ID

25266

Description

Southwest Oncology Group S0777 Registration Worksheet for OPEN - Step 2 Lenalidomide and Dexamethasone With or Without Bortezomib in Treating Patients With Previously Untreated Multiple Myeloma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=6ED9957B-AFDA-C3C3-E040-BB89AD434E9A

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=6ED9957B-AFDA-C3C3-E040-BB89AD434E9A

Keywords

Versions (2)
  1. 9/19/12 9/19/12 -
  2. 8/29/17 8/29/17 -
Uploaded on

August 29, 2017

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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Multiple Myeloma and Plasma Cell Neoplasm NCT00644228 Registration - Southwest Oncology Group S0777 Registration Worksheet - Step 2 - 2920797v1.0

English

No Instruction available.

1 forms  
  1. StudyEvent: Southwest Oncology Group S0777 Registration Worksheet - Step 2
    1. No Instruction available.
For All Institutions
Description

For All Institutions

Alias
UMLS CUI-1
C1955348
UMLS CUI-2
C2607850
UMLS CUI-3
C0026764
Is registering institution a SWOG institution
Description

RegisteringInstitutionSouthwestOncologyGroupAffiliationInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C21541
NCI Thesaurus ObjectClass-2
C25645
NCI Thesaurus Property
C25699
NCI Thesaurus Property-2
C25412
NCI Thesaurus ValueDomain
C38147
UMLS CUI [1,1]
C0018704
UMLS CUI [1,2]
C1519429
SWOG Patient ID
Description

SWOG Patient ID

Data type

text

Alias
UMLS CUI [1,1]
C2348585
UMLS CUI [1,2]
C1519429
For SWOG Institutions
Description

For SWOG Institutions

Alias
UMLS CUI-1
C1519429
UMLS CUI-2
C1320722
UMLS CUI-3
C0026764
Registrar's SWOG Roster ID Number
Description

RegistrarSouthwestOncologyGroupIdentifierNumber

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C25699
NCI Thesaurus ObjectClass
C25357
UMLS CUI [1,1]
C0557514
UMLS CUI [1,2]
C0237753
UMLS CUI [1,3]
C0600091
UMLS CUI [1,4]
C1519429
SWOG Investigator Number
Description

SouthwestOncologyGroupInvestigatorIdentifierNumber

Data type

integer

Alias
NCI Thesaurus ValueDomain
C25337
NCI Thesaurus Property
C25364
NCI Thesaurus ObjectClass
C25699
NCI Thesaurus ObjectClass-2
C17089
UMLS CUI [1,1]
C2986286
UMLS CUI [1,2]
C1519429
SWOG Treating Institution Number
Description

SouthwestOncologyGroupTreatingInstitutionIdentifierNumber

Data type

integer

Alias
NCI Thesaurus ObjectClass
C25699
NCI Thesaurus ObjectClass-2
C25705
NCI Thesaurus ObjectClass-3
C41206
NCI Thesaurus Property
C25364
NCI Thesaurus ValueDomain
C25337
UMLS CUI [1,1]
C1519429
UMLS CUI [1,2]
C1272753
UMLS CUI [1,3]
C0600091
Patient Information
Description

Patient Information

Alias
UMLS CUI-1
C1955348
UMLS CUI-2
C0026764
Projected Start Date of Treatment
Description

Treatment Start Date

Data type

date

Alias
NCI Thesaurus ObjectClass
C15368
NCI Thesaurus ObjectClass-2
C25631
NCI Thesaurus Property
C25431
NCI Thesaurus Property-2
C25275
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ValueDomain-2
C25431
UMLS CUI [1,1]
C0087111
UMLS CUI [1,2]
C0808070
UMLS CUI [1,3]
C0026764
Patient Eligibility
Description

Patient Eligibility

Alias
UMLS CUI-1
C1516637
UMLS CUI-2
C0013893
UMLS CUI-3
C0026764
Has the Southwest Oncology Group Registration Worksheet been completed entirely and is the patient eligible according to the current version of protocol section 5.0
Description

SouthwestOncologyGroupPatientRegistrationEligibilityDeterminationInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus ObjectClass-2
C25699
NCI Thesaurus Property
C25646
NCI Thesaurus Property-2
C25171
NCI Thesaurus ValueDomain
C38147
UMLS CUI [1,1]
C0013893
UMLS CUI [1,2]
C1514821
UMLS CUI [1,3]
C1519429
UMLS CUI [2]
C0026764
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Similar models

No Instruction available.

