ID
2905
Description
NCIC OV 21 Death Report Form Comparing Three Combination Chemotherapy Regimens in Treating Patients With Stage IIB, Stage IIC, Stage III, or Stage IV Ovarian Epithelial Cancer, Primary Peritoneal Cancer, or Fallopian Tube Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=69B794A7-2EA4-1666-E040-BB89AD432FB9
Link
Keywords
Versions (2)
- 9/19/12 9/19/12 -
- 1/9/15 1/9/15 - Martin Dugas
Uploaded on
September 19, 2012
DOI
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License
Creative Commons BY-NC 3.0 Legacy
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Ovarian Cancer NCT00993655 Off Treatment - NCIC OV 21 Death Report Form - 2874203v1.0
The aim of the "Death Report" Folder is to collect death information. The "Death Report" Folder should be completed at the time of death. It should be submitted electronically within 8 weeks of the patient's death.
Description
Date/cause Of Death/autopsy
Description
DeathDocumentedDate
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ObjectClass
- C28554
- UMLS 2011AA ObjectClass
- C0011065
- NCI Thesaurus Property
- C25356
- UMLS 2011AA Property
- C1301725
Description
PatientDeathSpecify
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C28554
- UMLS 2011AA Property
- C0011065
Description
AutopsyPerformedInd-3
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
- NCI Thesaurus ObjectClass
- C25153
- UMLS 2011AA ObjectClass
- C0004398
- NCI Thesaurus Property
- C38000
- UMLS 2011AA Property
- C0884358
Description
Comments
Description
Contact Information
Description
CRAName
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS 2011AA ValueDomain
- C1547383
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
- NCI Thesaurus ObjectClass
- C25465
- UMLS 2011AA ObjectClass
- C1516627
Description
ClinicalResearchAssociatePersonTelephoneNumber
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C25395
- UMLS 2011AA Property
- C0039457
- NCI Thesaurus ObjectClass
- C25465
- UMLS 2011AA ObjectClass
- C1516627
Description
ClinicalResearchAssociatePersonFaxNumber
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus ObjectClass
- C25465
- UMLS 2011AA ObjectClass
- C1516627
- NCI Thesaurus Property
- C25210
- UMLS 2011AA Property
- C0085205
Description
InstitutionName
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS 2011AA ValueDomain
- C1547383
- NCI Thesaurus ObjectClass
- C21541
- UMLS 2011AA ObjectClass
- C0018704
- NCI Thesaurus ValueDomain
- C21541
- UMLS 2011AA ValueDomain
- C0018704
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
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The aim of the "Death Report" Folder is to collect death information. The "Death Report" Folder should be completed at the time of death. It should be submitted electronically within 8 weeks of the patient's death.
C0237753 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
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C16960 (NCI Thesaurus ObjectClass)
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C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0282411 (UMLS 2011AA Property)
C1547383 (UMLS 2011AA ValueDomain)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25465 (NCI Thesaurus ObjectClass)
C1516627 (UMLS 2011AA ObjectClass)
C0237753 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
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