ID

2563

Description

Follow-up Assessment (FA) Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B122D2BC-9A32-4DD0-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B122D2BC-9A32-4DD0-E034-0003BA12F5E7

Keywords

Versions (2)
  1. 9/19/12 9/19/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
Uploaded on

September 19, 2012

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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Melanoma (Skin) Follow-Up - Follow-up Assessment (FA) - 2074729v3.0

English

No Instruction available.

1 forms  
  1. StudyEvent: Follow-up Assessment (FA)
    1. No Instruction available.
Ccrr Module For Follow-up Assessment (fa)
Description

Ccrr Module For Follow-up Assessment (fa)

Patient ID (Pt. ID issued during registration or previously issued patient ID)
Description

Pt.ID

Data type

text

Institution ID:
Description

InstitutionNo.

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
Patient Initials: (F ML)
Description

PatientInitialsName

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25536
UMLS 2011AA Property
C1555582
Institution:
Description

InstitutionName

Data type

text

Date of History and Physical:
Description

DateofHistoryandPhysical:

Data type

text

Alias
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus ObjectClass
C18772
UMLS 2011AA ObjectClass
C0262926
Date of P/A and Lateral Chest X-ray
Description

DateofP/AandLateralChestX-ray

Data type

text

Date of LDH: (Year Month Day)
Description

DateLDHObtained

Data type

text

Is LDH greater than upper limit of institutional norm:
Description

IsLDHgreaterthanupperlimitofinstitutionalnorm:

Data type

text

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Completed by:
Description

CompletedBy

Data type

text

Date: (Year Month Day)
Description

FormCompletionDate,Original

Data type

date

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Similar models

No Instruction available.

1 forms
  1. StudyEvent: Follow-up Assessment (FA)
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Ccrr Module For Follow-up Assessment (fa)
Pt.ID
Item
Patient ID (Pt. ID issued during registration or previously issued patient ID)
text
InstitutionNo.
Item
Institution ID:
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
PatientInitialsName
Item
Patient Initials: (F ML)
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25536 (NCI Thesaurus Property)
C1555582 (UMLS 2011AA Property)
InstitutionName
Item
Institution:
text
DateofHistoryandPhysical:
Item
Date of History and Physical:
text
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C18772 (NCI Thesaurus ObjectClass)
C0262926 (UMLS 2011AA ObjectClass)
DateofP/AandLateralChestX-ray
Item
Date of P/A and Lateral Chest X-ray
text
DateLDHObtained
Item
Date of LDH: (Year Month Day)
text
Item
Is LDH greater than upper limit of institutional norm:
text
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
CL.1
Code List
Is LDH greater than upper limit of institutional norm:
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CompletedBy
Item
Completed by:
text
FormCompletionDate,Original
Item
Date: (Year Month Day)
date
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