ID

2840

Description

Physical Exam Screening form for C3D 3.12 Adopters Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FEF2E3DC-3E2D-329B-E034-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FEF2E3DC-3E2D-329B-E034-0003BA3F9857

Keywords

Versions (2)
  1. 9/19/12 9/19/12 -
  2. 9/20/21 9/20/21 -
Uploaded on

September 19, 2012

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License

Creative Commons BY-NC 3.0 Legacy
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On-Study - PHYSICAL EXAM SCREEN - 2390964v1.0

English

Dates will appear as 'DD-MON-YYYY'

1 forms  
  1. StudyEvent: PHYSICAL EXAM SCREEN
    1. Dates will appear as 'DD-MON-YYYY'
Physical Exam--screening
Description

Physical Exam--screening

Evaluation Date
Description

EvaluationDate

Data type

date

Alias
NCI Thesaurus Property
C25164
UMLS 2011AA Property
C0011008
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C25214
UMLS 2011AA ObjectClass
C0220825
Body System Type
Description

BodySystemType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C13041
UMLS 2011AA ObjectClass
C1268086
NCI Thesaurus Property
C25700
UMLS 2011AA Property
C0449913
Finding Results Indicator
Description

FindingResultIndicator

Data type

text

Alias
NCI Thesaurus ValueDomain
C20200
UMLS 2011AA ValueDomain
C1274040
NCI Thesaurus ObjectClass
C3367
UMLS 2011AA ObjectClass
C0037088
NCI Metathesaurus Property
CL282989
Comment Change From Baseline Text
Description

CommentChangeFromBaselineText

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ObjectClass
C25213
UMLS 2011AA ObjectClass
C1442488
NCI Thesaurus ObjectClass
C25446
UMLS 2011AA ObjectClass
C0392747
NCI Metathesaurus Property
C0947611
Comments
Description

Comments

Note Date
Description

NoteDate

Data type

date

Alias
NCI Thesaurus Property
C25164
UMLS 2011AA Property
C0011008
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Metathesaurus ObjectClass
C1317574
Research Comments Text
Description

ResearchCommentsText

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
UMLS 2011AA Property
C0282411
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Similar models

Dates will appear as 'DD-MON-YYYY'

