ID

3437

Description

Record physical exam results during treatment. Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AEA85D27-6C63-77D7-E040-BB89AD4373FC

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AEA85D27-6C63-77D7-E040-BB89AD4373FC

Keywords

Versions (1)
  1. 9/20/12 9/20/12 -
Uploaded on

September 20, 2012

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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Physical Exam (Courses) - 3292697v1.0

English

No Instruction available.

1 forms  
  1. StudyEvent: Physical Exam (Courses)
    1. No Instruction available.
Physical Exam - Courses
Description

Physical Exam - Courses

Visit Date (Enter the date the physical examination took place.)
Description

FormCompletionDate

Data type

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
PE Done? (Indicate whether the physical examination was performed.)
Description

PatientPhysicalExaminationInd-2

Data type

text

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
Date of Examination (Enter the date the physical examination took place.)
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
Day in Course (Cycle) (Number of days since the beginning of the course is derived from the course initiation start date and examination date.)
Description

CourseDayNumber

Data type

double

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus Property
C25301
UMLS 2011AA Property
C0439228
NCI Thesaurus ObjectClass
C25379
UMLS 2011AA ObjectClass
C0750729
Change from Baseline (Indicate whether the finding results were changed compared with that of baseline.)
Description

ChangefromBaselineIndicator

Data type

text

Alias
NCI Thesaurus Property
C25180
UMLS 2011AA Property
C1522602
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
NCI Thesaurus ObjectClass
C25213
UMLS 2011AA ObjectClass
C1442488
NCI Thesaurus ObjectClass
C25446
UMLS 2011AA ObjectClass
C0392747
Change from Previous Evaluation? (Indicate whether the finding results were changed compared with that of previous evaluation.)
Description

PhysicalExamChangeIndicator

Data type

text

Alias
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C25446
UMLS 2011AA Property
C0392747
Finding Result (Indicate whether the finding results for the particular body system.)
Description

FindingResultIndicator

Data type

text

Alias
NCI Thesaurus ValueDomain
C20200
UMLS 2011AA ValueDomain
C1274040
NCI Thesaurus ObjectClass
C3367
UMLS 2011AA ObjectClass
C0037088
NCI Metathesaurus Property
CL282989
Comments (If the finding results of a particular body system have changed from baseline, give a brief description of the change.)
Description

CommentChangeFromBaselineText

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ObjectClass
C25213
UMLS 2011AA ObjectClass
C1442488
NCI Thesaurus ObjectClass
C25446
UMLS 2011AA ObjectClass
C0392747
NCI Metathesaurus Property
C0947611
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Similar models

No Instruction available.

1 forms
  1. StudyEvent: Physical Exam (Courses)
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Physical Exam - Courses
FormCompletionDate
Item
Visit Date (Enter the date the physical examination took place.)
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)
Item
PE Done? (Indicate whether the physical examination was performed.)
text
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
CL.1
Code List
PE Done? (Indicate whether the physical examination was performed.)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
EvaluationDate
Item
Date of Examination (Enter the date the physical examination took place.)
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)
CourseDayNumber
Item
Day in Course (Cycle) (Number of days since the beginning of the course is derived from the course initiation start date and examination date.)
double
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25301 (NCI Thesaurus Property)
C0439228 (UMLS 2011AA Property)
C25379 (NCI Thesaurus ObjectClass)
C0750729 (UMLS 2011AA ObjectClass)
Item
Change from Baseline (Indicate whether the finding results were changed compared with that of baseline.)
text
C25180 (NCI Thesaurus Property)
C1522602 (UMLS 2011AA Property)
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C25213 (NCI Thesaurus ObjectClass)
C1442488 (UMLS 2011AA ObjectClass)
C25446 (NCI Thesaurus ObjectClass)
C0392747 (UMLS 2011AA ObjectClass)
CL.2
Code List
Change from Baseline (Indicate whether the finding results were changed compared with that of baseline.)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item
Change from Previous Evaluation? (Indicate whether the finding results were changed compared with that of previous evaluation.)
text
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25446 (NCI Thesaurus Property)
C0392747 (UMLS 2011AA Property)
CL.3
Code List
Change from Previous Evaluation? (Indicate whether the finding results were changed compared with that of previous evaluation.)
CL Item
Yes: C49488 (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No: C49487 (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item
Finding Result (Indicate whether the finding results for the particular body system.)
text
C20200 (NCI Thesaurus ValueDomain)
C1274040 (UMLS 2011AA ValueDomain)
C3367 (NCI Thesaurus ObjectClass)
C0037088 (UMLS 2011AA ObjectClass)
CL282989 (NCI Metathesaurus Property)
CL.4
Code List
Finding Result (Indicate whether the finding results for the particular body system.)
CL Item
Normal (N)
C14165 (NCI Thesaurus)
C0205307 (UMLS 2011AA)
CL Item
Abnormal (A)
C25401 (NCI Thesaurus)
C0205161 (UMLS 2011AA)
CL Item
Not Examined (X)
CommentChangeFromBaselineText
Item
Comments (If the finding results of a particular body system have changed from baseline, give a brief description of the change.)
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25213 (NCI Thesaurus ObjectClass)
C1442488 (UMLS 2011AA ObjectClass)
C25446 (NCI Thesaurus ObjectClass)
C0392747 (UMLS 2011AA ObjectClass)
C0947611 (NCI Metathesaurus Property)
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