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Long-Term Follow-Up for Survival & Disease Status

1 forms  
Default Itemgroup
Description

Default Itemgroup

Site number
Description

Site number

Data type

text

Alias
UMLS CUI [1,1]
C0018704
UMLS CUI [1,2]
C0600091
Patient number
Description

Patient number

Data type

text

Alias
UMLS CUI [1]
C1830427
Patient initials
Description

Patient initials

Data type

text

Alias
UMLS CUI [1]
C2986440
Patient status
Description

Patient vital status

Data type

text

Alias
UMLS CUI [1]
C1148433
Date of status
Description

Date of status

Data type

date

Alias
UMLS CUI [1]
C2985720
How contact was made
Description

Contact

Data type

text

Alias
UMLS CUI [1]
C2051442
Does the patient have an ongoing response to Iodine I 131 Tositumomab?
Description

Iodine I 131 Tositumomab

Data type

boolean

Alias
UMLS CUI [1]
C0768182
Additional therapy for NHL since the last LTFU
Description

Additional therapy for NHL since the last LTFU

Alias
UMLS CUI-1
C0024305
UMLS CUI-2
C1706712
Has any additional therapy for NHL been administered?
Description

additional therapy for NHL

Data type

boolean

Alias
UMLS CUI [1,1]
C0024305
UMLS CUI [1,2]
C1706712
Subsequent NHL therapy since last LTFU
Description

Lymphoma, Non-Hodgkin Therapeutic procedure Following Visit

Data type

text

Alias
UMLS CUI [1,1]
C0024305
UMLS CUI [1,2]
C0087111
UMLS CUI [1,3]
C0332282
UMLS CUI [1,4]
C0545082
Start Date
Description

Start Date, Lymphoma, Non-Hodgkin, Therapeutic procedure

Data type

date

Alias
UMLS CUI [1,1]
C0024305
UMLS CUI [1,2]
C0087111
UMLS CUI [1,3]
C0808070
Stop Date
Description

End date, Lymphoma, Non-Hodgkin, Therapeutic procedure

Data type

date

Alias
UMLS CUI [1,1]
C0024305
UMLS CUI [1,2]
C0087111
UMLS CUI [1,3]
C0806020
Total number of cycles
Description

chemotherapeutics regimen total number of cycles ordered, Lymphoma, Non-Hodgkin, Therapeutic procedure

Data type

text

Alias
UMLS CUI [1,1]
C2045831
UMLS CUI [1,2]
C0024305
Myelodysplasia
Description

Myelodysplasia

Alias
UMLS CUI-1
C0026985
Has the patient had a documented diagnosis of myelodysplasia?
Description

Myelodysplasia diagnosis

Data type

boolean

Alias
UMLS CUI [1,1]
C0026985
UMLS CUI [1,2]
C0011900
If yes, date of diagnosis
Description

Myelodysplasia Date of diagnosis

Data type

date

Alias
UMLS CUI [1,1]
C0026985
UMLS CUI [1,2]
C2316983
AML
Description

AML

Alias
UMLS CUI-1
C0023467
Has the patient had a documented diagnosis of AML?
Description

AML diagnosis

Data type

boolean

Alias
UMLS CUI [1,1]
C0023467
UMLS CUI [1,2]
C0011900
If yes, date of diagnosis
Description

AML date of diagnosis

Data type

date

Alias
UMLS CUI [1,1]
C0023467
UMLS CUI [1,2]
C2316983
Another malignancy
Description

Another malignancy

Alias
UMLS CUI-1
C0006826
Has the patient had a diagnosis of another malignancy?
Description

Malignancy diagnosis

Data type

boolean

Alias
UMLS CUI [1,1]
C0006826
UMLS CUI [1,2]
C0011900
If yes, date of diagnosis
Description

Malignancy Date of diagnosis

Data type

date

Alias
UMLS CUI [1,1]
C0006826
UMLS CUI [1,2]
C2316983
TSH measurement
Description

TSH measurement

Alias
UMLS CUI-1
C0202230
Date
Description

TSH measurement Date

Data type

date

Alias
UMLS CUI [1,1]
C0202230
UMLS CUI [1,2]
C0011008
Result
Description

TSH measurement Result

Data type

float

Measurement units
  • µIU/mL
Alias
UMLS CUI [1,1]
C0202230
UMLS CUI [1,2]
C1254595
µIU/mL
Not done
Description

TSH measurement Not done

Data type

boolean

Alias
UMLS CUI [1,1]
C0202230
UMLS CUI [1,2]
C1272696
HAMA
Description

HAMA

Alias
UMLS CUI-1
C1291910
Was a HAMA obtained since the last LTFU?
Description

HAMA since last encounter

Data type

text

Alias
UMLS CUI [1,1]
C1291910
UMLS CUI [1,2]
C3872643
If yes, enter accession #
Description

