ID

3032

Beschrijving

On Study Form - RF02B Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=CCE2BABD-1F19-494E-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=CCE2BABD-1F19-494E-E034-0003BA12F5E7

Trefwoorden

Versies (2)
  1. 19-09-12 19-09-12 -
  2. 09-01-15 09-01-15 - Martin Dugas
Geüploaded op

19 september 2012

DOI

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Licentie

Creative Commons BY-NC 3.0 Legacy
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Sarcoma, Kaposi xxx On-Study - On Study Form - RF02B - 2266958v3.0

Engels

No Instruction available.

1 Formulieren  
  1. StudyEvent: On Study Form - RF02B
    1. No Instruction available.
Ccrr Module For On Study Form - Rf02b
Beschrijving

Ccrr Module For On Study Form - Rf02b

Patient Initials
Beschrijving

PatientInitialsName

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25536
UMLS 2011AA Property
C1555582
Study#
Beschrijving

ProtocolCoordinatingIdentifierNumber

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C25320
UMLS 2011AA ObjectClass
C1507394
NCI Thesaurus Property
C25462
UMLS 2011AA Property
C0700114
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Site#
Beschrijving

NCIInstitutionIdentifierCode

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25162
UMLS 2011AA ValueDomain
C0805701
NCI Thesaurus ObjectClass
C21541
UMLS 2011AA ObjectClass
C0018704
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ObjectClass
C19202
UMLS 2011AA ObjectClass
C1513882
ID#
Beschrijving

PatientCoordinatingIdentifierNumber

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25462
UMLS 2011AA Property
C0700114
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Date of Enrollment
Beschrijving

PatientRegistrationDate

Datatype

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ValueDomain
C25367
NCI Thesaurus Property
C25646
UMLS 2011AA Property
C1514821
Institution Name
Beschrijving

InstitutionName

Datatype

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
Date of Malignancy Diagnosis
Beschrijving

CancerInitialDiagnosisDate

Datatype

date

Alias
NCI Thesaurus ObjectClass
C9305
UMLS 2011AA ObjectClass
C0006826
NCI Thesaurus Property
C25509
UMLS 2011AA Property
C1279901
NCI Thesaurus Property
C15220
UMLS 2011AA Property
C0011900
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ValueDomain
C25367
Other therapy (e.g. hyperthermia, etc.), Specify
Beschrijving

PriorOtherTherapyName

Datatype

text

Prior or concurrent other malignancy?
Beschrijving

PriorCancerDiagnosisInd-3

Datatype

text

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass
C9305
UMLS 2011AA ObjectClass
C0006826
NCI Thesaurus ObjectClass
C25629
UMLS 2011AA ObjectClass
C0332152
NCI Thesaurus Property
C15220
UMLS 2011AA Property
C0011900
Date of Malignancy Diagnosis
Beschrijving

PriorCancerDiagnosisDate

Datatype

date

Malignancy/Primary Site
Beschrijving

DiseasePrimarySiteICD-OCode

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25162
UMLS 2011AA ValueDomain
C0805701
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus Property
C25251
UMLS 2011AA Property
C0205225
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
Malignancy/Primary Site
Beschrijving

DiseasePrimarySiteICD-OCode

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25162
UMLS 2011AA ValueDomain
C0805701
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus Property
C25251
UMLS 2011AA Property
C0205225
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
Other, Specify
Beschrijving

DiseasePrimarySiteText

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus Property
C25251
UMLS 2011AA Property
C0205225
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
Other, Specify
Beschrijving

DiseasePrimarySiteText

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus Property
C25251
UMLS 2011AA Property
C0205225
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
Histology
Beschrijving

TumorHistologicCategorySpecify

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus ObjectClass
C3262
UMLS 2011AA ObjectClass
C0027651
NCI Thesaurus Property
C25526
UMLS 2011AA Property
C0205462
NCI Thesaurus Property
C25161
UMLS 2011AA Property
C0008902
Histology
Beschrijving

TumorHistologicCategorySpecify

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus ObjectClass
C3262
UMLS 2011AA ObjectClass
C0027651
NCI Thesaurus Property
C25526
UMLS 2011AA Property
C0205462
NCI Thesaurus Property
C25161
UMLS 2011AA Property
C0008902
Prior therapy for this malignancy?
Beschrijving

CancerPriorTreatmentInd-3

Datatype

text

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass
C9305
UMLS 2011AA ObjectClass
C0006826
NCI Thesaurus Property
C25629
UMLS 2011AA Property
C0332152
NCI Thesaurus Property
C15368
Prior therapy for this malignancy?
Beschrijving

CancerPriorTreatmentInd-3

Datatype

text

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass
C9305
UMLS 2011AA ObjectClass
C0006826
NCI Thesaurus Property
C25629
UMLS 2011AA Property
C0332152
NCI Thesaurus Property
C15368
If Yes, check all that apply
Beschrijving

PriorChemotherapyAdministeredInd-3

Datatype

text

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass
C15632
UMLS 2011AA ObjectClass
C0392920
NCI Thesaurus ObjectClass
C25629
UMLS 2011AA ObjectClass
C0332152
NCI Thesaurus Property
C25382
UMLS 2011AA Property
C1521801
If Yes, check all that apply
Beschrijving

PriorChemotherapyAdministeredInd-3

Datatype

text

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass
C15632
UMLS 2011AA ObjectClass
C0392920
NCI Thesaurus ObjectClass
C25629
UMLS 2011AA ObjectClass
C0332152
NCI Thesaurus Property
C25382
UMLS 2011AA Property
C1521801
Other 2, Specify
Beschrijving

PriorTherapyOtherName

Datatype

text

Alias
NCI Thesaurus ObjectClass
C25629
UMLS 2011AA ObjectClass
C0332152
NCI Thesaurus ObjectClass
C15368
NCI Thesaurus Property
C17649
UMLS 2011AA Property
C0205394
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ValueDomain
C42614
UMLS 2011AA ValueDomain
C0027365
Other 2, Specify
Beschrijving

PriorTherapyOtherName

Datatype

text

Alias
NCI Thesaurus ObjectClass
C25629
UMLS 2011AA ObjectClass
C0332152
NCI Thesaurus ObjectClass
C15368
NCI Thesaurus Property
C17649
UMLS 2011AA Property
C0205394
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ValueDomain
C42614
UMLS 2011AA ValueDomain
C0027365
Other 2, Specify
Beschrijving

PriorTherapyOtherName

Datatype

text

Alias
NCI Thesaurus ObjectClass
C25629
UMLS 2011AA ObjectClass
C0332152
NCI Thesaurus ObjectClass
C15368
NCI Thesaurus Property
C17649
UMLS 2011AA Property
C0205394
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ValueDomain
C42614
UMLS 2011AA ValueDomain
C0027365
Agent Name - unnamed
Beschrijving

AgentName

Datatype

text

Alias
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ObjectClass
C1708
UMLS 2011AA ObjectClass
C0450442
NCI Thesaurus ValueDomain
C1708
UMLS 2011AA ValueDomain
C0450442
NCI Thesaurus ValueDomain
C42614
UMLS 2011AA ValueDomain
C0027365
Agent Name - unnamed
Beschrijving

AgentName

Datatype

text

Alias
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ObjectClass
C1708
UMLS 2011AA ObjectClass
C0450442
NCI Thesaurus ValueDomain
C1708
UMLS 2011AA ValueDomain
C0450442
NCI Thesaurus ValueDomain
C42614
UMLS 2011AA ValueDomain
C0027365
Agent Name - unnamed
Beschrijving

AgentName

Datatype

text

Alias
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ObjectClass
C1708
UMLS 2011AA ObjectClass
C0450442
NCI Thesaurus ValueDomain
C1708
UMLS 2011AA ValueDomain
C0450442
NCI Thesaurus ValueDomain
C42614
UMLS 2011AA ValueDomain
C0027365
Agent Name - unnamed
Beschrijving

AgentName

Datatype

text

Alias
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ObjectClass
C1708
UMLS 2011AA ObjectClass
C0450442
NCI Thesaurus ValueDomain
C1708
UMLS 2011AA ValueDomain
C0450442
NCI Thesaurus ValueDomain
C42614
UMLS 2011AA ValueDomain
C0027365
Date of HIV+ diagnosis
Beschrijving

DateofHIV+diagnosis

Datatype

text

Date of AIDS diagnosis
Beschrijving

DateofAIDSdiagnosis

Datatype

text

CDC HIV Risk Group
Beschrijving

CDCHIVRiskGroup

Datatype

text

Other, Specify
Beschrijving

Other,Specify

Datatype

text

Biological response modifiers or cytokines, Specify
Beschrijving

Biologicalresponsemodifiersorcytokines,Specify

Datatype

text

Biological response modifiers or cytokines, Specify
Beschrijving

Biologicalresponsemodifiersorcytokines,Specify

Datatype

text

Is patient receiving antiretroviral therapy concurrently?
Beschrijving

Ispatientreceivingantiretroviraltherapyconcurrently?

Datatype

text

Has patient received any antiretroviral therapy prescribed prior to registration?
Beschrijving

Haspatientreceivedanyantiretroviraltherapyprescribedpriortoregistration?

Datatype

text

Duration of Prior Antiretroviral Therapy
Beschrijving

DurationofPriorAntiretroviralTherapy

Datatype

text

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1 Formulieren
  1. StudyEvent: On Study Form - RF02B
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Ccrr Module For On Study Form - Rf02b
PatientInitialsName
Item
Patient Initials
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)
ProtocolCoordinatingIdentifierNumber
Item
Study#
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25320 (NCI Thesaurus ObjectClass)
C1507394 (UMLS 2011AA ObjectClass)
C25462 (NCI Thesaurus Property)
C0700114 (UMLS 2011AA Property)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
NCIInstitutionIdentifierCode
Item
Site#
text
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
C21541 (NCI Thesaurus ObjectClass)
C0018704 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C19202 (NCI Thesaurus ObjectClass)
C1513882 (UMLS 2011AA ObjectClass)
PatientCoordinatingIdentifierNumber
Item
ID#
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25462 (NCI Thesaurus Property)
C0700114 (UMLS 2011AA Property)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
PatientRegistrationDate
Item
Date of Enrollment
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus ValueDomain)
C25646 (NCI Thesaurus Property)
C1514821 (UMLS 2011AA Property)
InstitutionName
Item
Institution Name
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C21541 (NCI Thesaurus ObjectClass)
C0018704 (UMLS 2011AA ObjectClass)
C21541 (NCI Thesaurus ValueDomain)
C0018704 (UMLS 2011AA ValueDomain)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
CancerInitialDiagnosisDate
Item
Date of Malignancy Diagnosis
date
C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C25509 (NCI Thesaurus Property)
C1279901 (UMLS 2011AA Property)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain)
PriorOtherTherapyName
Item
Other therapy (e.g. hyperthermia, etc.), Specify
text
Item
Prior or concurrent other malignancy?
text
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
CL.5
Code List
Prior or concurrent other malignancy?
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
PriorCancerDiagnosisDate
Item
Date of Malignancy Diagnosis
date
Item
Malignancy/Primary Site
text
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C25251 (NCI Thesaurus Property)
C0205225 (UMLS 2011AA Property)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
CL.6
Code List
Malignancy/Primary Site
CL Item
KS (KS)
CL Item
NHL (NHL)
CL Item
HD (HD)
CL Item
Anal (Anal)
CL Item
Cervical (Cervical)
CL Item
Other (Other)
Item
Malignancy/Primary Site
text
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C25251 (NCI Thesaurus Property)
C0205225 (UMLS 2011AA Property)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
CL.6
Code List
Malignancy/Primary Site
CL Item
KS (KS)
CL Item
NHL (NHL)
CL Item
HD (HD)
CL Item
Anal (Anal)
CL Item
Cervical (Cervical)
CL Item
Other (Other)
DiseasePrimarySiteText
Item
Other, Specify
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C25251 (NCI Thesaurus Property)
C0205225 (UMLS 2011AA Property)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
DiseasePrimarySiteText
Item
Other, Specify
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C25251 (NCI Thesaurus Property)
C0205225 (UMLS 2011AA Property)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
TumorHistologicCategorySpecify
Item
Histology
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C25526 (NCI Thesaurus Property)
C0205462 (UMLS 2011AA Property)
C25161 (NCI Thesaurus Property)
C0008902 (UMLS 2011AA Property)
TumorHistologicCategorySpecify
Item
Histology
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C25526 (NCI Thesaurus Property)
C0205462 (UMLS 2011AA Property)
C25161 (NCI Thesaurus Property)
C0008902 (UMLS 2011AA Property)
Item
Prior therapy for this malignancy?
text
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus Property)
C0332152 (UMLS 2011AA Property)
C15368 (NCI Thesaurus Property)
CL.7
Code List
Prior therapy for this malignancy?
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item
Prior therapy for this malignancy?
text
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus Property)
C0332152 (UMLS 2011AA Property)
C15368 (NCI Thesaurus Property)
CL.7
Code List
Prior therapy for this malignancy?
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item
If Yes, check all that apply
text
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C15632 (NCI Thesaurus ObjectClass)
C0392920 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
CL.8
Code List
If Yes, check all that apply
CL Item
Systemic chemotherapy (Systemic chemotherapy)
CL Item
Biological response modifiers or cytokines (Biological response modifiers or cytokines)
CL Item
Surgery (excluding biopsy) (Surgery (excluding biopsy))
CL Item
Cryotherapy (Cryotherapy)
CL Item
Systemic steroid therapy (Systemic steroid therapy)
CL Item
Radiotherapy (Radiotherapy)
CL Item
Topical/Intralesional Therapy (Topical/Intralesional Therapy)
CL Item
Investigational Drug (Antitumor) (Investigational Drug (Antitumor))
CL Item
Other therapy (e.g. hyperthermia, etc.) (Other therapy (e.g. hyperthermia, etc.))
Item
If Yes, check all that apply
text
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C15632 (NCI Thesaurus ObjectClass)
C0392920 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
CL.8
Code List
If Yes, check all that apply
CL Item
Systemic chemotherapy (Systemic chemotherapy)
CL Item
Biological response modifiers or cytokines (Biological response modifiers or cytokines)
CL Item
Surgery (excluding biopsy) (Surgery (excluding biopsy))
CL Item
Cryotherapy (Cryotherapy)
CL Item
Systemic steroid therapy (Systemic steroid therapy)
CL Item
Radiotherapy (Radiotherapy)
CL Item
Topical/Intralesional Therapy (Topical/Intralesional Therapy)
CL Item
Investigational Drug (Antitumor) (Investigational Drug (Antitumor))
CL Item
Other therapy (e.g. hyperthermia, etc.) (Other therapy (e.g. hyperthermia, etc.))
PriorTherapyOtherName
Item
Other 2, Specify
text
C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass)
C17649 (NCI Thesaurus Property)
C0205394 (UMLS 2011AA Property)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C42614 (NCI Thesaurus ValueDomain)
C0027365 (UMLS 2011AA ValueDomain)
PriorTherapyOtherName
Item
Other 2, Specify
text
C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass)
C17649 (NCI Thesaurus Property)
C0205394 (UMLS 2011AA Property)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C42614 (NCI Thesaurus ValueDomain)
C0027365 (UMLS 2011AA ValueDomain)
PriorTherapyOtherName
Item
Other 2, Specify
text
C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass)
C17649 (NCI Thesaurus Property)
C0205394 (UMLS 2011AA Property)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C42614 (NCI Thesaurus ValueDomain)
C0027365 (UMLS 2011AA ValueDomain)
Item
Agent Name - unnamed
text
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C1708 (NCI Thesaurus ObjectClass)
C0450442 (UMLS 2011AA ObjectClass)
C1708 (NCI Thesaurus ValueDomain)
C0450442 (UMLS 2011AA ValueDomain)
C42614 (NCI Thesaurus ValueDomain)
C0027365 (UMLS 2011AA ValueDomain)
CL.12
Code List
Agent Name - unnamed
CL Item
Enfuvirtide (Enfuvirtide)
CL Item
Delavirdine (Delavirdine)
CL Item
Efavirenz (Efavirenz)
CL Item
Nevirapine (Nevirapine)
CL Item
Abacavir (Abacavir)
CL Item
Trizivir (Trizivir)
CL Item
ddI (ddI)
CL Item
Didanosine (Didanosine)
CL Item
Emtricitabine (Emtricitabine)
CL Item
3TC (3TC)
CL Item
Combivir (Combivir)
CL Item
d4T (d4T)
CL Item
Tenofovir DF (Tenofovir DF)
CL Item
ddC (ddC)
CL Item
AZT (AZT)
CL Item
Amprenavir (Amprenavir)
CL Item
Atazanavir (Atazanavir)
CL Item
Fosamaprenavir (Fosamaprenavir)
CL Item
Indinavir (Indinavir)
CL Item
Kaletra (Kaletra)
CL Item
Nelfinavir (Nelfinavir)
CL Item
Ritonavir (Ritonavir)
CL Item
Saquinavir (Saquinavir)
CL Item
Other (Other)
CL Item
Other, Specify (Other, Specify)
Item
Agent Name - unnamed
text
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C1708 (NCI Thesaurus ObjectClass)
C0450442 (UMLS 2011AA ObjectClass)
C1708 (NCI Thesaurus ValueDomain)
C0450442 (UMLS 2011AA ValueDomain)
C42614 (NCI Thesaurus ValueDomain)
C0027365 (UMLS 2011AA ValueDomain)
CL.12
Code List
Agent Name - unnamed
CL Item
Enfuvirtide (Enfuvirtide)
CL Item
