CALGBFormIdentifierNumber
Item
CALGB Form (C-714)
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C19464 (NCI Thesaurus ObjectClass)
C0376315 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25442 (NCI Thesaurus ObjectClass)
C1516238 (UMLS 2011AA ObjectClass)
ProtocolCALGBIdentifierNumber
Item
CALGB Study No.
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25320 (NCI Thesaurus ObjectClass)
C1507394 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25442 (NCI Thesaurus Property)
C1516238 (UMLS 2011AA Property)
PatientCALGBIdentifierNumber
Item
CALGB Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25442 (NCI Thesaurus Property)
C1516238 (UMLS 2011AA Property)
PatientAssessmentDate
Item
Assessment Date (mm dd yyyy)
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
Item
Are data amended
text
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
Code List
Are data amended
CL Item
Yes (yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
PatientInitialsName
Item
Patient Initials (Last, First Middle)
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)
PatientMedicalRecordNumber
Item
Patient Hospital No.
text
C25337 (NCI Thesaurus ValueDomain)
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)
CombinedInstitutionName
Item
Institution/Affiliate
text
C25454 (NCI Thesaurus ObjectClass)
C0205195 (UMLS 2011AA ObjectClass)
C21541 (NCI Thesaurus ObjectClass)
C0018704 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C21541 (NCI Thesaurus ValueDomain)
C0018704 (UMLS 2011AA ValueDomain)
ParticipatingGroupName
Item
Participating Group
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C25608 (NCI Thesaurus ObjectClass)
C0679823 (UMLS 2011AA ObjectClass)
C17005 (NCI Thesaurus ObjectClass)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
ProtocolParticipatingIdentifierNumber
Item
Participating Group Study No.
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25320 (NCI Thesaurus ObjectClass)
C1507394 (UMLS 2011AA ObjectClass)
C25608 (NCI Thesaurus Property)
C0679823 (UMLS 2011AA Property)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
PatientParticipatingIdentifierNumber
Item
Participating Group Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25608 (NCI Thesaurus Property)
C0679823 (UMLS 2011AA Property)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
ResponsiblePersonName
Item
Person Completing Form (Recommended Term for CRF Text "Responsible Person Name" Long Name of Recommended CDE, but not Doc Text Interviewer or CRA)
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C25657 (NCI Thesaurus ObjectClass)
C1273518 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
AssessmentIdentifierCount
Item
Assessment No.
double
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
Item
Over the past 4 weeks how often have you leaked urine
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C25711 (NCI Thesaurus Property)
C1524119 (UMLS 2011AA Property)
C4876 (NCI Thesaurus Property)
C1457887 (UMLS 2011AA Property)
C40416 (NCI Thesaurus Property)
C0015376 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
Over the past 4 weeks how often have you leaked urine
CL Item
More Than Once A Day (More than once a day)
CL Item
Once A Day (About once a day)
CL Item
More Than Once A Week (More than once a week)
CL Item
About Once A Week (About once a week)
CL Item
Rarely (Rarely or never)
C73116 (NCI Thesaurus)
C0522498 (UMLS 2011AA)
Item
Which of the following best describes your urinary control during the last 4 weeks
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C25711 (NCI Thesaurus Property)
C1524119 (UMLS 2011AA Property)
C4876 (NCI Thesaurus Property)
C1457887 (UMLS 2011AA Property)
C61299 (NCI Thesaurus Property)
C2587213 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
Which of the following best describes your urinary control during the last 4 weeks
CL Item
No Urinary Control (No urinary control whatsoever)
CL Item
Frequent Dribbling (Frequent dribbling)
CL Item
Occasional Dribbling (Occasional dribbling)
CL Item
Normal Urinary Control (Total control)
Item
How many pads or adult diapers per day did you usually use to control leakage during the last 4 weeks
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C17600 (NCI Thesaurus Property)
C0001675 (UMLS 2011AA Property)
C25340 (NCI Thesaurus Property)
C0457083 (UMLS 2011AA Property)
C0453880 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
How many pads or adult diapers per day did you usually use to control leakage during the last 4 weeks
CL Item
None (No pads)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
1 Per Day (1 pad per day)
CL Item
2 Per Day (2 pads per day)
CL Item
3+ Per Day (3 or more pads per day)
Item
Dripping or leaking urine (How big a problem, if any, has each of the following been for you during the last 4 weeks? Select one answer in each line.)
