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2511

Beschrijving

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

Trefwoorden

Versies (3)
  1. 19-09-12 19-09-12 -
  2. 09-01-15 09-01-15 - Martin Dugas
  3. 03-07-15 03-07-15 -
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19 september 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

    Engels

    No Instruction available.

    1 Formulieren  
    1. StudyEvent: Southwest Oncology Group Medical Conditions Questionnaire
      1. No Instruction available.
    Unnamed 1
    Beschrijving

    Unnamed 1

    SWOG Patient ID
    Beschrijving

    SWOGPatientID

    Datatype

    text

    SWOG Study No.
    Beschrijving

    SWOGStudyNo.

    Datatype

    text

    Registration Step
    Beschrijving

    RegistrationStep

    Datatype

    text

    Patient Initials (L, F M)
    Beschrijving

    PatientInitialsName

    Datatype

    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
    Beschrijving

    Date

    Datatype

    date

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

    MainMemberInstitution/Affiliate

    Datatype

    text

    Physician
    Beschrijving

    RegisteredInvestigator

    Datatype

    text

    Unnamed 2
    Beschrijving

    Unnamed 2

    Unnamed 3
    Beschrijving

    Unnamed 3

    Have you ever had a heart attack?
    Beschrijving

    Haveyoueverhadaheartattack?

    Datatype

    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.)
    Beschrijving

    Haveyoueverbeentreatedforheartfailure?

    Datatype

    text

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

    LowerExtremityPatientArteryBypassPersonalMedicalHistoryInd-2

    Datatype

    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?
    Beschrijving

    HeartPatientArteryBypassPersonalMedicalHistoryInd-3

    Datatype

    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)?
    Beschrijving

    Haveyouhadastroke,cerebrovascularaccident,bloodclotorbleedinginthebrain,ortransientischemicattack(TIA)?

    Datatype

    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?
    Beschrijving

    Ifyouhavehadanyoftheseproblems,doyouhavedifficultymovinganarmorlegasaresultofthestrokeorcerebrovascularaccident?

    Datatype

    text

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

    Doyouhaveasthma?

    Datatype

    text

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

    Ifyouhaveasthma,doyoutakemedicinesforyourasthma?

    Datatype

    text

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

    Doyouhaveemphysema,chronicbronchitis,orchronicobstructivelungdisease?

    Datatype

    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?
    Beschrijving

    Ifyouhaveanyoftheselungdiseases,doyoutakemedicinesforyourcondition?

    Datatype

    text

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

    Doyouhavestomachulcers,orpepticulcerdisease?

    Datatype

    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?
    Beschrijving

    Ifyouhaveanyoftheseconditions,hasitbeendiagnosedbyadoctorlookingintoyourstomachthroughascope,orbyaskingyoutoswallowachalkydyeandthenhavingx-raystaken?

    Datatype

    text

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

    Doyouhavediabetes(highbloodsugar)?

    Datatype

    text

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

    Ifyouhavediabetes,areyoubeingtreatedforit?

    Datatype

    text

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

    Ifyouhavediabetes,hasitcausedproblemswithyourkidneys?

    Datatype

    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?
    Beschrijving

    Ifyouhavediabetes,hasitcausedproblemswithyoureyes,treatedbyanophthalmologist?

    Datatype

    text

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

    Haveyoueverhadpoorkidneyfunction(bloodtestsshowhighcreatinine)?

    Datatype

    text

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

    Haveyouhaveusedhemodialysisorperitonealdialysis?

    Datatype

    text

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

    Haveyoueverreceivedakidneytransplantation?

    Datatype

    text

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

    Doyouhaverheumatoidarthritis?

    Datatype

    text

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

    Ifyouhaverheumatoidarthritis,doyoutakemedicationsforitregularly?

    Datatype

    text

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

    Doyouhavelupus(systemiclupuserythematosus)?

    Datatype

    text

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

    Doyouhavepolymyalgiarheumatica(inflammatorydisordercausingjointandmusclepain)?

    Datatype

    text

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

    DoyouhaveAlzheimer'sDisease,oranotherformofdementia?

    Datatype

    text

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

    Doyouhavecirrhosis,orseriousliverdamage?

    Datatype

    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?
    Beschrijving

    Haveyouhadanytypeofcancer(otherthancommonskincancersuchasbasalorsquamouscellskincancer)thatwassuccessfullytreatedmorethan5yearsago?

    Datatype

    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?
    Beschrijving

    Ifyouweretreatedforcancermorethan5yearsagohadthecancerspread,ormetastasized,tootherpartsofyourbody?

    Datatype

    text

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

    PatientAcquiredImmunodeficiencySyndromeAssessmentInd-3

    Datatype

    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?
    Beschrijving

    Haveyouhadweightlossthatrequiredmedicaltreatment?

    Datatype

    text

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

    Ccrr Module For Southwest Oncology Group Medical Conditions Questionnaire

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    No Instruction available.

    1 Formulieren
    1. StudyEvent: Southwest Oncology Group Medical Conditions Questionnaire
      1. No Instruction available.
    Name
    Type
    Description | Question | Decode (Coded Value)
    Datatype
    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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