5yearsagohadthecancerspread,ormetastasized,tootherpartsofyourbody?

    Tipo de datos

    text

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

    PatientAcquiredImmunodeficiencySyndromeAssessmentInd-3

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS 2011AA ValueDomain
    C1512699
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus Property
    C2851
    UMLS 2011AA Property
    C0001175
    Have you had weight loss that required medical treatment?
    Descripción

    Haveyouhadweightlossthatrequiredmedicaltreatment?

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180
    UMLS 2011AA ValueDomain
    C1522602
    Ccrr Module For Southwest Oncology Group Medical Conditions Questionnaire
    Descripción

    Ccrr Module For Southwest Oncology Group Medical Conditions Questionnaire

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    Similar models

    No Instruction available.

    1 formularios
    1. StudyEvent: Southwest Oncology Group Medical Conditions Questionnaire
      1. No Instruction available.
    Name
    Tipo
    Description | Question | Decode (Coded Value)
    Tipo de datos
    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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