ID

42744

Beschrijving

S0100 PATHOLOGY SUBMISSION FORM Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AEB412F0-20C0-418F-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AEB412F0-20C0-418F-E034-0003BA12F5E7

Trefwoorden

Versies (3)
  1. 19-09-12 19-09-12 -
  2. 21-08-17 21-08-17 -
  3. 17-09-21 17-09-21 -
Geüploaded op

17 september 2021

DOI

Voor een aanvraag inloggen.

Licentie

Creative Commons BY-NC 3.0 Legacy
Model Commentaren :

Hier kunt u commentaar leveren op het model. U kunt de tekstballonnen bij de itemgroepen en items gebruiken om er specifiek commentaar op te geven.

Terug naar het model Commentaren
Itemgroep Commentaren voor :

Item Commentaren voor :

U moet ingelogd zijn om formulieren te downloaden. AUB inloggen of schrijf u gratis in.

Leukemia null Pathology - S0100 PATHOLOGY SUBMISSION FORM - 2070699v3.0

Engels

Instructions: Submit a copy of this form to the SWOG Statistical Center. Mail required materials and this form to the following pathologist: David Head, MD Vanderbilt Clinical Labs 4605 TVC 1161 21st Ave. S. Nashville, TN 37232

1 Formulieren  
Ccrr Module For S0100 Pathology Submission Form
Beschrijving

Ccrr Module For S0100 Pathology Submission Form

Alias
UMLS CUI-1
C0030664
UMLS CUI-2
C0023418
SWOG Study No.
Beschrijving

Study Number

Datatype

text

Alias
UMLS CUI [1,1]
C0008976
UMLS CUI [1,2]
C0600091
Registration Step
Beschrijving

Registration Step

Datatype

text

Alias
UMLS CUI-1
C1514821
SWOG Patient ID
Beschrijving

Patient ID

Datatype

text

Alias
UMLS CUI [1]
C2348585
Patient Initials
Beschrijving

Patient Initials

Datatype

text

Alias
UMLS CUI [1]
C2986440
Institution/Affiliate
Beschrijving

Institution

Datatype

text

Alias
UMLS CUI [1,1]
C1301943
UMLS CUI [1,2]
C0600091
Physician
Beschrijving

Treating Physician

Datatype

text

Alias
NCI Thesaurus Property
C25364
NCI Thesaurus ObjectClass
C25741
NCI Thesaurus ObjectClass-2
C25705
UMLS CUI [1]
C1710470
Reason for Submission
Beschrijving

Reason for Submission

Datatype

text

Alias
UMLS CUI [1,1]
C0030673
UMLS CUI [1,2]
C0392360
No. of Slides
Beschrijving

Number of Slides

Datatype

text

Alias
UMLS CUI [1,1]
C1705201
UMLS CUI [1,2]
C0449788
Date Sample Obtained
Beschrijving

Specimen Collection Date

Datatype

date

Alias
UMLS CUI [1]
C1302413
1 W Peripheral Smear Slide, Enclosed
Beschrijving

Peripheral Smear Slide

Datatype

boolean

Alias
NCI Thesaurus ValueDomain
C25180
UMLS CUI [1,1]
C2238079
UMLS CUI [1,2]
C1705201
1 WG Stained BM Aspirate Slide, Enclosed
Beschrijving

Aspirate Slide

Datatype

boolean

Alias
NCI Thesaurus ValueDomain
C25180
UMLS CUI [1,1]
C0370199
UMLS CUI [1,2]
C1705201
5 Unstained Smear Slides, Enclosed
Beschrijving

Unstained Smear Slides

Datatype

boolean

Alias
NCI Thesaurus ValueDomain
C25180
UMLS CUI [1,1]
C0444186
UMLS CUI [1,2]
C1705201
BM Report, Enclosed
Beschrijving

BM Report

Datatype

boolean

Alias
NCI Thesaurus ValueDomain
C25180
UMLS CUI [1]
C0684224
Pathology Submission form - Leukemia Addendum, Enclosed
Beschrijving

Leukemia Addendum

Datatype

boolean

Alias
NCI Thesaurus ValueDomain
C25180
UMLS CUI [1,1]
C0023418
UMLS CUI [1,2]
C1510776
1 Stained biopsy touch prep, Enclosed
Beschrijving

Stained biopsy touch prep

Datatype

boolean

Alias
UMLS CUI [1,1]
C0005558
UMLS CUI [1,2]
C2986582
UMLS CUI [1,3]
C2827487
4 Unstained biopsy touch preps, Enclosed
Beschrijving

Unstained biopsy touch preps

Datatype

boolean

Alias
NCI Thesaurus ValueDomain
C25180
UMLS CUI [1,1]
C0005558
UMLS CUI [1,2]
C2827487
UMLS CUI [1,3]
C1883469
1 H&E section of the biopsy, Enclosed
Beschrijving

