ID

43104

Description

E4599 On-Study Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A1346A5B-91C6-6A0E-E034-080020C9C0E0

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A1346A5B-91C6-6A0E-E034-080020C9C0E0

Keywords

Versions (2)
  1. 12/16/14 12/16/14 - Martin Dugas
  2. 9/20/21 9/20/21 -
Uploaded on

September 20, 2021

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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Lung Cancer null On-Study - E4599 On-Study Form - 2036140v3.0

English

No Instruction available.

1 forms  
  1. StudyEvent: E4599 On-Study Form
    1. No Instruction available.
On-study form
Description

On-study form

Date of data transfer
Description

Dateofdatatransfer

Data type

text

Transfer Method
Description

TransferMethod

Data type

text

Specify other transfer method
Description

Specifyothertransfermethod

Data type

text

Patient Name
Description

PatientName

Data type

text

Particip. Group Protocol Number
Description

Particip.GroupProtocolNumber

Data type

double

Patient Study ID, Participating Group
Description

PatientStudyID,ParticipatingGroup

Data type

text

Institution Name
Description

InstitutionName

Data type

text

Affiliate Name
Description

AffiliateName

Data type

text

Patient Height
Description

Patient Height

Data type

integer

Measurement units
  • cm
Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25347
UMLS CUI-1
C0489786
cm
Body Surface Area
Description

Body Surface Area

Data type

float

Measurement units
  • m2
Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25157
UMLS CUI-1
C0005902
m2
Patient Weight
Description

Patient Weight

Data type

float

Measurement units
  • kg
Alias
UMLS CUI-1
C1305866
kg
Performance Status
Description

PerformanceStatus

Data type

text

Urine dipstick result
Description

Urinedipstickresult

Data type

text

Date of urine dipstick
Description

Dateofurinedipstick

Data type

text

Date of 24 hour urine for protein
Description

Dateof24hoururineforprotein

Data type

text

Weight Loss Prior Six Months
Description

Weight Loss past 6 months

Data type

float

Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C3445
UMLS CUI-1
C1262477
UMLS CUI-2
C3828652
Protein in urine (mg/24hr)
Description

Proteininurine(mg/24hr)

Data type

text

Stage Grouping
Description

StageGrouping

Data type

text

Histologic Type
Description

HistologicType

Data type

text

Histologic Type, Other Name
Description

HistologicType,OtherName

Data type

text

Disease Assessment, Measurable Ind
Description

DiseaseAssessment,MeasurableInd

Data type

text

Disease Assessment, Non-measurable Ind
Description

DiseaseAssessment,Non-measurableInd

Data type

text

Metastatic Site
Description

MetastaticSite

Data type

text

Metastatic Site Indicator
Description

MetastaticSiteIndicator

Data type

text

Pleural Effusion Ind
Description

PleuralEffusionInd

Data type

text

Pleural Effusion, Malignant Ind
Description

PleuralEffusion,MalignantInd

Data type

text

Lab Unit Type
Description

LabUnitType

Data type

text

Assessment Type, Target
Description

AssessmentType

Data type

text

Lab, Chemistry, Albumin
Description

Lab,Chemistry,Albumin

Data type

double

Date Albumin Obtained
Description

DateAlbuminObtained

Data type

text

LDH LLN
Description

LDHLLN

Data type

text

Lab, Chemistry, Lactate Dehydrogenase
Description

Lab,Chemistry,LactateDehydrogenase

Data type

double

Date LDH Obtained
Description

DateLDHObtained

Data type

text

Prior Surgery Ind
Description

PriorSurgeryInd

Data type

text

Prior Chemotherapy Ind
Description

PriorChemotherapyInd

Data type

text

Prior RT Ind
Description

PriorRTInd

Data type

text

Prior other systemic therapy
Description

Prior Other Systemic Therapy

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C17649
NCI Thesaurus ObjectClass
C15698
NCI Thesaurus ObjectClass
C25629
NCI Thesaurus Property
C25382
NCI Thesaurus ValueDomain
C38147
Prior RT End Date
Description

PriorRTEndDate

Data type

date

Other systemic therapy, specify
Description

Othersystemictherapy,specify

Data type

text

Date of last dose
Description

Last Dose Date

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ObjectClass
C25488
NCI Thesaurus ObjectClass
C25551
NCI Thesaurus Property
C25275
Comments
Description

Comments

Data type

text

Comments2
Description

Comments2

Data type

text

Patient Race/Ethnicity
Description

Patient Race

Data type

text

Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C17049
UMLS CUI-1
C0034510
Payment Method
Description

PaymentMethod

Data type

text

Amended Data Ind
Description

AmendedDataInd

Data type

text

Alias
NCI Thesaurus ObjectClass
C25474
UMLS 2011AA ObjectClass
C1511726
NCI Thesaurus Property
C25416
UMLS 2011AA Property
C1691222
Step Number
Description

StepNumber

Data type

text

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Similar models

No Instruction available.

