ID
2700
Descripción
AMC-075 Pregnancy Report Form (PRF) Vorinostat and Combination Chemotherapy With Rituximab in Treating Patients With Previously Untreated HIV-Related Diffuse Large B-Cell Non-Hodgkin Lymphoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A0F9B852-8D06-8306-E040-BB89AD434EB4
Link
Palabras clave
Versiones (2)
- 19/9/12 19/9/12 -
- 29/8/17 29/8/17 -
Subido en
19 de septiembre de 2012
DOI
Para solicitar uno, por favor iniciar sesión.
Licencia
Creative Commons BY-NC 3.0 Legacy
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Lymphoma NCT01193842 On-Study - AMC-075 Pregnancy Report Form (PRF) - 3228000v1.0
For date fields, if the month and year are known, but the exact date is not, please enter "15" for the day.
- StudyEvent: AMC-075 Pregnancy Report Form (PRF)
Descripción
Current Pregnancy Information
Descripción
PatientMostRecentPregnancyTestDate
Tipo de datos
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Metathesaurus Property
- C0032976
- NCI Thesaurus Property
- C25577
- UMLS 2011AA Property
- C1513491
Descripción
PregnancyLaboratoryProcedurePerformedType
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus Property
- C38000
- UMLS 2011AA Property
- C0884358
- NCI Thesaurus ObjectClass
- C25742
- UMLS 2011AA ObjectClass
- C0032961
- NCI Thesaurus ObjectClass
- C25294
- UMLS 2011AA ObjectClass
- C0022885
Descripción
PatientSerumPregnancyTestInd-3
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C13325
- UMLS 2011AA Property
- C0229671
- NCI Thesaurus Property
- C92949
Descripción
PatientSerumPregnancyTestDate
Tipo de datos
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C13325
- UMLS 2011AA Property
- C0229671
- NCI Thesaurus Property
- C92949
Descripción
LastMenstrualCycleOccurrenceDate
Tipo de datos
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ObjectClass
- C25551
- UMLS 2011AA ObjectClass
- C1517741
- NCI Thesaurus Property
- C25275
- UMLS 2011AA Property
- C2745955
- NCI Thesaurus ObjectClass
- C16838
- UMLS 2011AA ObjectClass
- C0025329
Descripción
PatientEstimatedConceptionDate
Tipo de datos
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C25498
- UMLS 2011AA Property
- C0750572
- NCI Thesaurus Property
- C16465
- UMLS 2011AA Property
- C0009637
Descripción
PregnancyDeliveryDate
Tipo de datos
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ObjectClass
- C25742
- UMLS 2011AA ObjectClass
- C0032961
- NCI Thesaurus Property
- C61560
Descripción
Previous Pregnancy Information
Descripción
PatientPregnancyCount
Tipo de datos
double
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus ValueDomain
- C25463
- UMLS 2011AA ValueDomain
- C0750480
- NCI Thesaurus Property
- C25742
- UMLS 2011AA Property
- C0032961
Descripción
PregnancyLiveBirthCount
Tipo de datos
double
Alias
- NCI Thesaurus ValueDomain
- C25463
- UMLS 2011AA ValueDomain
- C0750480
Descripción
PatientPregnancySpontaneousAbortionCount
Tipo de datos
double
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus ValueDomain
- C25463
- UMLS 2011AA ValueDomain
- C0750480
- NCI Thesaurus Property
- C25742
- UMLS 2011AA Property
- C0032961
Descripción
PatientPregnancyTherapeuticAbortionCount
Tipo de datos
double
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus ValueDomain
- C25463
- UMLS 2011AA ValueDomain
- C0750480
- NCI Thesaurus Property
- C25742
- UMLS 2011AA Property
- C0032961
Descripción
DataUnknownText
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ObjectClass
- C25474
- UMLS 2011AA ObjectClass
- C1511726
- NCI Thesaurus Property
- C17998
- UMLS 2011AA Property
- C0439673
Descripción
PersonPreviousPregnancyComplicationInd-3
Tipo de datos
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
- NCI Thesaurus Property
- C25627
- UMLS 2011AA Property
- C0205156
- NCI Thesaurus Property
- C34941
- UMLS 2011AA Property
- C0032962
Descripción
PersonPreviousPregnancyComplicationSpecify
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C25627
- UMLS 2011AA Property
- C0205156
- NCI Thesaurus Property
- C34941
- UMLS 2011AA Property
- C0032962
Descripción
PersonCongenitalAbnormalityPregnancyInd-3
Tipo de datos
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
- NCI Thesaurus Property
- C25742
- UMLS 2011AA Property
- C0032961
- NCI Thesaurus Property
- C2849
- UMLS 2011AA Property
- C0000768
Descripción
PatientCongenitalAbnormalitySpecify
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C2849
- UMLS 2011AA Property
- C0000768
Descripción
Relevant Medical History
Descripción
PersonPersonalMedicalHistoryPregnancyText
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C25742
- UMLS 2011AA Property
- C0032961
- NCI Thesaurus Property
- C18772
- UMLS 2011AA Property
- C0262926
Descripción
PersonFatherKnownIndicator
Tipo de datos
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus ValueDomain
- C25180
- UMLS 2011AA ValueDomain
- C1522602
- NCI Thesaurus Property
- C25174
- UMLS 2011AA Property
- C0015671
- NCI Thesaurus Property
- C80137
- UMLS 2011AA Property
- C0205309
Descripción
FatherPersonChildCount
Tipo de datos
double
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus ObjectClass
- C25174
- UMLS 2011AA ObjectClass
- C0015671
- NCI Thesaurus ValueDomain
- C25463
- UMLS 2011AA ValueDomain
- C0750480
- NCI Thesaurus Property
- C42708
- UMLS 2011AA Property
- C0680063
Descripción
FatherAgeValue
Tipo de datos
double
Unidades de medida
- year
Alias
- NCI Thesaurus ObjectClass
- C25174
- UMLS 2011AA ObjectClass
- C0015671
- NCI Thesaurus Property
- C25150
- UMLS 2011AA Property
- C0001779
- NCI Thesaurus ValueDomain
- C25712
- UMLS 2011AA ValueDomain
- C1522609
Descripción
DataUnknownText
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ObjectClass
- C25474
- UMLS 2011AA ObjectClass
- C1511726
- NCI Thesaurus Property
- C17998
- UMLS 2011AA Property
- C0439673
Descripción
ConcomitantDiseaseOrganSystemPersonalMedicalHistorySpecify
Tipo de datos
text
Alias
- NCI Thesaurus ObjectClass
- C2991
- UMLS 2011AA ObjectClass
- C0012634
- NCI Thesaurus ObjectClass
- C25730
- UMLS 2011AA ObjectClass
- C0521115
- NCI Thesaurus Property
- C18772
- UMLS 2011AA Property
- C0262926
- NCI Thesaurus Property
- C12919
- UMLS 2011AA Property
- C0460002
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
Descripción
Comments
Similar models
For date fields, if the month and year are known, but the exact date is not, please enter "15" for the day.
- StudyEvent: AMC-075 Pregnancy Report Form (PRF)
C0376315 (UMLS 2011AA ObjectClass)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C49153 (NCI Thesaurus ObjectClass)
C1705294 (UMLS 2011AA ObjectClass)
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C1513491 (UMLS 2011AA Property)
C0332307 (UMLS 2011AA ValueDomain)
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C0022885 (UMLS 2011AA ObjectClass)
C1512699 (UMLS 2011AA ValueDomain)
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C0030705 (UMLS 2011AA ObjectClass)
C13325 (NCI Thesaurus Property)
C0229671 (UMLS 2011AA Property)
C92949 (NCI Thesaurus Property)
C1705108 (UMLS 2011AA)
C1298908 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C0011008 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C13325 (NCI Thesaurus Property)
C0229671 (UMLS 2011AA Property)
C92949 (NCI Thesaurus Property)
C0011008 (UMLS 2011AA ValueDomain)
C25551 (NCI Thesaurus ObjectClass)
C1517741 (UMLS 2011AA ObjectClass)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
C16838 (NCI Thesaurus ObjectClass)
C0025329 (UMLS 2011AA ObjectClass)
C0011008 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25498 (NCI Thesaurus Property)
C0750572 (UMLS 2011AA Property)
C16465 (NCI Thesaurus Property)
C0009637 (UMLS 2011AA Property)
C0011008 (UMLS 2011AA ValueDomain)
C25742 (NCI Thesaurus ObjectClass)
C0032961 (UMLS 2011AA ObjectClass)
C61560 (NCI Thesaurus Property)
C0030705 (UMLS 2011AA ObjectClass)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C25742 (NCI Thesaurus Property)
C0032961 (UMLS 2011AA Property)
C0750480 (UMLS 2011AA ValueDomain)
C0030705 (UMLS 2011AA ObjectClass)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C25742 (NCI Thesaurus Property)
C0032961 (UMLS 2011AA Property)
C0030705 (UMLS 2011AA ObjectClass)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C25742 (NCI Thesaurus Property)
C0032961 (UMLS 2011AA Property)
C1527021 (UMLS 2011AA ValueDomain)
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C17998 (NCI Thesaurus Property)
C0439673 (UMLS 2011AA Property)
C0027361 (UMLS 2011AA ObjectClass)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C25627 (NCI Thesaurus Property)
C0205156 (UMLS 2011AA Property)
C34941 (NCI Thesaurus Property)
C0032962 (UMLS 2011AA Property)
C1705108 (UMLS 2011AA)
C1298908 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C1521902 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25627 (NCI Thesaurus Property)
C0205156 (UMLS 2011AA Property)
C34941 (NCI Thesaurus Property)
C0032962 (UMLS 2011AA Property)
C0027361 (UMLS 2011AA ObjectClass)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C25742 (NCI Thesaurus Property)
C0032961 (UMLS 2011AA Property)
C2849 (NCI Thesaurus Property)
C0000768 (UMLS 2011AA Property)
C1705108 (UMLS 2011AA)
C1298908 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C1521902 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C2849 (NCI Thesaurus Property)
C0000768 (UMLS 2011AA Property)
C1527021 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25742 (NCI Thesaurus Property)
C0032961 (UMLS 2011AA Property)
C18772 (NCI Thesaurus Property)
C0262926 (UMLS 2011AA Property)
C0027361 (UMLS 2011AA ObjectClass)
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C25174 (NCI Thesaurus Property)
C0015671 (UMLS 2011AA Property)
C80137 (NCI Thesaurus Property)
C0205309 (UMLS 2011AA Property)
C1705108 (UMLS 2011AA)
C1298908 (UMLS 2011AA)
C0027361 (UMLS 2011AA ObjectClass)
C25174 (NCI Thesaurus ObjectClass)
C0015671 (UMLS 2011AA ObjectClass)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C42708 (NCI Thesaurus Property)
C0680063 (UMLS 2011AA Property)
C0015671 (UMLS 2011AA ObjectClass)
C25150 (NCI Thesaurus Property)
C0001779 (UMLS 2011AA Property)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C17998 (NCI Thesaurus Property)
C0439673 (UMLS 2011AA Property)
C0012634 (UMLS 2011AA ObjectClass)
C25730 (NCI Thesaurus ObjectClass)
C0521115 (UMLS 2011AA ObjectClass)
C18772 (NCI Thesaurus Property)
C0262926 (UMLS 2011AA Property)
C12919 (NCI Thesaurus Property)
C0460002 (UMLS 2011AA Property)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0282411 (UMLS 2011AA Property)