HAMA accession number

Data type

text

Alias
UMLS CUI [1,1]
C1291910
UMLS CUI [1,2]
C1510755
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Similar models

Long-Term Follow-Up for Survival & Disease Status

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Site number
Item
Site number
text
C0018704 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
Patient number
Item
Patient number
text
C1830427 (UMLS CUI [1])
Patient initials
Item
Patient initials
text
C2986440 (UMLS CUI [1])
Item
Patient status
text
C1148433 (UMLS CUI [1])
Patient status
Code List
Patient status
CL Item
Alive (1)
CL Item
Dead (complete "Notification of Patient Death" Form) (2)
CL Item
Lost to follow-up (3)
Date of status
Item
Date of status
date
C2985720 (UMLS CUI [1])
Item
How contact was made
text
C2051442 (UMLS CUI [1])
contact
Code List
How contact was made
CL Item
Tumor registry (1)
CL Item
Contact with patient (2)
CL Item
Contact with MD (3)
CL Item
Other (4)
CL Item
Other (4)
Iodine I 131 Tositumomab
Item
Does the patient have an ongoing response to Iodine I 131 Tositumomab?
boolean
C0768182 (UMLS CUI [1])
Item Group
Additional therapy for NHL since the last LTFU
C0024305 (UMLS CUI-1)
C1706712 (UMLS CUI-2)
additional therapy for NHL
Item
Has any additional therapy for NHL been administered?
boolean
C0024305 (UMLS CUI [1,1])
C1706712 (UMLS CUI [1,2])
Lymphoma, Non-Hodgkin Therapeutic procedure Following Visit
Item
Subsequent NHL therapy since last LTFU
text
C0024305 (UMLS CUI [1,1])
C0087111 (UMLS CUI [1,2])
C0332282 (UMLS CUI [1,3])
C0545082 (UMLS CUI [1,4])
Start Date, Lymphoma, Non-Hodgkin, Therapeutic procedure
Item
Start Date
date
C0024305 (UMLS CUI [1,1])
C0087111 (UMLS CUI [1,2])
C0808070 (UMLS CUI [1,3])
End date, Lymphoma, Non-Hodgkin, Therapeutic procedure
Item
Stop Date
date
C0024305 (UMLS CUI [1,1])
C0087111 (UMLS CUI [1,2])
C0806020 (UMLS CUI [1,3])
chemotherapeutics regimen total number of cycles ordered, Lymphoma, Non-Hodgkin, Therapeutic procedure
Item
Total number of cycles
text
C2045831 (UMLS CUI [1,1])
C0024305 (UMLS CUI [1,2])
Item Group
Myelodysplasia
C0026985 (UMLS CUI-1)
Myelodysplasia diagnosis
Item
Has the patient had a documented diagnosis of myelodysplasia?
boolean
C0026985 (UMLS CUI [1,1])
C0011900 (UMLS CUI [1,2])
Myelodysplasia Date of diagnosis
Item
If yes, date of diagnosis
date
C0026985 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
Item Group
AML
C0023467 (UMLS CUI-1)
AML diagnosis
Item
Has the patient had a documented diagnosis of AML?
boolean
C0023467 (UMLS CUI [1,1])
C0011900 (UMLS CUI [1,2])
AML date of diagnosis
Item
If yes, date of diagnosis
date
C0023467 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
Item Group
Another malignancy
C0006826 (UMLS CUI-1)
Malignancy diagnosis
Item
Has the patient had a diagnosis of another malignancy?
boolean
C0006826 (UMLS CUI [1,1])
C0011900 (UMLS CUI [1,2])
Malignancy Date of diagnosis
Item
If yes, date of diagnosis
date
C0006826 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
Item Group
TSH measurement
C0202230 (UMLS CUI-1)
TSH measurement Date
Item
Date
date
C0202230 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
TSH measurement Result
Item
Result
float
C0202230 (UMLS CUI [1,1])
C1254595 (UMLS CUI [1,2])
TSH measurement Not done
Item
Not done
boolean
C0202230 (UMLS CUI [1,1])
C1272696 (UMLS CUI [1,2])
Item Group
HAMA
C1291910 (UMLS CUI-1)
Item
Was a HAMA obtained since the last LTFU?
text
C1291910 (UMLS CUI [1,1])
C3872643 (UMLS CUI [1,2])
HAMA since last encounter
Code List
Was a HAMA obtained since the last LTFU?
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Not applicable (Not applicable)
HAMA accession number
Item
If yes, enter accession #
text
C1291910 (UMLS CUI [1,1])
C1510755 (UMLS CUI [1,2])
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