ID

25158

Descrição

AMC-053 AIDS and Cancer Specimen Resource (ACSR) Procurement Form (F37) 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=71583731-B144-1194-E040-BB89AD437269

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=71583731-B144-1194-E040-BB89AD437269

Palavras-chave

Versões (2)
  1. 19/09/2012 19/09/2012 -
  2. 28/08/2017 28/08/2017 -
Transferido a

28 de agosto de 2017

DOI

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Licença

Creative Commons BY-NC 3.0 Legacy
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AMC-053 AIDS and Cancer Specimen Resource (ACSR) Procurement Form (F37)

Inglês

No Instruction available.

1 Formulários  
  1. StudyEvent: AMC-053 AIDS and Cancer Specimen Resource (ACSR) Procurement Form (F37)
    1. No Instruction available.
Header
Descrição

Header

Alias
UMLS CUI-1
C1320722
UMLS CUI-2
C1332051
Visit number
Descrição

Visit number

Tipo de dados

integer

Alias
NCI Thesaurus ValueDomain
C25337
NCI Thesaurus ObjectClass
C16696
NCI Thesaurus Property
C25385
UMLS CUI [1]
C1549755
Specimen Procurement
Descrição

Specimen Procurement

Alias
UMLS CUI-1
C0370003
UMLS CUI-2
C1709695
UMLS CUI-3
C1332051
Date Specimen Obtained
Descrição

Date Specimen Obtained

Tipo de dados

date

Alias
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ObjectClass
C19157
NCI Thesaurus Property
C25452
NCI Thesaurus Property-2
C25275
UMLS CUI [1,1]
C0370003
UMLS CUI [1,2]
C1516698
UMLS CUI [1,3]
C0011008
Date Specimen Obtained
Descrição

Date Specimen Obtained

Tipo de dados

date

Alias
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ObjectClass
C19157
NCI Thesaurus Property
C25452
NCI Thesaurus Property-2
C25275
UMLS CUI [1,1]
C0370003
UMLS CUI [1,2]
C1516698
UMLS CUI [1,3]
C0011008
Specimen(s) obtained for donation to ACSR
Descrição

AIDSMalignancyConsortiumSpecimenProcurementInd-2

Tipo de dados

boolean

Alias
NCI Thesaurus ValueDomain
C38147
NCI Thesaurus ObjectClass
C19157
NCI Thesaurus ObjectClass-2
C19707
NCI Thesaurus Property
C54153
UMLS CUI [1,1]
C0370003
UMLS CUI [1,2]
C1515830
UMLS CUI [1,3]
C0680854
Specimen Type
Descrição

Specimen Type

Tipo de dados

integer

Alias
NCI Thesaurus ValueDomain
C25284
NCI Thesaurus ObjectClass
C19157
NCI Thesaurus Property
C25695
UMLS CUI [1,1]
C0370003
UMLS CUI [1,2]
C0332307
Other specify
Descrição

SpecimenCellSourceSpecify

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25685
NCI Thesaurus Property
C12508
NCI Thesaurus Property-2
C25683
NCI Thesaurus ObjectClass
C19157
UMLS CUI [1,1]
C0370003
UMLS CUI [1,2]
C0332307
ACSR site the specimen(s) shipped to
Descrição

AIDSMalignancyConsortiumSpecimenProcurementType

Tipo de dados

integer

Alias
NCI Thesaurus ValueDomain
C25284
NCI Thesaurus ObjectClass
C19157
NCI Thesaurus ObjectClass-2
C19707
NCI Thesaurus Property
C54153
UMLS CUI [1,1]
C0370003
UMLS CUI [1,2]
C1515830
UMLS CUI [1,3]
C0450429
Other, specify
Descrição

AIDSMalignancyConsortiumSpecimenProcurementSpecify

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25685
NCI Thesaurus ObjectClass
C19157
NCI Thesaurus ObjectClass-2
C19707
NCI Thesaurus Property
C54153
UMLS CUI [1,1]
C0370003
UMLS CUI [1,2]
C1515830
UMLS CUI [1,3]
C0450429
If specimens were not obtained for ACSR, please indicate reason
Descrição