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C13283 (NCI Thesaurus Property)
C0042036 (UMLS 2011AA Property)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C40416 (NCI Thesaurus Property)
C0015376 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Dripping or leaking urine (How big a problem, if any, has each of the following been for you during the last 4 weeks? Select one answer in each line.)
CL Item
No Problem (No problem)
CL Item
Mild Problem (Very small problem)
CL Item
Mild To Moderate Problem (Small problem)
CL Item
Moderate Problem (Moderate problem)
CL Item
Severe Problem (Big problem)
Item
Pain or burning on urination
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C3303 (NCI Thesaurus Property)
C0030193 (UMLS 2011AA Property)
C13283 (NCI Thesaurus Property)
C0042036 (UMLS 2011AA Property)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Pain or burning on urination
CL Item
No Problem (No problem)
CL Item
Mild Problem (Very small problem)
CL Item
Mild To Moderate Problem (Small problem)
CL Item
Moderate Problem (Moderate problem)
CL Item
Severe Problem (Big problem)
Item
Bleeding with urination
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C3090 (NCI Thesaurus Property)
C0018965 (UMLS 2011AA Property)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Bleeding with urination
CL Item
No Problem (No problem)
CL Item
Mild Problem (Very small problem)
CL Item
Mild To Moderate Problem (Small problem)
CL Item
Moderate Problem (Moderate problem)
CL Item
Severe Problem (Big problem)
Item
Weak urine stream or incomplete emptying
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C49160 (NCI Thesaurus Property)
C0205257 (UMLS 2011AA Property)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C25744 (NCI Thesaurus Property)
C0042034 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Weak urine stream or incomplete emptying
CL Item
No Problem (No problem)
CL Item
Mild Problem (Very small problem)
CL Item
Mild To Moderate Problem (Small problem)
CL Item
Moderate Problem (Moderate problem)
CL Item
Severe Problem (Big problem)
Item
Need to urinate frequently during the day
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C26906 (NCI Thesaurus Property)
C0677481 (UMLS 2011AA Property)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Need to urinate frequently during the day
CL Item
No Problem (No problem)
CL Item
Mild Problem (Very small problem)
CL Item
Mild To Moderate Problem (Small problem)
CL Item
Moderate Problem (Moderate problem)
CL Item
Severe Problem (Big problem)
Item
Overall, how big a problem has your urinary function been for you during the last 4 weeks (Select one.)
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C25605 (NCI Thesaurus Property)
C1561607 (UMLS 2011AA Property)
C25711 (NCI Thesaurus Property)
C1524119 (UMLS 2011AA Property)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Overall, how big a problem has your urinary function been for you during the last 4 weeks (Select one.)
CL Item
No Problem (No problem)
CL Item
Mild Problem (Very small problem)
CL Item
Mild To Moderate Problem (Small problem)
CL Item
Moderate Problem (Moderate problem)
CL Item
Severe Problem (Big problem)
Item
Urgency to have a bowel movement (How big a problem, if any, has each of the following been for you? Select one answer in each line.)
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C62788 (NCI Thesaurus Property)
C0426636 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Urgency to have a bowel movement (How big a problem, if any, has each of the following been for you? Select one answer in each line.)
CL Item
No Problem (No problem)
CL Item
Mild Problem (Very small problem)
CL Item
Mild To Moderate Problem (Small problem)
CL Item
Moderate Problem (Moderate problem)
CL Item
Severe Problem (Big problem)
Item
Increased frequency of bowel movements
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C25515 (NCI Thesaurus Property)
C0439603 (UMLS 2011AA Property)
C62787 (NCI Thesaurus Property)
C0011135 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Increased frequency of bowel movements
CL Item
Severe Problem (Big problem)
CL Item
Moderate Problem (Moderate problem)
CL Item
No Problem (No problem)
CL Item
Mild Problem (Very small problem)
CL Item
Mild To Moderate Problem (Small problem)
Item
Losing control of your stools
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C43362 (NCI Thesaurus Property)
C0003461 (UMLS 2011AA Property)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C0021167 (NCI Metathesaurus Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Losing control of your stools
CL Item
Severe Problem (Big problem)
CL Item
Moderate Problem (Moderate problem)
CL Item
No Problem (No problem)
CL Item
Mild Problem (Very small problem)
CL Item
Mild To Moderate Problem (Small problem)
Item
Bloody stools
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C12434 (NCI Thesaurus Property)
C0229664 (UMLS 2011AA Property)
C13234 (NCI Thesaurus Property)
C0015733 (UMLS 2011AA Property)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL Item
Severe Problem (Big problem)
CL Item
Moderate Problem (Moderate problem)
CL Item
No Problem (No problem)
CL Item
Mild Problem (Very small problem)
CL Item
Mild To Moderate Problem (Small problem)
Item
Abdominal/pelvic/rectal pain
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C3303 (NCI Thesaurus Property)
C0030193 (UMLS 2011AA Property)
C25342 (NCI Thesaurus Property)
C0000726 (UMLS 2011AA Property)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Abdominal/pelvic/rectal pain
CL Item
Severe Problem (Big problem)
CL Item
Moderate Problem (Moderate problem)
CL Item
No Problem (No problem)
CL Item
Mild Problem (Very small problem)
CL Item
Mild To Moderate Problem (Small problem)
Item
Overall, how big a problem have your bowel habits been for you during the last 4 weeks (Select one.)
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C25605 (NCI Thesaurus Property)
C1561607 (UMLS 2011AA Property)
C12736 (NCI Thesaurus Property)
C0021853 (UMLS 2011AA Property)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Overall, how big a problem have your bowel habits been for you during the last 4 weeks (Select one.)
CL Item
No Problem (No problem)
CL Item
Mild Problem (Very small problem)
CL Item
Mild To Moderate Problem (Small problem)
CL Item
Moderate Problem (Moderate problem)
CL Item
Severe Problem (Big problem)
Item
Your ability to have an erection (How would you rate each of the following during the last 4 weeks? Select one answer in each line.)
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C25518 (NCI Thesaurus Property)
C0542341 (UMLS 2011AA Property)
C25740 (NCI Thesaurus Property)
C0030847 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
Your ability to have an erection (How would you rate each of the following during the last 4 weeks? Select one answer in each line.)
CL Item
None (Very poor to None)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Good (Good)
C0205170 (NCI Metathesaurus)
CL Item
Very Good (Very Good)
Item
Your ability to reach orgasm (climax)
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C25518 (NCI Thesaurus Property)
C0542341 (UMLS 2011AA Property)
C16531 (NCI Thesaurus Property)
C0013746 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
Your ability to reach orgasm (climax)
CL Item
None (Very poor to None)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Good (Good)
C0205170 (NCI Metathesaurus)
CL Item
Very Good (Very Good)
Item
How would you describe the usual QUALITY of your erections during the last 4 weeks
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C25283 (NCI Thesaurus Property)
C0332306 (UMLS 2011AA Property)
C25740 (NCI Thesaurus Property)
C0030847 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
How would you describe the usual QUALITY of your erections during the last 4 weeks
CL Item
None (None at all)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Not Firm Enough For Any Sexual Activity (Not firm enough for any sexual activity)
CL Item
Firm Enough For Masturbation And Foreplay Only (Firm enough for masturbation and foreplay only)
CL Item
Firm Enough For Intercourse (Firm enough for intercourse)
Item
How would you describe the FREQUENCY of your erections during the last 4 weeks
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
C25740 (NCI Thesaurus Property)
C0030847 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
