ID
3438
Descripción
CALGB: 90401 Medications Supplement Form Docetaxel and Prednisone With or Without Bevacizumab in Treating Patients With Prostate Cancer That Did Not Respond to Hormone Therapy Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=359FF873-CDE9-6CE9-E044-0003BA3F9857
Link
Palabras clave
Versiones (4)
- 20/9/12 20/9/12 -
- 9/1/15 9/1/15 - Martin Dugas
- 16/6/15 16/6/15 -
- 20/9/21 20/9/21 -
Subido en
20 de septiembre de 2012
DOI
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Licencia
Creative Commons BY-NC 3.0 Legacy
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Prostate Cancer NCT00110214 Treatment - CALGB: 90401 Medications Supplement Form - 2664914v1.0
If submitting electronically, click the Send button when you have completed the form.
- StudyEvent: CALGB: 90401 Medications Supplement Form
Descripción
Unnamed2
Descripción
PatientInitialsName
Tipo de datos
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
Descripción
PatientMedicalRecordNumber
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C25261
- UMLS 2011AA Property
- C0205476
- NCI Thesaurus Property
- C25198
- UMLS 2011AA Property
- C0034869
Descripción
CombinedInstitutionName
Tipo de datos
text
Alias
- NCI Thesaurus ObjectClass
- C25454
- UMLS 2011AA ObjectClass
- C0205195
- NCI Thesaurus ObjectClass
- C21541
- UMLS 2011AA ObjectClass
- C0018704
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
- NCI Thesaurus ValueDomain
- C25191
- UMLS 2011AA ValueDomain
- C1547383
- NCI Thesaurus ValueDomain
- C21541
- UMLS 2011AA ValueDomain
- C0018704
Descripción
ParticipatingGroupName
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS 2011AA ValueDomain
- C1547383
- NCI Thesaurus ObjectClass
- C25608
- UMLS 2011AA ObjectClass
- C0679823
- NCI Thesaurus ObjectClass
- C17005
- UMLS 2011AA ObjectClass
- C1257890
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
Descripción
ProtocolParticipatingIdentifierNumber
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
- NCI Thesaurus ObjectClass
- C25320
- UMLS 2011AA ObjectClass
- C1507394
- NCI Thesaurus Property
- C25608
- UMLS 2011AA Property
- C0679823
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
Descripción
PatientParticipatingIdentifierNumber
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C25608
- UMLS 2011AA Property
- C0679823
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
Descripción
Unnamed Module 2
Descripción
CardiovascularAgentPriorYearReceivedInd-2
Tipo de datos
text
Alias
- NCI Thesaurus ObjectClass
- C2079
- UMLS 2011AA ObjectClass
- C0007209
- NCI Thesaurus Property
- C25629
- UMLS 2011AA Property
- C0332152
- NCI Thesaurus Property
- C29848
- UMLS 2011AA Property
- C0439234
- NCI Thesaurus Property
- C25639
- UMLS 2011AA Property
- C1514756
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Descripción
CardiovascularAgentPriorYearReceivedType
Tipo de datos
text
Alias
- NCI Thesaurus ObjectClass
- C2079
- UMLS 2011AA ObjectClass
- C0007209
- NCI Thesaurus Property
- C25629
- UMLS 2011AA Property
- C0332152
- NCI Thesaurus Property
- C29848
- UMLS 2011AA Property
- C0439234
- NCI Thesaurus Property
- C25639
- UMLS 2011AA Property
- C1514756
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
Descripción
AgentName
Tipo de datos
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
Descripción
DiabetesMellitusCurrentTherapeuticProcedureInd-2
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
- NCI Thesaurus Property
- C25471
- UMLS 2011AA Property
- C0521116
- NCI Thesaurus ObjectClass
- C2985
- UMLS 2011AA ObjectClass
- C0011849
- NCI Thesaurus Property
- C49236
- UMLS 2011AA Property
- C0087111
Descripción
DiabetesMellitusCurrentTherapeuticProcedureType
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus Property
- C25471
- UMLS 2011AA Property
- C0521116
- NCI Thesaurus ObjectClass
- C2985
- UMLS 2011AA ObjectClass
- C0011849
- NCI Thesaurus Property
- C49236
- UMLS 2011AA Property
- C0087111
Descripción
PatientPre-ExistingConditionInd-3
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Metathesaurus Property
- CL232826
Descripción
PatientPre-ExistingConditionText
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Metathesaurus Property
- CL232826
Descripción
PatientPre-ExistingConditionMostRecentDate
Tipo de datos
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus ValueDomain
- C25577
- UMLS 2011AA ValueDomain
- C1513491
- NCI Metathesaurus Property
- CL232826
Descripción
PatientGastrointestinalTractPerforationPre-ExistingConditionText
Tipo de datos
text
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C34082
- UMLS 2011AA Property
- C0017189
- NCI Metathesaurus Property
- CL232826
- NCI Thesaurus Property
- C4080
- UMLS 2011AA Property
- C0549099
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
Descripción
PatientGenitourinaryPerforationPre-ExistingConditionText
Tipo de datos
text
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C25350
- UMLS 2011AA Property
- C2709259
- NCI Metathesaurus Property
- CL232826
- NCI Thesaurus Property
- C4080
- UMLS 2011AA Property
- C0549099
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
Descripción
PatientHemorrhagePre-ExistingConditionText
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C26791
- UMLS 2011AA Property
- C0019080
- NCI Metathesaurus Property
- CL232826
Descripción
Footer
Descripción
ResearchCommentsText
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ObjectClass
- C15319
- NCI Thesaurus Property
- C25393
- UMLS 2011AA Property
- C0282411
Descripción
ResponsiblePersonName
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS 2011AA ValueDomain
- C1547383
- NCI Thesaurus ObjectClass
- C25657
- UMLS 2011AA ObjectClass
- C1273518
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
Descripción
FormOriginalCompleteDate
Tipo de datos
date
Alias
- NCI Thesaurus ObjectClass
- C19464
- UMLS 2011AA ObjectClass
- C0376315
- NCI Thesaurus Property
- C25250
- UMLS 2011AA Property
- C0205197
- NCI Thesaurus Property
- C25604
- UMLS 2011AA Property
- C0205313
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ValueDomain
- C25367
Similar models
If submitting electronically, click the Send button when you have completed the form.
