ID
2573
Description
E5508 Registration Worksheet (step 2) Bevacizumab or Pemetrexed Disodium Alone or In Combination After Induction Therapy in Treating Patients With Advanced Non-Squamous Non-Small Cell Lung Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=8528E45F-A327-F490-E040-BB89AD4356FC
Lien
Mots-clés
Versions (4)
- 19/09/2012 19/09/2012 -
- 11/08/2014 11/08/2014 - Martin Dugas
- 09/01/2015 09/01/2015 - Martin Dugas
- 17/09/2021 17/09/2021 -
Téléchargé le
19 septembre 2012
DOI
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Licence
Creative Commons BY-NC 3.0 Legacy
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Lung Cancer NCT01107626 Eligibility - E5508 Registration Worksheet (step 2) - 3078042v1.0
No Instruction available.
- StudyEvent: E5508 Registration Worksheet (step 2)
Description
Patient Demographics / Pre-treatment Characteristics
Description
PatientSexCode
Type de données
text
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C28421
- UMLS 2011AA Property
- C1522384
- NCI Thesaurus ValueDomain
- C25162
- UMLS 2011AA ValueDomain
- C0805701
- NCI Thesaurus ValueDomain
- C16960
- UMLS 2011AA ValueDomain
- C0030705
- NCI Thesaurus ValueDomain
- C28421
- UMLS 2011AA ValueDomain
- C1522384
Description
PersonBirthDate
Type de données
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C25155
- UMLS 2011AA Property
- C0005615
Description
PatientRaceCategory
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25372
- UMLS 2011AA ValueDomain
- C0683312
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C17049
- UMLS 2011AA Property
- C0034510
Description
AddressPostalCodeIdentifier
Type de données
text
Alias
- NCI Thesaurus ObjectClass
- C25407
- UMLS 2011AA ObjectClass
- C1442065
- NCI Thesaurus Property
- C25621
- UMLS 2011AA Property
- C1514254
- NCI Thesaurus ValueDomain
- C25364
- UMLS 2011AA ValueDomain
- C0600091
- NCI Thesaurus ValueDomain
- C25407
- UMLS 2011AA ValueDomain
- C1442065
- NCI Thesaurus ValueDomain
- C25621
- UMLS 2011AA ValueDomain
- C1514254
Description
PersonMalignantNeoplasmClinicalTrialEligibilityCriteriaType
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C9305
- UMLS 2011AA Property
- C0006826
- NCI Thesaurus Property
- C16112
- UMLS 2011AA Property
- C1516637
Description
PatientMedicalRecordNumber
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C25261
- UMLS 2011AA Property
- C0205476
- NCI Thesaurus Property
- C25198
- UMLS 2011AA Property
- C0034869
Description
PatientSSNNumber
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C25686
- UMLS 2011AA Property
- C1301821
Description
PatientInternationalPaymentType
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C25371
- UMLS 2011AA Property
- C0680264
- NCI Thesaurus Property
- C25541
- UMLS 2011AA Property
- C1512888
Description
PersonAddressCountryCode
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25162
- UMLS 2011AA ValueDomain
- C0805701
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C25407
- UMLS 2011AA Property
- C1442065
Description
ResearchCommentsText
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ObjectClass
- C15319
- NCI Thesaurus Property
- C25393
- UMLS 2011AA Property
- C0282411
Description
I Have Reviewed The Above Data And Agree The Date Are Accurate And Correct
Description
TreatingPhysicianSignatureText
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus Property
- C25678
- UMLS 2011AA Property
- C1519316
- NCI Thesaurus ObjectClass
- C51883
- UMLS 2011AA ObjectClass
- C1710470
Description
TreatingPhysicianSignatureDate
Type de données
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus Property
- C25678
- UMLS 2011AA Property
- C1519316
- NCI Thesaurus ObjectClass
- C51883
- UMLS 2011AA ObjectClass
- C1710470
Similar models
No Instruction available.
