ID

25269

Description

Concomitant Medications Excluding Antiretroviral Therapy - RF09 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=CCE1D9E3-15E5-4307-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=CCE1D9E3-15E5-4307-E034-0003BA12F5E7

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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Concomitant Medications Excluding Antiretroviral Therapy - RF09

English

No Instruction available.

1 forms  
  1. StudyEvent: Concomitant Medications Excluding Antiretroviral Therapy - RF09
    1. No Instruction available.
Ccrr Module For Concomitant Medications Excluding Antiretroviral Therapy - Rf09
Description

Ccrr Module For Concomitant Medications Excluding Antiretroviral Therapy - Rf09

Alias
UMLS CUI-1
C2347852
UMLS CUI-2
C0013227
Patient Initials
Description

PatientInitials

Data type

text

Alias
UMLS CUI [1]
C2986440
Study Number
Description

Study Identifier

Data type

text

Alias
UMLS CUI [1]
C2826693
Site Number
Description

Site Identifier

Data type

text

Alias
UMLS CUI [1,1]
C0018704
UMLS CUI [1,2]
C0600091
ID
Description

ID

Data type

text

Alias
UMLS CUI [1]
C2348585
Cycle Number
Description

Cycle Number

Data type

text

Alias
UMLS CUI [1]
C2045829
First day of cycle
Description

First day of cycle

Data type

date

Alias
UMLS CUI [1,1]
C1302181
UMLS CUI [1,2]
C0808070
During this cycle, has the subject started or stopped any medications?
Description

medications

Data type

boolean

Alias
UMLS CUI [1]
C0013227
Medication
Description

Medication Name

Data type

text

Alias
UMLS CUI [1]
C2360065
ACTG Drug Code
Description

ACTG Drug Code

Data type

text

Alias
UMLS CUI [1,1]
C1318970
UMLS CUI [1,2]
C0013227
UMLS CUI [1,3]
C0805701
Amount
Description

Amount

Data type

text

Alias
UMLS CUI [1,1]
C0178602
UMLS CUI [1,2]
C0013227
Units
Description

Units

Data type

text

Alias
UMLS CUI [1,1]
C1519795
UMLS CUI [1,2]
C0013227
Frequency
Description

Frequency(perday)

Data type

text

Alias
UMLS CUI [1]
C3476109
Started prior to study?
Description

Started prior to study

Data type

boolean

Alias
UMLS CUI [1]
C0013227
Date Started
Description

Date Started

Data type

date

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0808070
Stopped?
Description

Stopped medication

Data type

boolean

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C2746065
Date Stopped
Description

Date Stopped

Data type

date

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0806020
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Similar models

No Instruction available.

1 forms
  1. StudyEvent: Concomitant Medications Excluding Antiretroviral Therapy - RF09
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Ccrr Module For Concomitant Medications Excluding Antiretroviral Therapy - Rf09
C2347852 (UMLS CUI-1)
C0013227 (UMLS CUI-2)
PatientInitials
Item
Patient Initials
text
C2986440 (UMLS CUI [1])
Study Identifier
Item
Study Number
text
C2826693 (UMLS CUI [1])
Site Identifier
Item
Site Number
text
C0018704 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
ID
Item
ID
text
C2348585 (UMLS CUI [1])
Cycle Number
Item
Cycle Number
text
C2045829 (UMLS CUI [1])
First day of cycle
Item
First day of cycle
date
C1302181 (UMLS CUI [1,1])
C0808070 (UMLS CUI [1,2])
medications
Item
During this cycle, has the subject started or stopped any medications?
boolean
C0013227 (UMLS CUI [1])
Medication Name
Item
Medication
text
C2360065 (UMLS CUI [1])
ACTG Drug Code
Item
ACTG Drug Code
text
C1318970 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
C0805701 (UMLS CUI [1,3])
Amount
Item
Amount
text
C0178602 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
Units
Item
Units
text
C1519795 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
Frequency(perday)
Item
Frequency
text
C3476109 (UMLS CUI [1])
Started prior to study
Item
Started prior to study?
boolean
C0013227 (UMLS CUI [1])
Date Started
Item
Date Started
date
C0013227 (UMLS CUI [1,1])
C0808070 (UMLS CUI [1,2])
Stopped medication
Item
Stopped?
boolean
C0013227 (UMLS CUI [1,1])
C2746065 (UMLS CUI [1,2])
Date Stopped
Item
Date Stopped
date
C0013227 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
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