Delavirdine (Delavirdine)
CL Item
Efavirenz (Efavirenz)
CL Item
Nevirapine (Nevirapine)
CL Item
Abacavir (Abacavir)
CL Item
Trizivir (Trizivir)
CL Item
ddI (ddI)
CL Item
Didanosine (Didanosine)
CL Item
Emtricitabine (Emtricitabine)
CL Item
3TC (3TC)
CL Item
Combivir (Combivir)
CL Item
d4T (d4T)
CL Item
Tenofovir DF (Tenofovir DF)
CL Item
ddC (ddC)
CL Item
AZT (AZT)
CL Item
Amprenavir (Amprenavir)
CL Item
Atazanavir (Atazanavir)
CL Item
Fosamaprenavir (Fosamaprenavir)
CL Item
Indinavir (Indinavir)
CL Item
Kaletra (Kaletra)
CL Item
Nelfinavir (Nelfinavir)
CL Item
Ritonavir (Ritonavir)
CL Item
Saquinavir (Saquinavir)
CL Item
Other (Other)
CL Item
Other, Specify (Other, Specify)
Item
Agent Name - unnamed
text
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C1708 (NCI Thesaurus ObjectClass)
C0450442 (UMLS 2011AA ObjectClass)
C1708 (NCI Thesaurus ValueDomain)
C0450442 (UMLS 2011AA ValueDomain)
C42614 (NCI Thesaurus ValueDomain)
C0027365 (UMLS 2011AA ValueDomain)
CL.12
Code List
Agent Name - unnamed
CL Item
Enfuvirtide (Enfuvirtide)
CL Item
Delavirdine (Delavirdine)
CL Item
Efavirenz (Efavirenz)
CL Item
Nevirapine (Nevirapine)
CL Item
Abacavir (Abacavir)
CL Item
Trizivir (Trizivir)
CL Item
ddI (ddI)
CL Item
Didanosine (Didanosine)
CL Item
Emtricitabine (Emtricitabine)
CL Item
3TC (3TC)
CL Item
Combivir (Combivir)
CL Item
d4T (d4T)
CL Item
Tenofovir DF (Tenofovir DF)
CL Item
ddC (ddC)
CL Item
AZT (AZT)
CL Item
Amprenavir (Amprenavir)
CL Item
Atazanavir (Atazanavir)
CL Item
Fosamaprenavir (Fosamaprenavir)
CL Item
Indinavir (Indinavir)
CL Item
Kaletra (Kaletra)
CL Item
Nelfinavir (Nelfinavir)
CL Item
Ritonavir (Ritonavir)
CL Item
Saquinavir (Saquinavir)
CL Item
Other (Other)
CL Item
Other, Specify (Other, Specify)
Item
Agent Name - unnamed
text
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C1708 (NCI Thesaurus ObjectClass)
C0450442 (UMLS 2011AA ObjectClass)
C1708 (NCI Thesaurus ValueDomain)
C0450442 (UMLS 2011AA ValueDomain)
C42614 (NCI Thesaurus ValueDomain)
C0027365 (UMLS 2011AA ValueDomain)
CL.12
Code List
Agent Name - unnamed
CL Item
Enfuvirtide (Enfuvirtide)
CL Item
Delavirdine (Delavirdine)
CL Item
Efavirenz (Efavirenz)
CL Item
Nevirapine (Nevirapine)
CL Item
Abacavir (Abacavir)
CL Item
Trizivir (Trizivir)
CL Item
ddI (ddI)
CL Item
Didanosine (Didanosine)
CL Item
Emtricitabine (Emtricitabine)
CL Item
3TC (3TC)
CL Item
Combivir (Combivir)
CL Item
d4T (d4T)
CL Item
Tenofovir DF (Tenofovir DF)
CL Item
ddC (ddC)
CL Item
AZT (AZT)
CL Item
Amprenavir (Amprenavir)
CL Item
Atazanavir (Atazanavir)
CL Item
Fosamaprenavir (Fosamaprenavir)
CL Item
Indinavir (Indinavir)
CL Item
Kaletra (Kaletra)
CL Item
Nelfinavir (Nelfinavir)
CL Item
Ritonavir (Ritonavir)
CL Item
Saquinavir (Saquinavir)
CL Item
Other (Other)
CL Item
Other, Specify (Other, Specify)
DateofHIV+diagnosis
Item
Date of HIV+ diagnosis
text
DateofAIDSdiagnosis
Item
Date of AIDS diagnosis
text
Item
CDC HIV Risk Group
text
CL.1
Code List
CDC HIV Risk Group
CL Item
Homosexual or bisexual contact (Homosexual or bisexual contact)
CL Item
Hetersexual contact (Hetersexual contact)
CL Item
IV drug user (IV drug user)
CL Item
Transfusion recipient (Transfusion recipient)
CL Item
Hemophiliac (Hemophiliac)
CL Item
Other (Other)
Other,Specify
Item
Other, Specify
text
Biologicalresponsemodifiersorcytokines,Specify
Item
Biological response modifiers or cytokines, Specify
text
Biologicalresponsemodifiersorcytokines,Specify
Item
Biological response modifiers or cytokines, Specify
text
Item
Is patient receiving antiretroviral therapy concurrently?
text
CL.9
Code List
Is patient receiving antiretroviral therapy concurrently?
CL Item
Yes (Yes)
CL Item
No (No)
Item
Has patient received any antiretroviral therapy prescribed prior to registration?
text
CL.11
Code List
Has patient received any antiretroviral therapy prescribed prior to registration?
CL Item
Yes (Yes)
CL Item
No (No)
Item
Duration of Prior Antiretroviral Therapy
text
CL.13
Code List
Duration of Prior Antiretroviral Therapy
CL Item
<3 Months (<3 Months)
CL Item
3-6 Months (3-6 Months)
CL Item
>6-12 Months (>6-12 Months)
CL Item
>12 Months (>12 Months)
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