- StudyEvent: E5508 Registration Worksheet (step 2)
C1547383 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25536 (NCI Thesaurus Property)
C1555582 (UMLS 2011AA Property)
C25509 (NCI Thesaurus Property)
C1279901 (UMLS 2011AA Property)
C1547383 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25536 (NCI Thesaurus Property)
C1555582 (UMLS 2011AA Property)
C25551 (NCI Thesaurus Property)
C1517741 (UMLS 2011AA Property)
C1512698 (UMLS 2011AA ValueDomain)
C25250 (NCI Thesaurus Property)
C0205197 (UMLS 2011AA Property)
C25171 (NCI Thesaurus ObjectClass)
C0013893 (UMLS 2011AA ObjectClass)
C49073 (NCI Thesaurus Property)
C1707357 (UMLS 2011AA Property)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C1512699 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25171 (NCI Thesaurus Property)
C0013893 (UMLS 2011AA Property)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0030705 (UMLS 2011AA ObjectClass)
C12468 (NCI Thesaurus Property)
C0024109 (UMLS 2011AA Property)
C16112 (NCI Thesaurus Property)
C1516637 (UMLS 2011AA Property)
C38027 (NCI Thesaurus Property)
C1519504 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C0277556 (UMLS 2011AA)
C0332152 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
C25432 (NCI Thesaurus Property)
C1522427 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C17934 (NCI Thesaurus ObjectClass)
C0453996 (UMLS 2011AA ObjectClass)
C18772 (NCI Thesaurus Property)
C0262926 (UMLS 2011AA Property)
C0425293 (UMLS 2011AA)
C0030705 (UMLS 2011AA ObjectClass)
C28421 (NCI Thesaurus Property)
C1522384 (UMLS 2011AA Property)
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ValueDomain)
C0030705 (UMLS 2011AA ValueDomain)
C28421 (NCI Thesaurus ValueDomain)
C1522384 (UMLS 2011AA ValueDomain)
C0024554 (UMLS 2011AA)
C0015780 (UMLS 2011AA)
C0011008 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25155 (NCI Thesaurus Property)
C0005615 (UMLS 2011AA Property)
C0683312 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C17049 (NCI Thesaurus Property)
C0034510 (UMLS 2011AA Property)
C1515945 (UMLS 2011AA)
C0078988 (UMLS 2011AA)
C0085756 (UMLS 2011AA)
C1513907 (UMLS 2011AA)
C1706613 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C0007457 (UMLS 2011AA)
C1442065 (UMLS 2011AA ObjectClass)
C25621 (NCI Thesaurus Property)
C1514254 (UMLS 2011AA Property)
C25364 (NCI Thesaurus ValueDomain)
C0600091 (UMLS 2011AA ValueDomain)
C25407 (NCI Thesaurus ValueDomain)
C1442065 (UMLS 2011AA ValueDomain)
C25621 (NCI Thesaurus ValueDomain)
C1514254 (UMLS 2011AA ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C9305 (NCI Thesaurus Property)
C0006826 (UMLS 2011AA Property)
C16112 (NCI Thesaurus Property)
C1516637 (UMLS 2011AA Property)
C0152013 (UMLS 2011AA)
C0007131 (UMLS 2011AA)
C19594 (NCI Thesaurus)
C1518425 (UMLS 2011AA)
C0007131 (UMLS 2011AA)
C19594 (NCI Thesaurus)
C1518425 (UMLS 2011AA)
C0007120 (UMLS 2011AA)
C0007120 (UMLS 2011AA)
C3512 (NCI Thesaurus)
C0152013 (UMLS 2011AA)
C0237753 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25261 (NCI Thesaurus Property)
C0205476 (UMLS 2011AA Property)
C25198 (NCI Thesaurus Property)
C0034869 (UMLS 2011AA Property)
C0237753 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25686 (NCI Thesaurus Property)
C1301821 (UMLS 2011AA Property)
C0332307 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25371 (NCI Thesaurus Property)
C0680264 (UMLS 2011AA Property)
C25541 (NCI Thesaurus Property)
C1512888 (UMLS 2011AA Property)
C0018717 (UMLS 2011AA)
C0205394 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C0805701 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25407 (NCI Thesaurus Property)
C1442065 (UMLS 2011AA Property)
C0002838 (UMLS 2011AA)
C0041698 (UMLS 2011AA)
C0001732 (UMLS 2011AA)
C0003354 (UMLS 2011AA)
C0003353 (UMLS 2011AA)
C0003798 (UMLS 2011AA)
C0003023 (UMLS 2011AA)
