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ID

25154

Beschreibung

AMC-053 Off-Study Summary Form (F50) Bortezomib, Ifosfamide, Carboplatin, and Etoposide, With or Without Rituximab, in Treating Patients With Relapsed or Refractory AIDS-Related Non-Hodgkin Lymphoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=8B708D70-669B-F9DE-E040-BB89AD43114E

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=8B708D70-669B-F9DE-E040-BB89AD43114E

Stichworte

  1. 19.09.12 19.09.12 -
  2. 28.08.17 28.08.17 -
Hochgeladen am

28. August 2017

DOI

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Lizenz

Creative Commons BY-NC 3.0 Legacy

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    AMC-053 Off-Study Summary Form (F50)

    Please submit this form if the subject has (at least one of the following): 1) completed the post treatment follow-up period per protocol 2) been lost to follow-up 3) has refused follow-up 4) withdrew consent 5) has died. (Note: If all follow-up for a subject has been completed, all subjects (except those never initiating protocol therapy) must have both an Off Protocol Treatment Summary form and Off Study Summary form submitted.)

    Ccrr Module For Off Study Summary - Rf50
    Beschreibung

    Ccrr Module For Off Study Summary - Rf50

    Alias
    UMLS CUI-1
    C1518546
    UMLS CUI-2
    C1706244
    UMLS CUI-3
    C1332051
    Off Study Date
    Beschreibung

    Off-TreatmentStudyFollow-UpEndDate (mm/dd/yyyy)

    Datentyp

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    NCI Thesaurus ObjectClass
    C25601
    NCI Thesaurus ObjectClass-2
    C15206
    NCI Thesaurus Property
    C25275
    UMLS CUI [1,1]
    C1518544
    UMLS CUI [1,2]
    C0011008
    Off Study Reason
    Beschreibung

    Off-TreatmentStudyFollow-UpReason (select the primary reason)

    Datentyp

    integer

    Alias
    NCI Thesaurus ValueDomain
    C25638
    NCI Thesaurus Property
    C16033
    NCI Thesaurus ObjectClass
    C25601
    NCI Thesaurus ObjectClass-2
    C15206
    UMLS CUI [1,1]
    C1522577
    UMLS CUI [1,2]
    C1518546
    UMLS CUI [1,3]
    C0392360
    Other, specify
    Beschreibung

    Off-TreatmentStudyFollow-UpSpecify

    Datentyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    NCI Thesaurus Property
    C16033
    NCI Thesaurus ObjectClass
    C25601
    NCI Thesaurus ObjectClass-2
    C15206
    UMLS CUI [1,1]
    C1522577
    UMLS CUI [1,2]
    C1518546
    UMLS CUI [1,3]
    C0392360
    Comments
    Beschreibung

    Research Comments

    Datentyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704
    NCI Thesaurus ObjectClass
    C15319
    NCI Thesaurus Property
    C25393
    UMLS CUI [1,1]
    C0947611
    UMLS CUI [1,2]
    C1332051

    Ähnliche Modelle

    Please submit this form if the subject has (at least one of the following): 1) completed the post treatment follow-up period per protocol 2) been lost to follow-up 3) has refused follow-up 4) withdrew consent 5) has died. (Note: If all follow-up for a subject has been completed, all subjects (except those never initiating protocol therapy) must have both an Off Protocol Treatment Summary form and Off Study Summary form submitted.)

    Name
    Typ
    Description | Question | Decode (Coded Value)
    Datentyp
    Alias
    Item Group
    Ccrr Module For Off Study Summary - Rf50
    C1518546 (UMLS CUI-1)
    C1706244 (UMLS CUI-2)
    C1332051 (UMLS CUI-3)
    Off Study Date
    Item
    Off Study Date
    date
    C25164 (NCI Thesaurus ValueDomain)
    C25601 (NCI Thesaurus ObjectClass)
    C15206 (NCI Thesaurus ObjectClass-2)
    C25275 (NCI Thesaurus Property)
    C1518544 (UMLS CUI [1,1])
    C0011008 (UMLS CUI [1,2])
    Item
    Off Study Reason
    integer
    C25638 (NCI Thesaurus ValueDomain)
    C16033 (NCI Thesaurus Property)
    C25601 (NCI Thesaurus ObjectClass)
    C15206 (NCI Thesaurus ObjectClass-2)
    C1522577 (UMLS CUI [1,1])
    C1518546 (UMLS CUI [1,2])
    C0392360 (UMLS CUI [1,3])
    Code List
    Off Study Reason
    CL Item
    Protocol-defined Follow-up Completed (1)
    CL Item
    Lost To Follow-up (2)
    CL Item
    Patient Refused Follow-up (3)
    CL Item
    Death (4)
    CL Item
    Adverse Event/side Effects/complications (5)
    CL Item
    Other (6)
    Other, specify
    Item
    Other, specify
    text
    C25685 (NCI Thesaurus ValueDomain)
    C16033 (NCI Thesaurus Property)
    C25601 (NCI Thesaurus ObjectClass)
    C15206 (NCI Thesaurus ObjectClass-2)
    C1522577 (UMLS CUI [1,1])
    C1518546 (UMLS CUI [1,2])
    C0392360 (UMLS CUI [1,3])
    Research Comments
    Item
    Comments
    text
    C25704 (NCI Thesaurus ValueDomain)
    C15319 (NCI Thesaurus ObjectClass)
    C25393 (NCI Thesaurus Property)
    C0947611 (UMLS CUI [1,1])
    C1332051 (UMLS CUI [1,2])

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