- StudyEvent: CALGB: 90401 Medications Supplement Form
C0237753 (UMLS 2011AA ValueDomain)
C19464 (NCI Thesaurus ObjectClass)
C0376315 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
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C1516238 (UMLS 2011AA Property)
C0237753 (UMLS 2011AA ValueDomain)
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C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
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C1516238 (UMLS 2011AA Property)
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C0030705 (UMLS 2011AA ObjectClass)
C25536 (NCI Thesaurus Property)
C1555582 (UMLS 2011AA Property)
C0237753 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25261 (NCI Thesaurus Property)
C0205476 (UMLS 2011AA Property)
C25198 (NCI Thesaurus Property)
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C1547383 (UMLS 2011AA ValueDomain)
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C1547383 (UMLS 2011AA ValueDomain)
C25608 (NCI Thesaurus ObjectClass)
C0679823 (UMLS 2011AA ObjectClass)
C17005 (NCI Thesaurus ObjectClass)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C0237753 (UMLS 2011AA ValueDomain)
C25320 (NCI Thesaurus ObjectClass)
C1507394 (UMLS 2011AA ObjectClass)
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C0679823 (UMLS 2011AA Property)
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C16960 (NCI Thesaurus ObjectClass)
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C25608 (NCI Thesaurus Property)
C0679823 (UMLS 2011AA Property)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C0007209 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus Property)
C0332152 (UMLS 2011AA Property)
C29848 (NCI Thesaurus Property)
C0439234 (UMLS 2011AA Property)
C25639 (NCI Thesaurus Property)
C1514756 (UMLS 2011AA Property)
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C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
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C1708 (NCI Thesaurus ObjectClass)
C0450442 (UMLS 2011AA ObjectClass)
C1708 (NCI Thesaurus ValueDomain)
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C0027365 (UMLS 2011AA ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C25471 (NCI Thesaurus Property)
C0521116 (UMLS 2011AA Property)
C2985 (NCI Thesaurus ObjectClass)
C0011849 (UMLS 2011AA ObjectClass)
C49236 (NCI Thesaurus Property)
C0087111 (UMLS 2011AA Property)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0332307 (UMLS 2011AA ValueDomain)
C25471 (NCI Thesaurus Property)
C0521116 (UMLS 2011AA Property)
C2985 (NCI Thesaurus ObjectClass)
C0011849 (UMLS 2011AA ObjectClass)
C49236 (NCI Thesaurus Property)
C0087111 (UMLS 2011AA Property)
C0021641 (UMLS 2011AA)
C1512699 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
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C1298908 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
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CL232826 (NCI Metathesaurus Property)
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C25577 (NCI Thesaurus ValueDomain)
C1513491 (UMLS 2011AA ValueDomain)
CL232826 (NCI Metathesaurus Property)
C0030705 (UMLS 2011AA ObjectClass)
C34082 (NCI Thesaurus Property)
C0017189 (UMLS 2011AA Property)
CL232826 (NCI Metathesaurus Property)
C4080 (NCI Thesaurus Property)
C0549099 (UMLS 2011AA Property)
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
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C25350 (NCI Thesaurus Property)
C2709259 (UMLS 2011AA Property)
CL232826 (NCI Metathesaurus Property)
C4080 (NCI Thesaurus Property)
C0549099 (UMLS 2011AA Property)
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C26791 (NCI Thesaurus Property)
C0019080 (UMLS 2011AA Property)
CL232826 (NCI Metathesaurus Property)
C1527021 (UMLS 2011AA ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0282411 (UMLS 2011AA Property)
C1547383 (UMLS 2011AA ValueDomain)
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C1273518 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
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C25250 (NCI Thesaurus Property)
C0205197 (UMLS 2011AA Property)
C25604 (NCI Thesaurus Property)
C0205313 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
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