1 forms
  1. StudyEvent: PHYSICAL EXAM SCREEN
    1. Dates will appear as 'DD-MON-YYYY'
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Physical Exam--screening
EvaluationDate
Item
Evaluation Date
date
C25164 (NCI Thesaurus Property)
C0011008 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25214 (NCI Thesaurus ObjectClass)
C0220825 (UMLS 2011AA ObjectClass)
Item
Body System Type
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C13041 (NCI Thesaurus ObjectClass)
C1268086 (UMLS 2011AA ObjectClass)
C25700 (NCI Thesaurus Property)
C0449913 (UMLS 2011AA Property)
CL.1
Code List
Body System Type
CL Item
Abdomen (ABDOMEN)
C12664 (NCI Thesaurus)
C0230168 (UMLS 2011AA)
CL Item
Allergy Or Drug Sensitivity History (Allergy/Drug Sensitivity)
CL Item
Appearance (Appearance)
CL Item
Body As A Whole (Body as a Whole)
CL Item
Breasts (BREASTS)
C12971 (NCI Thesaurus)
C0006141 (UMLS 2011AA)
CL Item
Cardiovascular (CARDIOVASCULAR)
C25292 (NCI Thesaurus)
C0007226 (UMLS 2011AA)
CL Item
Central Nervous System (Central Nervous System)
C12438 (NCI Thesaurus)
C0927232 (UMLS 2011AA)
CL Item
Chest (Chest)
C25389 (NCI Thesaurus)
C0817096 (UMLS 2011AA)
CL Item
Constitutional (Constitutional)
C37931 (NCI Thesaurus)
C1511487 (UMLS 2011AA)
CL Item
Dermatologic (DERMATOLOGIC)
C0205489 (NCI Metathesaurus)
CL Item
Endocrine/metabolic (ENDOCRINE/METABOLIC)
CL Item
Extremities (Extremities)
C30140 (NCI Thesaurus)
CL Item
Gastrointestinal (GASTROINTESTINAL)
C13359 (NCI Thesaurus)
C0521362 (UMLS 2011AA)
CL Item
Genitalia (GENITALIA)
C25177 (NCI Thesaurus)
C0017420 (UMLS 2011AA)
CL Item
Genitourinary (Genitourinary)
CL Item
H/e/e/n/t (H/E/E/N/T)
CL Item
Hematologic (HEMATOLOGIC)
C0205488 (NCI Metathesaurus)
CL Item
Hematopoietic/lymph (HEMATOPOIETIC/LYMPH)
C12745 (NCI Thesaurus)
C0024204 (UMLS 2011AA)
CL Item
Hepatic (Hepatic)
C13308 (NCI Thesaurus)
C0205054 (UMLS 2011AA)
CL Item
Immune (IMMUNE)
C17997 (NCI Thesaurus)
C0439662 (UMLS 2011AA)
CL Item
Integumentary/hair (Integumentary/Hair)
CL Item
Musculoskeletal (MUSCULOSKELETAL)
C25348 (NCI Thesaurus)
C0497254 (UMLS 2011AA)
CL Item
Neck (NECK)
C13063 (NCI Thesaurus)
C0027530 (UMLS 2011AA)
CL Item
Neurologic (NEUROLOGIC)
C25262 (NCI Thesaurus)
C0205494 (UMLS 2011AA)
CL Item
Other (OTHER)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
CL Item
Pelvis (PELVIS)
C12767 (NCI Thesaurus)
C0030797 (UMLS 2011AA)
CL Item
Peripheral Vascular System (Peripheral Vascular)
C0225806 (NCI Metathesaurus)
CL Item
Psychologic (PSYCHOLOGIC)
CL Item
Pulmonary (Pulmonary)
C13304 (NCI Thesaurus)
C2709248 (UMLS 2011AA)
CL Item
Rectal (Rectal)
C25224 (NCI Thesaurus)
C0205052 (UMLS 2011AA)
CL Item
Renal (Renal)
C25225 (NCI Thesaurus)
C0022646 (UMLS 2011AA)
CL Item
Reproductive History (Reproductive History)
C17655 (NCI Thesaurus)
C0206076 (UMLS 2011AA)
CL Item
Respiratory (RESPIRATORY)
C25656 (NCI Thesaurus)
C0521346 (UMLS 2011AA)
CL Item
Spleen (Spleen)
C12432 (NCI Thesaurus)
C0037993 (UMLS 2011AA)
CL Item
Substance Abuse/dependency (Substance abuse/Dependency)
CL Item
Transfusion History (Transfusion History)
C30142 (NCI Thesaurus)
C1519604 (UMLS 2011AA)
CL Item
Urinary (URINARY)
C25711 (NCI Thesaurus)
C1524119 (UMLS 2011AA)
Item
Finding Results Indicator
text
C20200 (NCI Thesaurus ValueDomain)
C1274040 (UMLS 2011AA ValueDomain)
C3367 (NCI Thesaurus ObjectClass)
C0037088 (UMLS 2011AA ObjectClass)
CL282989 (NCI Metathesaurus Property)
CL.2
Code List
Finding Results Indicator
CL Item
Abnormal (A)
C25401 (NCI Thesaurus)
C0205161 (UMLS 2011AA)
CL Item
No Change (C)
CL Item
Equivocal (E)
C86071 (NCI Thesaurus)
C0332241 (UMLS 2011AA)
CL Item
Negative (G)
C25247 (NCI Thesaurus)
C0205160 (UMLS 2011AA)
CL Item
Improving (I)
C94226 (NCI Thesaurus)
CL Item
Not Applicable (L)
C48660 (NCI Thesaurus)
C1272460 (UMLS 2011AA)
CL Item
Normal (N)
C14165 (NCI Thesaurus)
C0205307 (UMLS 2011AA)
CL Item
No Source Data (O)
C53269 (NCI Thesaurus)
C1546437 (UMLS 2011AA)
CL Item
Positive (P)
C25246 (NCI Thesaurus)
C1446409 (UMLS 2011AA)
CL Item
Stable (S)
C30103 (NCI Thesaurus)
C0205360 (UMLS 2011AA)
CL Item
Unstable (U)
CL Item
Not Evaluable (V)
CL Item
Worse (W)
C71686 (NCI Thesaurus)
C1457868 (UMLS 2011AA)
CL Item
Not Examined (X)
CommentChangeFromBaselineText
Item
Comment Change From Baseline Text
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25213 (NCI Thesaurus ObjectClass)
C1442488 (UMLS 2011AA ObjectClass)
C25446 (NCI Thesaurus ObjectClass)
C0392747 (UMLS 2011AA ObjectClass)
C0947611 (NCI Metathesaurus Property)
Item Group
Comments
NoteDate
Item
Note Date
date
C25164 (NCI Thesaurus Property)
C0011008 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C1317574 (NCI Metathesaurus ObjectClass)
ResearchCommentsText
Item
Research Comments Text
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0282411 (UMLS 2011AA Property)
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