1 forms
  1. StudyEvent: Southwest Oncology Group S0777 Registration Worksheet - Step 2
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
For All Institutions
C1955348 (UMLS CUI-1)
C2607850 (UMLS CUI-2)
C0026764 (UMLS CUI-3)
Is registering institution a SWOG institution
Item
Is registering institution a SWOG institution
boolean
C21541 (NCI Thesaurus ObjectClass)
C25645 (NCI Thesaurus ObjectClass-2)
C25699 (NCI Thesaurus Property)
C25412 (NCI Thesaurus Property-2)
C38147 (NCI Thesaurus ValueDomain)
C0018704 (UMLS CUI [1,1])
C1519429 (UMLS CUI [1,2])
SWOG Patient ID
Item
SWOG Patient ID
text
C2348585 (UMLS CUI [1,1])
C1519429 (UMLS CUI [1,2])
Item Group
For SWOG Institutions
C1519429 (UMLS CUI-1)
C1320722 (UMLS CUI-2)
C0026764 (UMLS CUI-3)
Registrar's SWOG Roster ID Number
Item
Registrar's SWOG Roster ID Number
text
C25337 (NCI Thesaurus ValueDomain)
C25364 (NCI Thesaurus Property)
C25699 (NCI Thesaurus Property-2)
C25357 (NCI Thesaurus ObjectClass)
C0557514 (UMLS CUI [1,1])
C0237753 (UMLS CUI [1,2])
C0600091 (UMLS CUI [1,3])
C1519429 (UMLS CUI [1,4])
SWOG Investigator Number
Item
SWOG Investigator Number
integer
C25337 (NCI Thesaurus ValueDomain)
C25364 (NCI Thesaurus Property)
C25699 (NCI Thesaurus ObjectClass)
C17089 (NCI Thesaurus ObjectClass-2)
C2986286 (UMLS CUI [1,1])
C1519429 (UMLS CUI [1,2])
SWOG Treating Institution Number
Item
SWOG Treating Institution Number
integer
C25699 (NCI Thesaurus ObjectClass)
C25705 (NCI Thesaurus ObjectClass-2)
C41206 (NCI Thesaurus ObjectClass-3)
C25364 (NCI Thesaurus Property)
C25337 (NCI Thesaurus ValueDomain)
C1519429 (UMLS CUI [1,1])
C1272753 (UMLS CUI [1,2])
C0600091 (UMLS CUI [1,3])
Item Group
Patient Information
C1955348 (UMLS CUI-1)
C0026764 (UMLS CUI-2)
Treatment Start Date
Item
Projected Start Date of Treatment
date
C15368 (NCI Thesaurus ObjectClass)
C25631 (NCI Thesaurus ObjectClass-2)
C25431 (NCI Thesaurus Property)
C25275 (NCI Thesaurus Property-2)
C25164 (NCI Thesaurus ValueDomain)
C25431 (NCI Thesaurus ValueDomain-2)
C0087111 (UMLS CUI [1,1])
C0808070 (UMLS CUI [1,2])
C0026764 (UMLS CUI [1,3])
Item Group
Patient Eligibility
C1516637 (UMLS CUI-1)
C0013893 (UMLS CUI-2)
C0026764 (UMLS CUI-3)
Southwest Oncology Group Registration Worksheet been completed entirely and is the patient eligible according to the current version of protocol section 5.0
Item
Has the Southwest Oncology Group Registration Worksheet been completed entirely and is the patient eligible according to the current version of protocol section 5.0
boolean
C16960 (NCI Thesaurus ObjectClass)
C25699 (NCI Thesaurus ObjectClass-2)
C25646 (NCI Thesaurus Property)
C25171 (NCI Thesaurus Property-2)
C38147 (NCI Thesaurus ValueDomain)
C0013893 (UMLS CUI [1,1])
C1514821 (UMLS CUI [1,2])
C1519429 (UMLS CUI [1,3])
C0026764 (UMLS CUI [2])
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