ID
43068
Beschreibung
Southwest Oncology Group Registration Form (S0303) NCT00070122 Combination Chemotherapy and Bevacizumab in Treating Patients With Locally Advanced, Metastatic, or Recurrent Colorectal Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=BC61CF50-FD6D-101D-E034-0003BA12F5E7
Link
Stichworte
Versionen (5)
- 27.08.12 27.08.12 -
- 09.01.15 09.01.15 - Martin Dugas
- 09.01.15 09.01.15 - Martin Dugas
- 27.06.15 27.06.15 -
- 20.09.21 20.09.21 -
Hochgeladen am
20. September 2021
DOI
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Lizenz
Creative Commons BY-NC 3.0 Legacy
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Southwest Oncology Group Registration Form (S0303) NCT00070122
No Instruction available.
- StudyEvent: Southwest Oncology Group Registration Form (S0303)
Beschreibung
Patient demographics
Beschreibung
Patient Birth Date
Datentyp
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C0421451
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus ValueDomain-2
- C25367
- NCI Thesaurus Property
- C25155
Beschreibung
Gender
Datentyp
text
Alias
- NCI Thesaurus ValueDomain
- C25372
- UMLS CUI-1
- C0079399
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C17357
Beschreibung
PatientPaymentType
Datentyp
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
Beschreibung
PatientEthnicityCategory
Datentyp
text
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C29933
Beschreibung
Racial Group
Datentyp
text
Alias
- NCI Thesaurus ValueDomain
- C25372
- UMLS CUI-1
- C0034510
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C17049
Beschreibung
PatientSocialSecurityNumber
Datentyp
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
Beschreibung
PatientAddressPostalCode
Datentyp
text
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C25407
- UMLS 2011AA Property
- C1442065
Beschreibung
Country of current residence
Datentyp
text
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS CUI-1
- C3258975
- NCI Thesaurus ValueDomain
- C25464
- NCI Thesaurus Property
- C25407
- NCI Thesaurus ValueDomain-2
- C42614
Beschreibung
PatientSocialInsuranceIdentifierNumber
Datentyp
text
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus ObjectClass-2
- C62650
- UMLS 2011AA ObjectClass-2
- C0728831
- NCI Thesaurus ObjectClass-3
- C16745
- UMLS 2011AA ObjectClass-3
- C0021672
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
Beschreibung
AddressPostalCode
Datentyp
text
Alias
- NCI Thesaurus ValueDomain
- C25162
- UMLS 2011AA ValueDomain
- C0805701
- NCI Thesaurus ObjectClass
- C25407
- UMLS 2011AA ObjectClass
- C1442065
- NCI Thesaurus Property
- C25621
- UMLS 2011AA Property
- C1514254
Beschreibung
PerformanceStatus
Datentyp
text
Beschreibung
AdjuvantChemotherapyPriorAdministeredInd-3
Datentyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
- NCI Thesaurus ObjectClass
- C15632
- UMLS 2011AA ObjectClass
- C0392920
- NCI Thesaurus Property
- C25382
- UMLS 2011AA Property
- C1521801
Beschreibung
PatientEnglishComprehensionInd-3
Datentyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C43853
- UMLS 2011AA Property
- C1556083
- NCI Metathesaurus Property
- C0162340
Beschreibung
RegistrarSouthwestOncologyGroupIdentifierNumber
Datentyp
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
- NCI Thesaurus Property-2
- C25699
- UMLS 2011AA Property-2
- C1519429
- NCI Thesaurus ObjectClass
- C25357
- UMLS 2011AA ObjectClass
- C0557514
Beschreibung
SouthwestOncologyGroupTreatingInstitutionIdentifierNumber
Datentyp
float
Alias
- NCI Thesaurus ObjectClass
- C25699
- UMLS 2011AA ObjectClass
- C1519429
- NCI Thesaurus ObjectClass-2
- C25705
- UMLS 2011AA ObjectClass-2
- C1522326
- NCI Thesaurus ObjectClass-3
- C41206
- UMLS 2011AA ObjectClass-3
- C1272753
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
Beschreibung
IRB Approval Date
Datentyp
date
Alias
- NCI Thesaurus ObjectClass
- C25320
- UMLS CUI-1
- C2346500
- NCI Thesaurus Property
- C16741
- NCI Thesaurus Property-2
- C25425
- NCI Thesaurus ValueDomain
- C25164
- NCI Thesaurus ValueDomain-2
- C25367
Beschreibung
InformedConsentFormSignedDate
Datentyp
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
Beschreibung
Treatment Begin Date
Datentyp
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
Beschreibung
SouthwestOncologyGroupInvestigatorIdentifierNumber
Datentyp
float
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
- NCI Thesaurus ObjectClass
- C25699
- UMLS 2011AA ObjectClass
- C1519429
- NCI Thesaurus ObjectClass-2
- C17089
- UMLS 2011AA ObjectClass-2
- C0035173
Beschreibung
DateHIPAAAuthorizationsigned
Datentyp
text
Beschreibung
SpecimenResearchConsentRelatedInd-3
Datentyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
- NCI Thesaurus Property
- C15319
- NCI Thesaurus ObjectClass
- C19157
- UMLS 2011AA ObjectClass
- C0370003
- NCI Thesaurus Property-2
- C25460
- UMLS 2011AA Property
- C1511481
Beschreibung
BloodTissueSpecimenOtherDiseasesandDisordersResearchConsentInd-3
Datentyp
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
Beschreibung
Permission to contact Patient
Datentyp
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
Beschreibung
Ccrr Module For Southwest Oncology Group Registration Form (s0303)
Ähnliche Modelle
No Instruction available.
- StudyEvent: Southwest Oncology Group Registration Form (S0303)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1519429 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25699 (NCI Thesaurus Property-2)
C1514821 (UMLS CUI-1)
C25646 (NCI Thesaurus ObjectClass)
C0237753 (UMLS CUI-2)
C16154 (NCI Thesaurus Property)
C16154 (NCI Thesaurus ValueDomain-2)
C1522541 (UMLS CUI-1)
C32141 (NCI Thesaurus Property)
C15368 (NCI Thesaurus ObjectClass)
C1507394 (UMLS 2011AA ObjectClass)
C64382 (NCI Thesaurus Property)
C1879547 (UMLS 2011AA Property)
C41200 (NCI Thesaurus Property-2)
C0680532 (UMLS 2011AA Property-2)
C0011008 (UMLS 2011AA ValueDomain)
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
C25551 (NCI Thesaurus ValueDomain-2)
C1517741 (UMLS 2011AA ValueDomain-2)
C1299487 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25364 (NCI Thesaurus Property)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1519429 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25699 (NCI Thesaurus Property-2)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
C0421451 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25367 (NCI Thesaurus ValueDomain-2)
C25155 (NCI Thesaurus Property)
C0079399 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C17357 (NCI Thesaurus Property)
C0086287 (UMLS 2011AA)
C1706180 (UMLS 2011AA)
C0332307 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25371 (NCI Thesaurus Property)
C0680264 (UMLS 2011AA Property)
C0018717 (UMLS 2011AA)
C0205394 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C0030705 (UMLS 2011AA ObjectClass)
C29933 (NCI Thesaurus Property)
C1518424 (UMLS 2011AA)
C0034510 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C17049 (NCI Thesaurus Property)
C0007457 (UMLS 2011AA)
C0085756 (UMLS 2011AA)
C0078988 (UMLS 2011AA)
C0237753 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C0030705 (UMLS 2011AA ObjectClass)
C25407 (NCI Thesaurus Property)
C1442065 (UMLS 2011AA Property)
C3258975 (UMLS CUI-1)
C25464 (NCI Thesaurus ValueDomain)
C25407 (NCI Thesaurus Property)
C42614 (NCI Thesaurus ValueDomain-2)
C0030705 (UMLS 2011AA ObjectClass)
C62650 (NCI Thesaurus ObjectClass-2)
C0728831 (UMLS 2011AA ObjectClass-2)
C16745 (NCI Thesaurus ObjectClass-3)
C0021672 (UMLS 2011AA ObjectClass-3)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
C25407 (NCI Thesaurus ObjectClass)
C1442065 (UMLS 2011AA ObjectClass)
C25621 (NCI Thesaurus Property)
C1514254 (UMLS 2011AA Property)
C0205448 (UMLS 2011AA)
C1512699 (UMLS 2011AA ValueDomain)
C15632 (NCI Thesaurus ObjectClass)
C0392920 (UMLS 2011AA ObjectClass)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C1512699 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C43853 (NCI Thesaurus Property)
C1556083 (UMLS 2011AA Property)
C0162340 (NCI Metathesaurus Property)
C0237753 (UMLS 2011AA ValueDomain)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25699 (NCI Thesaurus Property-2)
C1519429 (UMLS 2011AA Property-2)
C25357 (NCI Thesaurus ObjectClass)
C0557514 (UMLS 2011AA ObjectClass)
C1519429 (UMLS 2011AA ObjectClass)
C25705 (NCI Thesaurus ObjectClass-2)
C1522326 (UMLS 2011AA ObjectClass-2)
C41206 (NCI Thesaurus ObjectClass-3)
C1272753 (UMLS 2011AA ObjectClass-3)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C2346500 (UMLS CUI-1)
C16741 (NCI Thesaurus Property)
C25425 (NCI Thesaurus Property-2)
C25164 (NCI Thesaurus ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
C16468 (NCI Thesaurus ObjectClass)
C0009797 (UMLS 2011AA ObjectClass)
C25679 (NCI Thesaurus Property)
C25631 (NCI Thesaurus ObjectClass-2)
C25431 (NCI Thesaurus Property)
C3173309 (UMLS CUI-1)
C25275 (NCI Thesaurus Property-2)
C25164 (NCI Thesaurus ValueDomain)
C25431 (NCI Thesaurus ValueDomain-2)
C0237753 (UMLS 2011AA ValueDomain)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25699 (NCI Thesaurus ObjectClass)
C1519429 (UMLS 2011AA ObjectClass)
C17089 (NCI Thesaurus ObjectClass-2)
C0035173 (UMLS 2011AA ObjectClass-2)
C1512699 (UMLS 2011AA ValueDomain)
C15319 (NCI Thesaurus Property)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C25460 (NCI Thesaurus Property-2)
C1511481 (UMLS 2011AA Property)
C0040300 (UMLS 2011AA ObjectClass)
C12434 (NCI Thesaurus ObjectClass-2)
C0229664 (UMLS 2011AA ObjectClass-2)
C19157 (NCI Thesaurus ObjectClass-3)
C0370003 (UMLS 2011AA ObjectClass-3)
C17649 (NCI Thesaurus Property)
C0205394 (UMLS 2011AA Property)
C15319 (NCI Thesaurus Property-2)
C2991 (NCI Thesaurus Property-3)
C0012634 (UMLS 2011AA Property-2)
C25460 (NCI Thesaurus Property-4)
C1511481 (UMLS 2011AA Property-3)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C1522577 (UMLS CUI-1)
C67527 (NCI Thesaurus Property)
C0521104 (UMLS CUI-2)
C25460 (NCI Thesaurus Property-2)
C16452 (NCI Thesaurus Property-3)
C38148 (NCI Thesaurus ValueDomain)