AIDSMalignancyConsortiumSpecimenNotSubmittedReason

Tipo de dados

integer

Alias
NCI Thesaurus ObjectClass
C19157
NCI Thesaurus ObjectClass-2
C19707
NCI Thesaurus Property
C25594
NCI Thesaurus Property-2
C25695
NCI Thesaurus ValueDomain
C25638
UMLS CUI [1,1]
C0370003
UMLS CUI [1,2]
C1516698
UMLS CUI [1,3]
C0392360
UMLS CUI [2]
C1515830
Other, specify
Descrição

AIDSMalignancyConsortiumSpecimenNotSubmittedSpecify

Tipo de dados

text

Alias
NCI Thesaurus ObjectClass
C19157
NCI Thesaurus ObjectClass-2
C19707
NCI Thesaurus Property
C25594
NCI Thesaurus Property-2
C25695
NCI Thesaurus ValueDomain
C25685
UMLS CUI [1,1]
C0370003
UMLS CUI [1,2]
C1516698
UMLS CUI [1,3]
C0392360
UMLS CUI [2]
C1515830
Study Coordinator
Descrição

Study Coordinator

Alias
UMLS CUI-1
C1332051
UMLS CUI-2
C1880174
UMLS CUI-3
C1710220
Study Coordinator's name
Descrição

AIDSMalignancyConsortiumPersonStudyCoordinatorName

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25191
NCI Thesaurus ObjectClass
C25190
NCI Thesaurus ObjectClass-2
C19707
NCI Thesaurus Property
C51880
UMLS CUI [1,1]
C1547383
UMLS CUI [1,2]
C1710220
E-mail
Descrição

E-mail

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25704
NCI Thesaurus ObjectClass
C25657
NCI Thesaurus Property
C42775
UMLS CUI [1,1]
C1705961
UMLS CUI [1,2]
C1710220
Phone Number
Descrição

Phone Number

Tipo de dados

integer

Alias
NCI Thesaurus ValueDomain
C25337
NCI Thesaurus Property
C25395
NCI Thesaurus ObjectClass
C19711
UMLS CUI [1,1]
C1515258
UMLS CUI [1,2]
C1710220
Comments
Descrição

Comments

Alias
UMLS CUI-1
C0947611
UMLS CUI-2
C1332051
Comments
Descrição

Research Comments

Tipo de dados

text

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

No Instruction available.

