ID

3087

Description

Course Initiation form for C3D 3.12 Adopters Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=0175BCA0-5585-5F61-E044-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=0175BCA0-5585-5F61-E044-0003BA3F9857

Keywords

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

September 19, 2012

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Creative Commons BY-NC 3.0 Legacy
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Treatment - COURSE INITIATION - 2411443v1.0

English

Dates will appear as 'DD-MON-YYYY'

1 forms  
  1. StudyEvent: COURSE INITIATION
    1. Dates will appear as 'DD-MON-YYYY'
Course Initiation
Description

Course Initiation

Course Number
Description

CourseNumber

Data type

double

Alias
NCI Thesaurus Property
C25337
UMLS 2011AA Property
C0237753
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C25379
UMLS 2011AA ObjectClass
C0750729
Course Start Date
Description

CourseStartDate

Data type

date

Alias
NCI Thesaurus ObjectClass
C25379
UMLS 2011AA ObjectClass
C0750729
NCI Metathesaurus ObjectClass
CL219258
NCI Thesaurus Property
C25164
UMLS 2011AA Property
C0011008
NCI Thesaurus Property
C25431
UMLS 2011AA Property
C0439659
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
Arm
Description

Arm

Data type

text

Alias
NCI Thesaurus ObjectClass
C32141
UMLS 2011AA ObjectClass
C1140618
NCI Thesaurus ObjectClass
C42651
UMLS 2011AA ObjectClass
C0442711
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
NCI Thesaurus Property
C25426
UMLS 2011AA Property
C1516050
Treatment Assignment Code at Enrollment
Description

EnrollmentTreatmentStudyAssignmentCode

Data type

text

Alias
NCI Thesaurus ObjectClass
C15368
NCI Thesaurus ObjectClass
C19992
UMLS 2011AA ObjectClass
C1516607
NCI Thesaurus Property
C25162
UMLS 2011AA Property
C0805701
NCI Thesaurus Property
C25426
UMLS 2011AA Property
C1516050
NCI Thesaurus ValueDomain
C25162
UMLS 2011AA ValueDomain
C0805701
NCI Thesaurus ValueDomain
C37948
UMLS 2011AA ValueDomain
C1516879
NCI Thesaurus ValueDomain
C25426
UMLS 2011AA ValueDomain
C1516050
NCI Thesaurus ValueDomain
C49656
UMLS 2011AA ValueDomain
C0087111
Treating Institution Text Code
Description

TreatingInstitutionTextCode

Data type

text

Alias
NCI Thesaurus ValueDomain
C25162
UMLS 2011AA ValueDomain
C0805701
NCI Thesaurus ObjectClass
C25705
UMLS 2011AA ObjectClass
C1522326
NCI Thesaurus ObjectClass
C19992
UMLS 2011AA ObjectClass
C1516607
NCI Metathesaurus Property
CL281747
Stop Date (This is a derived field and may be displayed on the form, if needed.)
Description

StopDate

Data type

date

Alias
NCI Thesaurus Property
C25164
UMLS 2011AA Property
C0011008
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C15368
NCI Thesaurus Property
C65125
UMLS 2011AA Property
C1947925
Vital Signs
Description

Vital Signs

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
Lab Collection Time
Description

LabCollectionTime

Data type

time

Alias
NCI Thesaurus Property
C25453
UMLS 2011AA Property
C1516698
NCI Thesaurus Property
C25207
UMLS 2011AA Property
C0040223
NCI Thesaurus ValueDomain
C25207
UMLS 2011AA ValueDomain
C0040223
NCI Thesaurus ObjectClass
C25294
UMLS 2011AA ObjectClass
C0022885
Height (cm)
Description

PersonHeightMeasurement

Data type

double

Measurement units
  • cm
Alias
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C25347
UMLS 2011AA Property
C0489786
cm
Body Weight in Kilograms
Description

BodyWeightinKilograms

Data type

double

Measurement units
  • Kg
Alias
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
NCI Thesaurus ObjectClass
C13041
UMLS 2011AA ObjectClass
C1268086
NCI Thesaurus Property
C25208
UMLS 2011AA Property
C0043100
Kg
BSA
Description