C0454691 (UMLS 2011AA)
C0003761 (UMLS 2011AA)
C0242536 (UMLS 2011AA)
C0004348 (UMLS 2011AA)
C0004340 (UMLS 2011AA)
C0282379 (UMLS 2011AA)
C0006036 (UMLS 2011AA)
C0004739 (UMLS 2011AA)
C0004732 (UMLS 2011AA)
C0004950 (UMLS 2011AA)
C0006409 (UMLS 2011AA)
C0006368 (UMLS 2011AA)
C0004684 (UMLS 2011AA)
C0006448 (UMLS 2011AA)
C0005126 (UMLS 2011AA)
C0006320 (UMLS 2011AA)
C0005918 (UMLS 2011AA)
C0006137 (UMLS 2011AA)
C0004683 (UMLS 2011AA)
C0005341 (UMLS 2011AA)
C1511278 (UMLS 2011AA)
C0006041 (UMLS 2011AA)
C0006539 (UMLS 2011AA)
C0004952 (UMLS 2011AA)
C0006823 (UMLS 2011AA)
C0009738 (UMLS 2011AA)
C0039021 (UMLS 2011AA)
C0009956 (UMLS 2011AA)
C0006802 (UMLS 2011AA)
C0008115 (UMLS 2011AA)
C0009367 (UMLS 2011AA)
C0010182 (UMLS 2011AA)
C0010435 (UMLS 2011AA)
C0006893 (UMLS 2011AA)
C0006888 (UMLS 2011AA)
C0010622 (UMLS 2011AA)
C0206578 (UMLS 2011AA)
C0019905 (UMLS 2011AA)
C0010343 (UMLS 2011AA)
C0018510 (UMLS 2011AA)
C0020174 (UMLS 2011AA)
C0021247 (UMLS 2011AA)
C0022067 (UMLS 2011AA)
C0022271 (UMLS 2011AA)
C0021201 (UMLS 2011AA)
C0022066 (UMLS 2011AA)
C0022065 (UMLS 2011AA)
C0020750 (UMLS 2011AA)
C0022277 (UMLS 2011AA)
C0022337 (UMLS 2011AA)
C0022418 (UMLS 2011AA)
C0022341 (UMLS 2011AA)
C0022558 (UMLS 2011AA)
C0006797 (UMLS 2011AA)
C0017550 (UMLS 2011AA)
C0009490 (UMLS 2011AA)
C0022804 (UMLS 2011AA)
C0007481 (UMLS 2011AA)
C0023190 (UMLS 2011AA)
C0036056 (UMLS 2011AA)
C0023668 (UMLS 2011AA)
C0038088 (UMLS 2011AA)
C0023617 (UMLS 2011AA)
C0023879 (UMLS 2011AA)
C0024176 (UMLS 2011AA)
C0023128 (UMLS 2011AA)
C0026544 (UMLS 2011AA)
C0026405 (UMLS 2011AA)
C0026374 (UMLS 2011AA)
C0024443 (UMLS 2011AA)
C0024851 (UMLS 2011AA)
C0024581 (UMLS 2011AA)
C0006416 (UMLS 2011AA)
C0026410 (UMLS 2011AA)
C0024403 (UMLS 2011AA)
C0024943 (UMLS 2011AA)
C0026514 (UMLS 2011AA)
C0024653 (UMLS 2011AA)
C0024944 (UMLS 2011AA)
C0024553 (UMLS 2011AA)
C0024548 (UMLS 2011AA)
C0025885 (UMLS 2011AA)
C0024552 (UMLS 2011AA)
C0026655 (UMLS 2011AA)
C0027366 (UMLS 2011AA)
C0028074 (UMLS 2011AA)
C0028366 (UMLS 2011AA)
C0028075 (UMLS 2011AA)
C0028002 (UMLS 2011AA)
C0027778 (UMLS 2011AA)
C0028423 (UMLS 2011AA)
C0027689 (UMLS 2011AA)
C0027496 (UMLS 2011AA)
C0028219 (UMLS 2011AA)
C0027978 (UMLS 2011AA)
C0028971 (UMLS 2011AA)
C0030266 (UMLS 2011AA)
C0031238 (UMLS 2011AA)
C0030375 (UMLS 2011AA)
C0030211 (UMLS 2011AA)
C0032356 (UMLS 2011AA)
C0031995 (UMLS 2011AA)
C0034044 (UMLS 2011AA)
C0032729 (UMLS 2011AA)
C0242397 (UMLS 2011AA)
C0030428 (UMLS 2011AA)
C0034366 (UMLS 2011AA)
C0035826 (UMLS 2011AA)
C0035978 (UMLS 2011AA)
C0036243 (UMLS 2011AA)
C0037623 (UMLS 2011AA)
C0036919 (UMLS 2011AA)
C0038642 (UMLS 2011AA)
C0038995 (UMLS 2011AA)
C0037173 (UMLS 2011AA)
C0037334 (UMLS 2011AA)
C0206579 (UMLS 2011AA)
C0037063 (UMLS 2011AA)
C0036154 (UMLS 2011AA)
C0036644 (UMLS 2011AA)
C0037640 (UMLS 2011AA)
C0038944 (UMLS 2011AA)
C0013754 (UMLS 2011AA)
C0039138 (UMLS 2011AA)
C0038983 (UMLS 2011AA)
C0007928 (UMLS 2011AA)
C0040363 (UMLS 2011AA)
C0039725 (UMLS 2011AA)
C0220928 (UMLS 2011AA)
C0041403 (UMLS 2011AA)
C0041388 (UMLS 2011AA)
C1452561 (UMLS 2011AA)
C0041400 (UMLS 2011AA)
C0041413 (UMLS 2011AA)
C0039260 (UMLS 2011AA)
C0039298 (UMLS 2011AA)
C0041580 (UMLS 2011AA)
C0041573 (UMLS 2011AA)
C0041700 (UMLS 2011AA)
C0042113 (UMLS 2011AA)
C0042177 (UMLS 2011AA)
C0042469 (UMLS 2011AA)
C0042658 (UMLS 2011AA)
C0042321 (UMLS 2011AA)
C0043402 (UMLS 2011AA)
C0024974 (UMLS 2011AA)
C0043445 (UMLS 2011AA)
C0043476 (UMLS 2011AA)
C1527021 (UMLS 2011AA ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0282411 (UMLS 2011AA Property)
C1527021 (UMLS 2011AA ValueDomain)
C25678 (NCI Thesaurus Property)
C1519316 (UMLS 2011AA Property)
C51883 (NCI Thesaurus ObjectClass)
C1710470 (UMLS 2011AA ObjectClass)
C0011008 (UMLS 2011AA ValueDomain)
C25678 (NCI Thesaurus Property)
C1519316 (UMLS 2011AA Property)
C51883 (NCI Thesaurus ObjectClass)
C1710470 (UMLS 2011AA ObjectClass)