1 Formulários
  1. StudyEvent: AMC-053 AIDS and Cancer Specimen Resource (ACSR) Procurement Form (F37)
    1. No Instruction available.
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de dados
Alias
Item Group
Header
C1320722 (UMLS CUI-1)
C1332051 (UMLS CUI-2)
Visit number
Item
Visit number
integer
C25337 (NCI Thesaurus ValueDomain)
C16696 (NCI Thesaurus ObjectClass)
C25385 (NCI Thesaurus Property)
C1549755 (UMLS CUI [1])
Item Group
Specimen Procurement
C0370003 (UMLS CUI-1)
C1709695 (UMLS CUI-2)
C1332051 (UMLS CUI-3)
Date Specimen Obtained
Item
Date Specimen Obtained
date
C25164 (NCI Thesaurus ValueDomain)
C19157 (NCI Thesaurus ObjectClass)
C25452 (NCI Thesaurus Property)
C25275 (NCI Thesaurus Property-2)
C0370003 (UMLS CUI [1,1])
C1516698 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
Date Specimen Obtained
Item
Date Specimen Obtained
date
C25164 (NCI Thesaurus ValueDomain)
C19157 (NCI Thesaurus ObjectClass)
C25452 (NCI Thesaurus Property)
C25275 (NCI Thesaurus Property-2)
C0370003 (UMLS CUI [1,1])
C1516698 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
donation to ACSR
Item
Specimen(s) obtained for donation to ACSR
boolean
C38147 (NCI Thesaurus ValueDomain)
C19157 (NCI Thesaurus ObjectClass)
C19707 (NCI Thesaurus ObjectClass-2)
C54153 (NCI Thesaurus Property)
C0370003 (UMLS CUI [1,1])
C1515830 (UMLS CUI [1,2])
C0680854 (UMLS CUI [1,3])
Item
Specimen Type
integer
C25284 (NCI Thesaurus ValueDomain)
C19157 (NCI Thesaurus ObjectClass)
C25695 (NCI Thesaurus Property)
C0370003 (UMLS CUI [1,1])
C0332307 (UMLS CUI [1,2])
CL.2
Code List
Specimen Type
CL Item
Serum (1)
CL Item
Plasma (2)
CL Item
Pbmc (peripheral Blood Mononuclear Cells) (3)
CL Item
Peripheral Blood (4)
CL Item
Tissue (5)
CL Item
Other (6)
Other specify
Item
Other specify
text
C25685 (NCI Thesaurus ValueDomain)
C12508 (NCI Thesaurus Property)
C25683 (NCI Thesaurus Property-2)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS CUI [1,1])
C0332307 (UMLS CUI [1,2])
Item
ACSR site the specimen(s) shipped to
integer
C25284 (NCI Thesaurus ValueDomain)
C19157 (NCI Thesaurus ObjectClass)
C19707 (NCI Thesaurus ObjectClass-2)
C54153 (NCI Thesaurus Property)
C0370003 (UMLS CUI [1,1])
C1515830 (UMLS CUI [1,2])
C0450429 (UMLS CUI [1,3])
CL.3
Code List
ACSR site the specimen(s) shipped to
CL Item
Gwu (1)
CL Item
Ucla (2)
CL Item
Ucsf (3)
CL Item
Osu (4)
CL Item
Suny/hscb (5)
CL Item
Jhu (6)
CL Item
Other (7)
Other, specify
Item
Other, specify
text
C25685 (NCI Thesaurus ValueDomain)
C19157 (NCI Thesaurus ObjectClass)
C19707 (NCI Thesaurus ObjectClass-2)
C54153 (NCI Thesaurus Property)
C0370003 (UMLS CUI [1,1])
C1515830 (UMLS CUI [1,2])
C0450429 (UMLS CUI [1,3])
Item
If specimens were not obtained for ACSR, please indicate reason
integer
C19157 (NCI Thesaurus ObjectClass)
C19707 (NCI Thesaurus ObjectClass-2)
C25594 (NCI Thesaurus Property)
C25695 (NCI Thesaurus Property-2)
C25638 (NCI Thesaurus ValueDomain)
C0370003 (UMLS CUI [1,1])
C1516698 (UMLS CUI [1,2])
C0392360 (UMLS CUI [1,3])
C1515830 (UMLS CUI [2])
CL.4
Code List
If specimens were not obtained for ACSR, please indicate reason
CL Item
Patient Had Previously Donated Specimen To Acsr (1)
CL Item
Patient Refused To Give Informed Consent For Acsr Specimen Donation (2)
CL Item
Patient Was Not Asked To Consider Acsr Specimen Donation (3)
CL Item
Other (4)
Other, specify
Item
Other, specify
text
C19157 (NCI Thesaurus ObjectClass)
C19707 (NCI Thesaurus ObjectClass-2)
C25594 (NCI Thesaurus Property)
C25695 (NCI Thesaurus Property-2)
C25685 (NCI Thesaurus ValueDomain)
C0370003 (UMLS CUI [1,1])
C1516698 (UMLS CUI [1,2])
C0392360 (UMLS CUI [1,3])
C1515830 (UMLS CUI [2])
Item Group
Study Coordinator
C1332051 (UMLS CUI-1)
C1880174 (UMLS CUI-2)
C1710220 (UMLS CUI-3)
Study Coordinator's name
Item
Study Coordinator's name
text
C25191 (NCI Thesaurus ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C19707 (NCI Thesaurus ObjectClass-2)
C51880 (NCI Thesaurus Property)
C1547383 (UMLS CUI [1,1])
C1710220 (UMLS CUI [1,2])
E-mail
Item
E-mail
text
C25704 (NCI Thesaurus ValueDomain)
C25657 (NCI Thesaurus ObjectClass)
C42775 (NCI Thesaurus Property)
C1705961 (UMLS CUI [1,1])
C1710220 (UMLS CUI [1,2])
Phone Number
Item
Phone Number
integer
C25337 (NCI Thesaurus ValueDomain)
C25395 (NCI Thesaurus Property)
C19711 (NCI Thesaurus ObjectClass)
C1515258 (UMLS CUI [1,1])
C1710220 (UMLS CUI [1,2])
Item Group
Comments
C0947611 (UMLS CUI-1)
C1332051 (UMLS CUI-2)
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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