ID

2964

Descrição

Information concerning the patient's off treatment date, reason and best response to treatment. Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AD006CC7-CD06-B0A3-E040-BB89AD437A16

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AD006CC7-CD06-B0A3-E040-BB89AD437A16

Palavras-chave

Versões (2)
  1. 19/09/2012 19/09/2012 -
  2. 08/01/2015 08/01/2015 - Martin Dugas
Transferido a

19 de setembro de 2012

DOI

Para um pedido faça login.

Licença

Creative Commons BY-NC 3.0 Legacy
Comentários do modelo :

Aqui pode comentar o modelo. Pode comentá-lo especificamente através dos balões de texto nos grupos de itens e itens.

Voltar para os comentários do modelo
Comentários do grupo de itens para :

Comentários do item para :

Para descarregar formulários, precisa de ter uma sessão iniciada. Por favor faça login ou registe-se gratuitamente.

Off Treatment - Off Treatment - 3278673v1.0

Inglês

No Instruction available.

1 Formulários  
  1. StudyEvent: Off Treatment
    1. No Instruction available.
Off Treatment
Descrição

Off Treatment

Visit Date (Enter the date the form is being completed.)
Descrição

FormCompletionDate

Tipo de dados

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C40988
UMLS 2011AA ObjectClass
C1516308
NCI Thesaurus Property
C25250
UMLS 2011AA Property
C0205197
Date Off Treatment (Enter the date when all courses have been completed including the normal observation period or discontinued and no further treatment courses are planned.)
Descrição

TreatmentPhaseEndDate

Tipo de dados

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Metathesaurus ObjectClass
C0087111
NCI Metathesaurus ObjectClass
C0205390
NCI Metathesaurus Property
C0205197
Reason Off Treatment (Select an off treatment reason from one of the following reason groups:)
Descrição

OffTreatmentReasonCode

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25162
UMLS 2011AA ValueDomain
C0805701
NCI Thesaurus ObjectClass
C25601
UMLS 2011AA ObjectClass
C1518544
NCI Thesaurus Property
C25365
UMLS 2011AA Property
C0678257
Explain 'Other' Reason Off Treatment (Enter an explanation for selecting "Other" for a Reason Off Treatment.)
Descrição

Off-TreatmentOtherDescriptionShortText

Tipo de dados

text

Alias
NCI Thesaurus ObjectClass
C25601
UMLS 2011AA ObjectClass
C1518544
NCI Thesaurus Property
C17649
UMLS 2011AA Property
C0205394
NCI Thesaurus Property
C25365
UMLS 2011AA Property
C0678257
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ValueDomain
C25365
UMLS 2011AA ValueDomain
C0678257
NCI Thesaurus ValueDomain
C25249
UMLS 2011AA ValueDomain
C1806781
Patient Began Protocol Specified Follow-up (Indicate whether or not the patient began the protocol-specified follow-up period.)
Descrição

Follow-UpStatusBeginPeriodIndicator

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
NCI Thesaurus Property
C25616
UMLS 2011AA Property
C1948053
NCI Thesaurus Property
C25431
UMLS 2011AA Property
C0439659
NCI Thesaurus ObjectClass
C25688
UMLS 2011AA ObjectClass
C0449438
Date of Last Medication Administration
Descrição

TreatmentEndDate

Tipo de dados

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C15368
NCI Thesaurus Property
C25275
UMLS 2011AA Property
C2745955
NCI Thesaurus Property
C25496
UMLS 2011AA Property
C2746065
Best Response to Treatment (Select the best overall response to treatment while on protocol.)
Descrição

BestResponseAssessmentType

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
NCI Thesaurus ObjectClass
C15368
NCI Thesaurus ObjectClass
C25432
UMLS 2011AA ObjectClass
C1522427
Date of Best Response (Enter the date that a Best Response of Treatment response of CR, PR, or MR was first observed, or that an SD response began.)
Descrição

BestResponseDate

Tipo de dados

date

Alias
NCI Thesaurus ObjectClass
C25755
UMLS 2011AA ObjectClass
C0871261
NCI Thesaurus ObjectClass
C25432
UMLS 2011AA ObjectClass
C1522427
NCI Thesaurus Property
C25164
UMLS 2011AA Property
C0011008
NCI Thesaurus Property
C25279
UMLS 2011AA Property
C0332162
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
Date of Disease Progression (Enter the date that progression or relapse was first observed i.e.: date of scan.)
Descrição

ProgressionDate

Tipo de dados

date

Alias
NCI Thesaurus Property
C25164
UMLS 2011AA Property
C0011008
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C17747
UMLS 2011AA ObjectClass
C0242656
Voltar ao início da página

Similar models

No Instruction available.

1 Formulários
  1. StudyEvent: Off Treatment
    1. No Instruction available.
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de dados
Alias
Item Group
Off Treatment
FormCompletionDate
Item
Visit Date (Enter the date the form is being completed.)
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)
TreatmentPhaseEndDate
Item
Date Off Treatment (Enter the date when all courses have been completed including the normal observation period or discontinued and no further treatment courses are planned.)
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C0087111 (NCI Metathesaurus ObjectClass)
C0205390 (NCI Metathesaurus ObjectClass)
C0205197 (NCI Metathesaurus Property)
Item
Reason Off Treatment (Select an off treatment reason from one of the following reason groups:)
text
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
C25601 (NCI Thesaurus ObjectClass)
C1518544 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
CL.1
Code List
Reason Off Treatment (Select an off treatment reason from one of the following reason groups:)
CL Item
Study Complete (C)
CL Item
Declined To Participate (X)
CL Item
Disease Progression Before Treatment (B)
CL Item
No Treatment, Per Protocol Criteria (Z)
CL Item
Not Treated - Other Reasons (U)
CL Item
Disease Progression (P)
C17747 (NCI Thesaurus)
C0242656 (UMLS 2011AA)
CL Item
Death On Study (D)
CL Item
Toxicity (T)
C27990 (NCI Thesaurus)
C0600688 (UMLS 2011AA)
CL Item
Complicating Disease (S)
CL Item
Cytogenetic Resistance (G)
CL Item
Alternative Treatment (A)
CL Item
Refused Further Treatment (R)
CL Item
Ineligible (I)
CL Item
Protocol Violation (V)
C48251 (NCI Thesaurus)
C1709750 (UMLS 2011AA)
CL Item
Pi Discretion (N)
CL Item
Other (O)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
CL Item
Treatment Period Completed (Q)
Off-TreatmentOtherDescriptionShortText
Item
Explain 'Other' Reason Off Treatment (Enter an explanation for selecting "Other" for a Reason Off Treatment.)
text
C25601 (NCI Thesaurus ObjectClass)
C1518544 (UMLS 2011AA ObjectClass)
C17649 (NCI Thesaurus Property)
C0205394 (UMLS 2011AA Property)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25365 (NCI Thesaurus ValueDomain)
C0678257 (UMLS 2011AA ValueDomain)
C25249 (NCI Thesaurus ValueDomain)
C1806781 (UMLS 2011AA ValueDomain)
Item
Patient Began Protocol Specified Follow-up (Indicate whether or not the patient began the protocol-specified follow-up period.)
text
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C25616 (NCI Thesaurus Property)
C1948053 (UMLS 2011AA Property)
C25431 (NCI Thesaurus Property)
C0439659 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ObjectClass)
C0449438 (UMLS 2011AA ObjectClass)
CL.2
Code List
Patient Began Protocol Specified Follow-up (Indicate whether or not the patient began the protocol-specified follow-up period.)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
TreatmentEndDate
Item
Date of Last Medication Administration
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C15368 (NCI Thesaurus ObjectClass)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
C25496 (NCI Thesaurus Property)
C2746065 (UMLS 2011AA Property)
Item
Best Response to Treatment (Select the best overall response to treatment while on protocol.)
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
C15368 (NCI Thesaurus ObjectClass)
C25432 (NCI Thesaurus ObjectClass)
C1522427 (UMLS 2011AA ObjectClass)
CL.3
Code List
Best Response to Treatment (Select the best overall response to treatment while on protocol.)
CL Item
Complete Response (CR)
CL Item
Less Than Partial Response (MR)
CL Item
Not Assessed (NA)
CL Item
Not Evauable (NE)
CL Item
Not Applicable Per Protocol (NP)
CL Item
Progressive Disease (PD)
C35571 (NCI Thesaurus)
C1335499 (UMLS 2011AA)
CL Item
Partial Response (PR)
C18212 (NCI Thesaurus)
CL Item
Stable Disease (SD)
C18213 (NCI Thesaurus)
C0677946 (UMLS 2011AA)
CL Item
Too Early (TE)
CL Item
Complete Response Unconfirmed (CRU)
CL Item
Non-cr/non-pd (Non-CR/Non-PD)
CL Item
Disease Unchanged (DU)
BestResponseDate
Item
Date of Best Response (Enter the date that a Best Response of Treatment response of CR, PR, or MR was first observed, or that an SD response began.)
date
C25755 (NCI Thesaurus ObjectClass)
C0871261 (UMLS 2011AA ObjectClass)
C25432 (NCI Thesaurus ObjectClass)
C1522427 (UMLS 2011AA ObjectClass)
C25164 (NCI Thesaurus Property)
C0011008 (UMLS 2011AA Property)
C25279 (NCI Thesaurus Property)
C0332162 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
ProgressionDate
Item
Date of Disease Progression (Enter the date that progression or relapse was first observed i.e.: date of scan.)
date
C25164 (NCI Thesaurus Property)
C0011008 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C17747 (NCI Thesaurus ObjectClass)
C0242656 (UMLS 2011AA ObjectClass)
Voltar ao início da página 

Contacto

Use este formulário para feedback, perguntas e sugestões de aperfeiçoamento.

Campos marcados com * são obrigatórios.

Ajuda

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial