ID
42851
Beskrivning
CALGB 30506 Registration Worksheet Form Chemotherapy or Observation in Treating Patients With Early Stage Non-Small Cell Lung Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=5E92C67F-D7CA-CFB0-E040-BB89AD432DA1
Länk
Nyckelord
Versioner (4)
- 2012-09-19 2012-09-19 -
- 2015-01-09 2015-01-09 - Martin Dugas
- 2015-01-09 2015-01-09 - Martin Dugas
- 2021-09-17 2021-09-17 -
Uppladdad den
17 september 2021
DOI
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Licens
Creative Commons BY-NC 3.0 Legacy
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Lung Cancer NCT00863512 Registration - CALGB 30506 Registration Worksheet Form - 2817354v1.0
A Randomized Phase III Trial to Evaluate the Potential Utility of a Genomic Prognostic Model to Identify Stage I Non-Small Cell Lung Cancer NSCLC) Patients as Candidates for Adjuvant Chemotherapy
- StudyEvent: CALGB 30506 Registration Worksheet Form
Beskrivning
Protocol Administration
Beskrivning
ProtocolIRBApprovedDate
Datatyp
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ObjectClass
- C25320
- UMLS 2011AA ObjectClass
- C1507394
- NCI Thesaurus ValueDomain-2
- C25367
- NCI Thesaurus Property
- C16741
- UMLS 2011AA Property
- C0086911
- NCI Thesaurus Property-2
- C25425
- UMLS 2011AA Property-2
- C0205540
Beskrivning
InformedConsentFormSignedDate
Datatyp
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ValueDomain-2
- C25367
- NCI Thesaurus ObjectClass
- C16468
- UMLS 2011AA ObjectClass
- C0009797
- NCI Thesaurus Property
- C25679
Beskrivning
Treatment Begin Date
Datatyp
date
Alias
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus ObjectClass-2
- C25631
- NCI Thesaurus Property
- C25431
- UMLS CUI-1
- C3173309
- NCI Thesaurus Property-2
- C25275
- NCI Thesaurus ValueDomain
- C25164
- NCI Thesaurus ValueDomain-2
- C25431
Beskrivning
PatientSignedDischargeMedicalRecordDate
Datatyp
date
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C25679
- NCI Metathesaurus Property
- C0012621
- NCI Thesaurus Property-2
- C45258
- UMLS 2011AA Property
- C0025102
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Beskrivning
InstitutionContactPersonName
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS 2011AA ValueDomain
- C1547383
- NCI Thesaurus ObjectClass
- C21541
- UMLS 2011AA ObjectClass
- C0018704
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
- NCI Thesaurus ObjectClass-2
- C25461
- UMLS 2011AA ObjectClass-2
- C0337611
Beskrivning
ContactPersonTelephoneNumber
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C25395
- UMLS 2011AA Property
- C0039457
- NCI Thesaurus ObjectClass-2
- C25461
- UMLS 2011AA ObjectClass-2
- C0337611
Beskrivning
ContactPersonFaxNumber
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus ObjectClass-2
- C25461
- UMLS 2011AA ObjectClass-2
- C0337611
- NCI Thesaurus Property
- C25210
- UMLS 2011AA Property
- C0085205
Beskrivning
Patient Demographics/pre-treatment Characteristics
Beskrivning
Patient Initials
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS CUI-1
- C2986440
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25536
Beskrivning
Patient Birth Date
Datatyp
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C0421451
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus ValueDomain-2
- C25367
- NCI Thesaurus Property
- C25155
Beskrivning
PatientPersonSocialSecurityNumber
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C25686
- UMLS 2011AA Property
- C1301821
Beskrivning
Medical Record Number
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS CUI-1
- C1301894
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25261
- NCI Thesaurus Property-2
- C25198
Beskrivning
Gender
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25372
- UMLS CUI-1
- C0079399
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C17357
Beskrivning
Patient Demographics/pre-treatment Characteristics2
Beskrivning
ECOG Performance Status
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25664
- UMLS CUI-1
- C1520224
- NCI Thesaurus Property
- C25367
- NCI Thesaurus ValueDomain-2
- C25491
- NCI Thesaurus ObjectClass
- C20641
Beskrivning
PatientPaymentType
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C25371
- UMLS 2011AA Property
- C0680264
Beskrivning
Patient Demographics/pre-treatment Characteristics3
Beskrivning
DiseaseDescriptionText
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ObjectClass
- C2991
- UMLS 2011AA ObjectClass
- C0012634
- NCI Thesaurus Property
- C25365
- UMLS 2011AA Property
- C0678257
Beskrivning
PatientAddressPostalCode
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25162
- UMLS 2011AA ValueDomain
- C0805701
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C25407
- UMLS 2011AA Property
- C1442065
Beskrivning
Country of current residence
Datatyp
text
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS CUI-1
- C3258975
- NCI Thesaurus ValueDomain
- C25464
- NCI Thesaurus Property
- C25407
- NCI Thesaurus ValueDomain-2
- C42614
Beskrivning
Certification Of Eligibility And Protocol Design
Beskrivning
Protocol Design
Beskrivning
StudyStratificationText
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ObjectClass
- C15206
- UMLS 2011AA ObjectClass
- C0008972
- NCI Thesaurus Property
- C25689
- UMLS 2011AA Property
- C1514983
Beskrivning
DiseasesandDisordersPathologyDescriptionText
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ObjectClass
- C2991
- UMLS 2011AA ObjectClass
- C0012634
- NCI Thesaurus Property
- C18189
- UMLS 2011AA Property
- C0030664
- NCI Thesaurus Property-2
- C25365
- UMLS 2011AA Property-2
- C0678257
Beskrivning
Protocol Treatment Arm
Datatyp
text
Alias
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus ObjectClass-2
- C42651
- UMLS CUI-1
- C1522541
- NCI Thesaurus Property
- C32141
- NCI Thesaurus Property-2
- C25426
- NCI Thesaurus ValueDomain
- C25704
Beskrivning
Initial Patient Consent For Specimen Use
Beskrivning
TissueSpecimenMalignantNeoplasmRelatedResearchConsentInd-3
Datatyp
boolean
Alias
- NCI Thesaurus ObjectClass
- C12801
- UMLS 2011AA ObjectClass
- C0040300
- NCI Thesaurus ObjectClass-2
- C19157
- UMLS 2011AA ObjectClass-2
- C0370003
- NCI Thesaurus Property
- C15319
- NCI Thesaurus Property-2
- C25648
- UMLS 2011AA Property
- C0439849
- NCI Thesaurus Property-3
- C9305
- UMLS 2011AA Property-2
- C0006826
- NCI Thesaurus Property-4
- C25460
- UMLS 2011AA Property-3
- C1511481
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
Beskrivning
BloodTissueSpecimenOtherDiseasesandDisordersResearchConsentInd-3
Datatyp
boolean
Alias
- NCI Thesaurus ObjectClass
- C12801
- UMLS 2011AA ObjectClass
- C0040300
- NCI Thesaurus ObjectClass-2
- C12434
- UMLS 2011AA ObjectClass-2
- C0229664
- NCI Thesaurus ObjectClass-3
- C19157
- UMLS 2011AA ObjectClass-3
- C0370003
- NCI Thesaurus Property
- C17649
- UMLS 2011AA Property
- C0205394
- NCI Thesaurus Property-2
- C15319
- NCI Thesaurus Property-3
- C2991
- UMLS 2011AA Property-2
- C0012634
- NCI Thesaurus Property-4
- C25460
- UMLS 2011AA Property-3
- C1511481
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
Beskrivning
Permission to contact Patient
Datatyp
boolean
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS CUI-1
- C1522577
- NCI Thesaurus Property
- C67527
- UMLS CUI-2
- C0521104
- NCI Thesaurus Property-2
- C25460
- NCI Thesaurus Property-3
- C16452
- NCI Thesaurus ValueDomain
- C38148
Beskrivning
PatientQualityofLifeConsentInd-2
Datatyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
- NCI Thesaurus Property
- C17047
- UMLS 2011AA Property
- C0518214
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property-2
- C25460
- UMLS 2011AA Property-2
- C1511481
Beskrivning
Patient Name
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS CUI-1
- C1299487
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25364
Beskrivning
PersonFullAddressText
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C25407
- UMLS 2011AA Property
- C1442065
Beskrivning
ParticipantHomeTelephoneNumberTelecommunicationsNumber
Datatyp
text
Alias
- NCI Thesaurus ObjectClass
- C29867
- UMLS 2011AA ObjectClass
- C0679646
- NCI Thesaurus Property
- C18002
- UMLS 2011AA Property
- C0442519
- NCI Thesaurus Property-2
- C40978
- UMLS 2011AA Property-2
- C1515258
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
- NCI Thesaurus ValueDomain-2
- C17188
- UMLS 2011AA ValueDomain-2
- C0039449
Beskrivning
Registration Information
Beskrivning
Trial subject ID CALGB
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS CUI-1
- C2348585
- NCI Thesaurus ObjectClass
- C16960
- UMLS CUI-2
- C1516238
- NCI Thesaurus Property
- C25364
- NCI Thesaurus Property-2
- C25442
Beskrivning
PatientRegistrationDate
Datatyp
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus ValueDomain-2
- C25367
- NCI Thesaurus Property
- C25646
- UMLS 2011AA Property
- C1514821
Beskrivning
Trial subject ID Participating Group
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS CUI-1
- C2348585
- NCI Thesaurus ObjectClass
- C16960
- UMLS CUI-2
- C2347449
- NCI Thesaurus Property
- C25608
- NCI Thesaurus Property-2
- C25364
Beskrivning
RegisteringPersonIdentifierSignatureName
Datatyp
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus ObjectClass-2
- C25645
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
- NCI Thesaurus ValueDomain
- C25191
- UMLS 2011AA ValueDomain
- C1547383
- NCI Thesaurus ValueDomain-2
- C25678
- UMLS 2011AA ValueDomain-2
- C1519316
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A Randomized Phase III Trial to Evaluate the Potential Utility of a Genomic Prognostic Model to Identify Stage I Non-Small Cell Lung Cancer NSCLC) Patients as Candidates for Adjuvant Chemotherapy
- StudyEvent: CALGB 30506 Registration Worksheet Form
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C0030705 (UMLS 2011AA ObjectClass)
C25679 (NCI Thesaurus Property)
C0012621 (NCI Metathesaurus Property)
C45258 (NCI Thesaurus Property-2)
C0025102 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
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C0237753 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25461 (NCI Thesaurus ObjectClass-2)
C0337611 (UMLS 2011AA ObjectClass-2)
C25210 (NCI Thesaurus Property)
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C0030705 (UMLS 2011AA ObjectClass)
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C0018717 (UMLS 2011AA)
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C0439673 (UMLS 2011AA)
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