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Informatie:
Fout:
ID
2563
Beschrijving
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
Trefwoorden
Versies (2)
- 19-09-12 19-09-12 -
- 09-01-15 09-01-15 - Martin Dugas
Geüploaded op
19 september 2012
DOI
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Licentie
Creative Commons BY-NC 3.0 Legacy
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Melanoma (Skin) Follow-Up - Follow-up Assessment (FA) - 2074729v3.0
No Instruction available.
- StudyEvent: Follow-up Assessment (FA)
Similar models
No Instruction available.
- StudyEvent: Follow-up Assessment (FA)
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
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)
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)
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)
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)
C1512699 (UMLS 2011AA ValueDomain)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
C1298908 (UMLS 2011AA)
CompletedBy
Item
Completed by:
text
FormCompletionDate,Original
Item
Date: (Year Month Day)
date