PersonBodySurfaceAreaValue

Data type

double

Measurement units
  • m2
Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
NCI Thesaurus Property
C25157
UMLS 2011AA Property
C0005902
m2
Zubrod Performance Status Score
Description

ZubrodPerformanceStatusScore

Data type

text

Alias
NCI Thesaurus Property
C25367
NCI Thesaurus ObjectClass
C20641
UMLS 2011AA ObjectClass
C1518965
NCI Thesaurus ValueDomain
C25338
UMLS 2011AA ValueDomain
C0449820
Karnofsky Performance Status Score
Description

KarnofskyPerformanceStatusScore

Data type

text

Alias
NCI Thesaurus Property
C25367
NCI Thesaurus ObjectClass
C20641
UMLS 2011AA ObjectClass
C1518965
NCI Thesaurus ValueDomain
C25338
UMLS 2011AA ValueDomain
C0449820
Lansky Performance Status Score
Description

LanskyPerformanceStatusScore

Data type

text

Alias
NCI Thesaurus Property
C25367
NCI Thesaurus ObjectClass
C20641
UMLS 2011AA ObjectClass
C1518965
NCI Thesaurus ValueDomain
C25338
UMLS 2011AA ValueDomain
C0449820
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: COURSE INITIATION
    1. Dates will appear as 'DD-MON-YYYY'
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Course Initiation
CourseNumber
Item
Course Number
double
C25337 (NCI Thesaurus Property)
C0237753 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25379 (NCI Thesaurus ObjectClass)
C0750729 (UMLS 2011AA ObjectClass)
CourseStartDate
Item
Course Start Date
date
C25379 (NCI Thesaurus ObjectClass)
C0750729 (UMLS 2011AA ObjectClass)
CL219258 (NCI Metathesaurus ObjectClass)
C25164 (NCI Thesaurus Property)
C0011008 (UMLS 2011AA Property)
C25431 (NCI Thesaurus Property)
C0439659 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
Arm
Item
Arm
text
C32141 (NCI Thesaurus ObjectClass)
C1140618 (UMLS 2011AA ObjectClass)
C42651 (NCI Thesaurus ObjectClass)
C0442711 (UMLS 2011AA ObjectClass)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C25426 (NCI Thesaurus Property)
C1516050 (UMLS 2011AA Property)
EnrollmentTreatmentStudyAssignmentCode
Item
Treatment Assignment Code at Enrollment
text
C15368 (NCI Thesaurus ObjectClass)
C19992 (NCI Thesaurus ObjectClass)
C1516607 (UMLS 2011AA ObjectClass)
C25162 (NCI Thesaurus Property)
C0805701 (UMLS 2011AA Property)
C25426 (NCI Thesaurus Property)
C1516050 (UMLS 2011AA Property)
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
C37948 (NCI Thesaurus ValueDomain)
C1516879 (UMLS 2011AA ValueDomain)
C25426 (NCI Thesaurus ValueDomain)
C1516050 (UMLS 2011AA ValueDomain)
C49656 (NCI Thesaurus ValueDomain)
C0087111 (UMLS 2011AA ValueDomain)
TreatingInstitutionTextCode
Item
Treating Institution Text Code
text
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
C25705 (NCI Thesaurus ObjectClass)
C1522326 (UMLS 2011AA ObjectClass)
C19992 (NCI Thesaurus ObjectClass)
C1516607 (UMLS 2011AA ObjectClass)
CL281747 (NCI Metathesaurus Property)
StopDate
Item
Stop Date (This is a derived field and may be displayed on the form, if needed.)
date
C25164 (NCI Thesaurus Property)
C0011008 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C15368 (NCI Thesaurus ObjectClass)
C65125 (NCI Thesaurus Property)
C1947925 (UMLS 2011AA Property)
Item Group
Vital Signs
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)
LabCollectionTime
Item
Lab Collection Time
time
C25453 (NCI Thesaurus Property)
C1516698 (UMLS 2011AA Property)
C25207 (NCI Thesaurus Property)