H&E biopsy

Datatype

boolean

Alias
NCI Thesaurus ValueDomain
C25180
UMLS CUI [1,1]
C0523207
UMLS CUI [1,2]
C0005558
4 Unstained peripheral blood smears, Enclosed
Beschrijving

Unstained peripheral blood smears

Datatype

boolean

Alias
NCI Thesaurus ValueDomain
C25180
UMLS CUI [1,1]
C2238079
UMLS CUI [1,2]
C1705201
UMLS CUI [1,3]
C1883469
Specimen #
Beschrijving

Specimen ID

Datatype

text

Alias
UMLS CUI [1,1]
C0370003
UMLS CUI [1,2]
C0600091
Notes
Beschrijving

Comments

Datatype

text

Alias
UMLS CUI [1,1]
C0947611
UMLS CUI [1,2]
C0030664
UMLS CUI [1,3]
C0023418
Terug naar het begin van de pagina

Similar models

Instructions: Submit a copy of this form to the SWOG Statistical Center. Mail required materials and this form to the following pathologist: David Head, MD Vanderbilt Clinical Labs 4605 TVC 1161 21st Ave. S. Nashville, TN 37232

1 Formulieren
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Ccrr Module For S0100 Pathology Submission Form
C0030664 (UMLS CUI-1)
C0023418 (UMLS CUI-2)
Study Number
Item
SWOG Study No.
text
C0008976 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
Registration Step
Item
Registration Step
text
C1514821 (UMLS CUI-1)
Patient ID
Item
SWOG Patient ID
text
C2348585 (UMLS CUI [1])
Patient Initials
Item
Patient Initials
text
C2986440 (UMLS CUI [1])
Institution
Item
Institution/Affiliate
text
C1301943 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
Treating Physician
Item
Physician
text
C25364 (NCI Thesaurus Property)
C25741 (NCI Thesaurus ObjectClass)
C25705 (NCI Thesaurus ObjectClass-2)
C1710470 (UMLS CUI [1])
Item
Reason for Submission
text
C0030673 (UMLS CUI [1,1])
C0392360 (UMLS CUI [1,2])
CL.1
Code List
Reason for Submission
CL Item
Prestudy (Prestudy)
Number of Slides
Item
No. of Slides
text
C1705201 (UMLS CUI [1,1])
C0449788 (UMLS CUI [1,2])
Specimen Collection Date
Item
Date Sample Obtained
date
C1302413 (UMLS CUI [1])
Peripheral Smear Slide
Item
1 W Peripheral Smear Slide, Enclosed
boolean
C25180 (NCI Thesaurus ValueDomain)
C2238079 (UMLS CUI [1,1])
C1705201 (UMLS CUI [1,2])
Aspirate Slide
Item
1 WG Stained BM Aspirate Slide, Enclosed
boolean
C25180 (NCI Thesaurus ValueDomain)
C0370199 (UMLS CUI [1,1])
C1705201 (UMLS CUI [1,2])
Unstained Smear Slides
Item
5 Unstained Smear Slides, Enclosed
boolean
C25180 (NCI Thesaurus ValueDomain)
C0444186 (UMLS CUI [1,1])
C1705201 (UMLS CUI [1,2])
BM Report
Item
BM Report, Enclosed
boolean
C25180 (NCI Thesaurus ValueDomain)
C0684224 (UMLS CUI [1])
Leukemia Addendum
Item
Pathology Submission form - Leukemia Addendum, Enclosed
boolean
C25180 (NCI Thesaurus ValueDomain)
C0023418 (UMLS CUI [1,1])
C1510776 (UMLS CUI [1,2])
Stained biopsy touch prep
Item
1 Stained biopsy touch prep, Enclosed
boolean
C0005558 (UMLS CUI [1,1])
C2986582 (UMLS CUI [1,2])
C2827487 (UMLS CUI [1,3])
Unstained biopsy touch preps
Item
4 Unstained biopsy touch preps, Enclosed
boolean
C25180 (NCI Thesaurus ValueDomain)
C0005558 (UMLS CUI [1,1])
C2827487 (UMLS CUI [1,2])
C1883469 (UMLS CUI [1,3])
H&E biopsy
Item
1 H&E section of the biopsy, Enclosed
boolean
C25180 (NCI Thesaurus ValueDomain)
C0523207 (UMLS CUI [1,1])
C0005558 (UMLS CUI [1,2])
Unstained peripheral blood smears
Item
4 Unstained peripheral blood smears, Enclosed
boolean
C25180 (NCI Thesaurus ValueDomain)
C2238079 (UMLS CUI [1,1])
C1705201 (UMLS CUI [1,2])
C1883469 (UMLS CUI [1,3])
Specimen ID
Item
Specimen #
text
C0370003 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
Comments
Item
Notes
text
C0947611 (UMLS CUI [1,1])
C0030664 (UMLS CUI [1,2])
C0023418 (UMLS CUI [1,3])
Terug naar het begin van de pagina 

Contact

Gebruik dit formulier voor feedback, vragen en verbeteringsvoorstellen.

Velden gemarkeerd met een * zijn verplicht.

Help

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial