Informatie:
Fout:
ID
26130
Beschrijving
AMC-063 Missed Visit Form (F35) Bortezomib in Treating Patients With Relapsed or Refractory AIDS-Related Kaposi Sarcoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=815FD129-E16B-59A5-E040-BB89AD431E71
Link
Trefwoorden
Versies (1)
- 09-10-17 09-10-17 -
Houder van rechten
AIDS Malignancy Consortium
Geüploaded op
9 oktober 2017
DOI
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Licentie
Creative Commons BY-NC 3.0
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AMC-063 Missed Visit Form (F35)
No Instruction available.
- StudyEvent: AMC-063 Missed Visit Form (F35)
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No Instruction available.
- StudyEvent: AMC-063 Missed Visit Form (F35)
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Header - Missed Visit Form (F35)
C1320722 (UMLS CUI-1)
C1512346 (UMLS CUI-2)
C0276535 (UMLS CUI-3)
C1512346 (UMLS CUI-2)
C0276535 (UMLS CUI-3)
Visit number
Item
Visit number
integer
C25337 (NCI Thesaurus ValueDomain)
C16696 (NCI Thesaurus ObjectClass)
C25385 (NCI Thesaurus Property)
C1549755 (UMLS CUI [1])
C16696 (NCI Thesaurus ObjectClass)
C25385 (NCI Thesaurus Property)
C1549755 (UMLS CUI [1])
Item Group
Missed Visit Information
C1512346 (UMLS CUI-1)
C1705492 (UMLS CUI-2)
C1533716 (UMLS CUI-3)
C0276535 (UMLS CUI-4)
C1705492 (UMLS CUI-2)
C1533716 (UMLS CUI-3)
C0276535 (UMLS CUI-4)
Missed Visit Date
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])
C1705492 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
C16960 (NCI Thesaurus ObjectClass)
C48190 (NCI Thesaurus Property)
C25716 (NCI Thesaurus Property-2)
C1512346 (UMLS CUI [1,1])
C1705492 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
Item
Reason patient missed visit
text
C25638 (NCI Thesaurus ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C48190 (NCI Thesaurus Property)
C25716 (NCI Thesaurus Property-2)
C1512346 (UMLS CUI [1,1])
C1705492 (UMLS CUI [1,2])
C0392360 (UMLS CUI [1,3])
C16960 (NCI Thesaurus ObjectClass)
C48190 (NCI Thesaurus Property)
C25716 (NCI Thesaurus Property-2)
C1512346 (UMLS CUI [1,1])
C1705492 (UMLS CUI [1,2])
C0392360 (UMLS CUI [1,3])
CL Item
Patient Forgot (Patient forgot)
CL Item
Health Reasons (Health reasons)
CL Item
Patient Could Not Get Off Work (Patient could not get off work)
CL Item
Patient Unable To Obtain Dependent Care (Patient unable to obtain dependent care)
CL Item
Patient Had Transportation Problems (Patient had transportation problems)
CL Item
Patient Unhappy With Frequency Of Visits (Patient unhappy with frequency of visits)
CL Item
Scheduling Difficulties (Scheduling difficulties)
CL Item
Patient Decided To Discontinue Study (Patient decided to discontinue study)
CL Item
Patient Experienced An Adverse Event (Patient experienced an Adverse Event)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
C0205394 (UMLS 2011AA)
Reason patient missed visit
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])
C1705492 (UMLS CUI [1,2])
C0392360 (UMLS CUI [1,3])
C16960 (NCI Thesaurus ObjectClass)
C48190 (NCI Thesaurus Property)
C25716 (NCI Thesaurus Property-2)
C1512346 (UMLS CUI [1,1])
C1705492 (UMLS CUI [1,2])
C0392360 (UMLS CUI [1,3])
Next visit scheduled
Item
Next visit scheduled
boolean
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])
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])
Research Comments
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0947611 (UMLS CUI [1,1])
C0276535 (UMLS CUI [1,2])
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0947611 (UMLS CUI [1,1])
C0276535 (UMLS CUI [1,2])