How would you describe the FREQUENCY of your erections during the last 4 weeks
CL Item
Never (I NEVER had an erection when I wanted one)
CL Item
Less Than Half (I had an erection LESS THAN HALF the time I wanted one)
CL Item
About Half (approximately 50%) (I had an erection ABOUT HALF the time I wanted one)
CL Item
More Than Half (I had an erection MORE THAN HALF the time I wanted one)
CL Item
Normal (I had an erection WHENEVER I wanted one)
C14165 (NCI Thesaurus)
C0205307 (UMLS 2011AA)
Item
Overall, how would you rate your ability to function sexually during the last 4 weeks
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C25605 (NCI Thesaurus Property)
C1561607 (UMLS 2011AA Property)
C25518 (NCI Thesaurus Property)
C0542341 (UMLS 2011AA Property)
C37986 (NCI Thesaurus Property)
C0023618 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
Code List
Overall, how would you rate your ability to function sexually during the last 4 weeks
CL Item
Very Poor (Very poor)
CL Item
Good (Good)
C0205170 (NCI Metathesaurus)
CL Item
Very Good (Very Good)
Item
Overall, how big a problem has your sexual function or lack of sexual function been for you during the last 4 weeks
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C25605 (NCI Thesaurus Property)
C1561607 (UMLS 2011AA Property)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C37986 (NCI Thesaurus Property)
C0023618 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Overall, how big a problem has your sexual function or lack of sexual function been for you during the last 4 weeks
CL Item
No Problem (No problem)
CL Item
Mild Problem (Very small problem)
CL Item
Mild To Moderate Problem (Small problem)
CL Item
Moderate Problem (Moderate problem)
CL Item
Severe Problem (Big problem)
Item
Hot flashes (How big a problem during the last 4 weeks, if any, has each of the following been for you? Select one answer in each line.)
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C3109 (NCI Thesaurus Property)
C0600142 (UMLS 2011AA Property)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Hot flashes (How big a problem during the last 4 weeks, if any, has each of the following been for you? Select one answer in each line.)
CL Item
No Problem (No problem)
CL Item
Mild Problem (Very small problem)
CL Item
Mild To Moderate Problem (Small problem)
CL Item
Moderate Problem (Moderate problem)
CL Item
Severe Problem (Big problem)
Item
Breast tenderness/enlargement
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C12971 (NCI Thesaurus Property)
C0006141 (UMLS 2011AA Property)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C3399 (NCI Thesaurus Property)
C0038999 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Breast tenderness/enlargement
CL Item
No Problem (No problem)
CL Item
Mild Problem (Very small problem)
CL Item
Mild To Moderate Problem (Small problem)
CL Item
Moderate Problem (Moderate problem)
CL Item
Severe Problem (Big problem)
Item
Feeling depressed
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C2982 (NCI Thesaurus Property)
C0011570 (UMLS 2011AA Property)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Feeling depressed
CL Item
No Problem (No problem)
CL Item
Mild Problem (Very small problem)
CL Item
Mild To Moderate Problem (Small problem)
CL Item
Moderate Problem (Moderate problem)
CL Item
Severe Problem (Big problem)
Item
Lack of energy
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C3036 (NCI Thesaurus Property)
C0015672 (UMLS 2011AA Property)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL Item
No Problem (No problem)
CL Item
Mild Problem (Very small problem)
CL Item
Mild To Moderate Problem (Small problem)
CL Item
Moderate Problem (Moderate problem)
CL Item
Severe Problem (Big problem)
Item
Change in body weight
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C12410 (NCI Thesaurus ObjectClass)
C0033572 (UMLS 2011AA ObjectClass)
C25208 (NCI Thesaurus Property)
C0043100 (UMLS 2011AA Property)
C28020 (NCI Thesaurus Property)
C0033213 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Change in body weight
CL Item
No Problem (No problem)
CL Item
Mild Problem (Very small problem)
CL Item
Mild To Moderate Problem (Small problem)
CL Item
Moderate Problem (Moderate problem)
CL Item
Severe Problem (Big problem)
ResponsiblePersonSignatureText
Item
Completed by (Last name, First Name)
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25657 (NCI Thesaurus ObjectClass)
C1273518 (UMLS 2011AA ObjectClass)
C25678 (NCI Thesaurus Property)
C1519316 (UMLS 2011AA Property)
FormCompleteDate
Item
Date Form Completed (mm dd yyyy)
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C40988 (NCI Thesaurus ObjectClass)
C1516308 (UMLS 2011AA ObjectClass)
C25250 (NCI Thesaurus Property)
C0205197 (UMLS 2011AA Property)
C25367 (NCI Thesaurus ValueDomain)