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ID

25268

Beschreibung

AMC-064 Missed Visit Form (F35) Study of Blood and Tissue Samples From Patients With Aggressive Non-Hodgkin B-Cell Lymphoma or Hodgkin Lymphoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=7C993962-28AC-EDFE-E040-BB89AD43562B

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=7C993962-28AC-EDFE-E040-BB89AD43562B

Stichworte

Versionen (2)
  1. 19.09.12 19.09.12 -
  2. 29.08.17 29.08.17 -
Hochgeladen am

29. August 2017

DOI

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Lizenz

Creative Commons BY-NC 3.0 Legacy
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    AMC-064 Missed Visit Form (F35)

    Englisch

    No Instruction available.

    1 Formulare  
    1. StudyEvent: AMC-064 Missed Visit Form (F35)
      1. No Instruction available.
    Header - Missed Visit Form
    Beschreibung

    Header - Missed Visit Form

    Alias
    UMLS CUI-1
    C1320722 (Administrative documentation)
    SNOMED
    405624007
    UMLS CUI-2
    C1512346 (Patient Visit)
    UMLS CUI-3
    C3805387 (Burkitt lymphoma (B-cell lymphoma))
    UMLS CUI-4
    C0019829 (Hodgkin Disease)
    SNOMED
    14537002
    Visit number
    Beschreibung

    Visit number

    Datentyp

    integer

    Alias
    NCI Thesaurus ValueDomain
    C25337 (undefined)
    NCI Thesaurus ObjectClass
    C16696 (undefined)
    NCI Thesaurus Property
    C25385 (undefined)
    UMLS CUI [1]
    C1549755 (Visit Number)
    Missed Visit Information
    Beschreibung

    Missed Visit Information

    Alias
    UMLS CUI-1
    C1512346 (Patient Visit)
    UMLS CUI-2
    C1533716 (Information)
    UMLS CUI-3
    C3805387 (Burkitt lymphoma (B-cell lymphoma))
    UMLS CUI-4
    C0019829 (Hodgkin Disease)
    SNOMED
    14537002
    Missed Visit Date
    Beschreibung

    PatientAbsentVisitDate (mm/dd/yyyy)

    Datentyp

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164 (undefined)
    NCI Thesaurus ObjectClass
    C16960 (undefined)
    NCI Thesaurus Property
    C48190 (undefined)
    NCI Thesaurus Property-2
    C25716 (undefined)
    UMLS CUI [1,1]
    C1512346 (Patient Visit)
    UMLS CUI [1,2]
    C0332197 (Absent)
    SNOMED
    2667000
    LOINC
    LA9634-2
    UMLS CUI [1,3]
    C0011008 (Date in time)
    SNOMED
    410671006
    Reason patient missed visit
    Beschreibung

    PatientAbsentVisitReason

    Datentyp

    integer

    Alias
    NCI Thesaurus ValueDomain
    C25638 (undefined)
    NCI Thesaurus ObjectClass
    C16960 (undefined)
    NCI Thesaurus Property
    C48190 (undefined)
    NCI Thesaurus Property-2
    C25716 (undefined)
    UMLS CUI [1,1]
    C1512346 (Patient Visit)
    UMLS CUI [1,2]
    C0332197 (Absent)
    SNOMED
    2667000
    LOINC
    LA9634-2
    UMLS CUI [1,3]
    C0392360 (Indication of (contextual qualifier))
    SNOMED
    230165009
    LOINC
    MTHU008319
    Other, specify
    Beschreibung

    PatientAbsentVisitSpecify

    Datentyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685 (undefined)
    NCI Thesaurus ObjectClass
    C16960 (undefined)
    NCI Thesaurus Property
    C48190 (undefined)
    NCI Thesaurus Property-2
    C25716 (undefined)
    UMLS CUI [1,1]
    C1512346 (Patient Visit)
    UMLS CUI [1,2]
    C0332197 (Absent)
    SNOMED
    2667000
    LOINC
    LA9634-2
    UMLS CUI [1,3]
    C0392360 (Indication of (contextual qualifier))
    SNOMED
    230165009
    LOINC
    MTHU008319
    Next visit scheduled
    Beschreibung

    PatientScheduleNextVisitInd-2 (Items missed will be made up at the new visit.)

    Datentyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960 (undefined)
    NCI Thesaurus Property
    C53286 (undefined)
    NCI Thesaurus Property-2
    C25211 (undefined)
    NCI Thesaurus Property-3
    C25716 (undefined)
    NCI Thesaurus ValueDomain
    C38147 (undefined)
    UMLS CUI [1,1]
    C0515681 (Schedule return visit, as appropriate)
    UMLS CUI [1,2]
    C1512346 (Patient Visit)
    Comments
    Beschreibung

    Comments

    Alias
    UMLS CUI-1
    C0947611 (Comment)
    LOINC
    LP72293-1
    UMLS CUI-2
    C1512346 (Patient Visit)
    UMLS CUI-4
    C3805387 (Burkitt lymphoma (B-cell lymphoma))
    UMLS CUI-5
    C0019829 (Hodgkin Disease)
    SNOMED
    14537002
    Comments
    Beschreibung

    Research Comments

    Datentyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704 (undefined)
    NCI Thesaurus ObjectClass
    C15319 (undefined)
    NCI Thesaurus Property
    C25393 (undefined)
    UMLS CUI [1,1]
    C0947611 (Comment)
    LOINC
    LP72293-1
    UMLS CUI [1,2]
    C1512346 (Patient Visit)
    UMLS CUI [2]
    C3805387 (Burkitt lymphoma (B-cell lymphoma))
    UMLS CUI [3]
    C0019829 (Hodgkin Disease)
    SNOMED
    14537002
    Zum Seitenanfang zurückkehren

    Ähnliche Modelle

    No Instruction available.

    1 Formulare
    1. StudyEvent: AMC-064 Missed Visit Form (F35)
      1. No Instruction available.
    Name
    Typ
    Description | Question | Decode (Coded Value)
    Datentyp
    Alias
    Item Group
    Header - Missed Visit Form
    C1320722 (UMLS CUI-1)
    C1512346 (UMLS CUI-2)
    C3805387 (UMLS CUI-3)
    C0019829 (UMLS CUI-4)
    Visit number
    Item
    Visit number
    integer
    C25337 (NCI Thesaurus ValueDomain)
    C16696 (NCI Thesaurus ObjectClass)
    C25385 (NCI Thesaurus Property)
    C1549755 (UMLS CUI [1])
    Item Group
    Missed Visit Information
    C1512346 (UMLS CUI-1)
    C1533716 (UMLS CUI-2)
    C3805387 (UMLS CUI-3)
    C0019829 (UMLS CUI-4)
    Missed Visit
    Item
    Missed Visit Date
    date
    C25164 (NCI Thesaurus ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C48190 (NCI Thesaurus Property)
    C25716 (NCI Thesaurus Property-2)
    C1512346 (UMLS CUI [1,1])
    C0332197 (UMLS CUI [1,2])
    C0011008 (UMLS CUI [1,3])
    Item
    Reason patient missed visit
    integer
    C25638 (NCI Thesaurus ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C48190 (NCI Thesaurus Property)
    C25716 (NCI Thesaurus Property-2)
    C1512346 (UMLS CUI [1,1])
    C0332197 (UMLS CUI [1,2])
    C0392360 (UMLS CUI [1,3])
    CL.1
    Code List
    Reason patient missed visit
    CL Item
    Patient Forgot (1)
    CL Item
    Health Reasons (2)
    CL Item
    Patient Could Not Get Off Work (3)
    CL Item
    Patient Unable To Obtain Dependent Care (4)
    CL Item
    Patient Had Transportation Problems (5)
    CL Item
    Patient Unhappy With Frequency Of Visits (6)
    CL Item
    Scheduling Difficulties (7)
    CL Item
    Patient Decided To Discontinue Study (8)
    CL Item
    Patient Experienced An Adverse Event (9)
    CL Item
    Other (10)
    Other, specify
    Item
    Other, specify
    text
    C25685 (NCI Thesaurus ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C48190 (NCI Thesaurus Property)
    C25716 (NCI Thesaurus Property-2)
    C1512346 (UMLS CUI [1,1])
    C0332197 (UMLS CUI [1,2])
    C0392360 (UMLS CUI [1,3])
    Next visit scheduled
    Item
    Next visit scheduled
    text
    C16960 (NCI Thesaurus ObjectClass)
    C53286 (NCI Thesaurus Property)
    C25211 (NCI Thesaurus Property-2)
    C25716 (NCI Thesaurus Property-3)
    C38147 (NCI Thesaurus ValueDomain)
    C0515681 (UMLS CUI [1,1])
    C1512346 (UMLS CUI [1,2])
    Item Group
    Comments
    C0947611 (UMLS CUI-1)
    C1512346 (UMLS CUI-2)
    C3805387 (UMLS CUI-4)
    C0019829 (UMLS CUI-5)
    Research Comments
    Item
    Comments
    text
    C25704 (NCI Thesaurus ValueDomain)
    C15319 (NCI Thesaurus ObjectClass)
    C25393 (NCI Thesaurus Property)
    C0947611 (UMLS CUI [1,1])
    C1512346 (UMLS CUI [1,2])
    C3805387 (UMLS CUI [2])
    C0019829 (UMLS CUI [3])
    Zum Seitenanfang zurückkehren 

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