C0040223 (UMLS 2011AA Property)
C25207 (NCI Thesaurus ValueDomain)
C0040223 (UMLS 2011AA ValueDomain)
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
PersonHeightMeasurement
Item
Height (cm)
double
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25347 (NCI Thesaurus Property)
C0489786 (UMLS 2011AA Property)
BodyWeightinKilograms
Item
Body Weight in Kilograms
double
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
C13041 (NCI Thesaurus ObjectClass)
C1268086 (UMLS 2011AA ObjectClass)
C25208 (NCI Thesaurus Property)
C0043100 (UMLS 2011AA Property)
PersonBodySurfaceAreaValue
Item
BSA
double
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C25157 (NCI Thesaurus Property)
C0005902 (UMLS 2011AA Property)
Item
Zubrod Performance Status Score
text
C25367 (NCI Thesaurus Property)
C20641 (NCI Thesaurus ObjectClass)
C1518965 (UMLS 2011AA ObjectClass)
C25338 (NCI Thesaurus ValueDomain)
C0449820 (UMLS 2011AA ValueDomain)
CL.1
Code List
Zubrod Performance Status Score
CL Item
Normal Activity (0)
CL Item
Symptoms, But Nearly Fully Ambulatory (1)
CL Item
Some Bed Time, But Needs To Be In Bed <50% Of Normal Daytime (2)
CL Item
Needs To Be In Bed > 50% Of Normal Daytime (3)
CL Item
Unable To Get Out Of Bed (4)
Item
Karnofsky Performance Status Score
text
C25367 (NCI Thesaurus Property)
C20641 (NCI Thesaurus ObjectClass)
C1518965 (UMLS 2011AA ObjectClass)
C25338 (NCI Thesaurus ValueDomain)
C0449820 (UMLS 2011AA ValueDomain)
CL.2
Code List
Karnofsky Performance Status Score
CL Item
Dead (0)
CL Item
Moribund, Fatal Processes Progressing Rapidly (10)
CL Item
Normal, No Complaints, No Evidence Of Disease (100)
CL Item
Very Sick, Hospitalization Indicated. Death Not Imminent (20)
CL Item
Severely Disabled, Hospitalization Indicated. Death Not Imminent (30)
CL Item
Disabled, Requires Special Care And Assistance (40)
CL Item
Requires Considerable Assistance And Frequent Medical Care (50)
CL Item
Requires Occasional Assistance, But Is Able To Care For Most Of His/her Needs (60)
CL Item
Cares For Self, Unable To Carry On Normal Activity Or To Do Active Work (70)
CL Item
Normal Activity With Effort; Some Signs Or Symptoms Of Disease (80)
CL Item
Able To Carry On Normal Activity; Minor Signs Or Symptoms Of Disease (90)
Item
Lansky Performance Status Score
text
C25367 (NCI Thesaurus Property)
C20641 (NCI Thesaurus ObjectClass)
C1518965 (UMLS 2011AA ObjectClass)
C25338 (NCI Thesaurus ValueDomain)
C0449820 (UMLS 2011AA ValueDomain)
CL.3
Code List
Lansky Performance Status Score
CL Item
Unresponsive (0)
CL Item
No Play; Does Not Get Out Of Bed. (10)
CL Item
Fully Active, Normal (100)
CL Item
Often Sleeping; Play Entirely Limited To Very Passive Activities. (20)
CL Item
In Bed; Needs Assistance Even For Quiet Play. (30)
CL Item
Mostly In Bed; Participates In Quiet Activities. (40)
CL Item
Gets Dressed, But Lies Around Much Of The Day; No Active Play, Able To Participate In All Quiet Play And Activities. (50)
CL Item
Up And Around, But Minimal Active Play; Keeps Busy With Quieter Activities. (60)
CL Item
Both Greater Restriction Of And Less Time Spent In Play Activity (70)
CL Item
Active, But Tires More Quickly (80)
CL Item
Minor Restrictions In Physically Strenuous Activity (90)
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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