1 forms
  1. StudyEvent: E4599 On-Study Form
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
On-study form
Dateofdatatransfer
Item
Date of data transfer
text
TransferMethod
Item
Transfer Method
text
Specifyothertransfermethod
Item
Specify other transfer method
text
PatientName
Item
Patient Name
text
Particip.GroupProtocolNumber
Item
Particip. Group Protocol Number
double
PatientStudyID,ParticipatingGroup
Item
Patient Study ID, Participating Group
text
InstitutionName
Item
Institution Name
text
AffiliateName
Item
Affiliate Name
text
Patient Height
Item
Patient Height
integer
C16960 (NCI Thesaurus ObjectClass)
C25347 (NCI Thesaurus Property)
C0489786 (UMLS CUI-1)
Body Surface Area
Item
Body Surface Area
float
C16960 (NCI Thesaurus ObjectClass)
C25157 (NCI Thesaurus Property)
C0005902 (UMLS CUI-1)
Patient Weight
Item
Patient Weight
float
C1305866 (UMLS CUI-1)
PerformanceStatus
Item
Performance Status
text
Urinedipstickresult
Item
Urine dipstick result
text
Dateofurinedipstick
Item
Date of urine dipstick
text
Dateof24hoururineforprotein
Item
Date of 24 hour urine for protein
text
Weight Loss past 6 months
Item
Weight Loss Prior Six Months
float
C16960 (NCI Thesaurus ObjectClass)
C3445 (NCI Thesaurus Property)
C1262477 (UMLS CUI-1)
C3828652 (UMLS CUI-2)
Proteininurine(mg/24hr)
Item
Protein in urine (mg/24hr)
text
StageGrouping
Item
Stage Grouping
text
HistologicType
Item
Histologic Type
text
HistologicType,OtherName
Item
Histologic Type, Other Name
text
DiseaseAssessment,MeasurableInd
Item
Disease Assessment, Measurable Ind
text
DiseaseAssessment,Non-measurableInd
Item
Disease Assessment, Non-measurable Ind
text
MetastaticSite
Item
Metastatic Site
text
MetastaticSiteIndicator
Item
Metastatic Site Indicator
text
PleuralEffusionInd
Item
Pleural Effusion Ind
text
PleuralEffusion,MalignantInd
Item
Pleural Effusion, Malignant Ind
text
LabUnitType
Item
Lab Unit Type
text
AssessmentType
Item
Assessment Type, Target
text
Lab,Chemistry,Albumin
Item
Lab, Chemistry, Albumin
double
DateAlbuminObtained
Item
Date Albumin Obtained
text
LDHLLN
Item
LDH LLN
text
Lab,Chemistry,LactateDehydrogenase
Item
Lab, Chemistry, Lactate Dehydrogenase
double
DateLDHObtained
Item
Date LDH Obtained
text
PriorSurgeryInd
Item
Prior Surgery Ind
text
PriorChemotherapyInd
Item
Prior Chemotherapy Ind
text
PriorRTInd
Item
Prior RT Ind
text
Prior Other Systemic Therapy
Item
Prior other systemic therapy
boolean
C17649 (NCI Thesaurus ObjectClass)
C15698 (NCI Thesaurus ObjectClass)
C25629 (NCI Thesaurus ObjectClass)
C25382 (NCI Thesaurus Property)
C38147 (NCI Thesaurus ValueDomain)
PriorRTEndDate
Item
Prior RT End Date
date
Othersystemictherapy,specify
Item
Other systemic therapy, specify
text
Last Dose Date
Item
Date of last dose
date
C25164 (NCI Thesaurus ValueDomain)
C25488 (NCI Thesaurus ObjectClass)
C25551 (NCI Thesaurus ObjectClass)
C25275 (NCI Thesaurus Property)
Comments
Item
Comments
text
Comments2
Item
Comments2
text
Patient Race
Item
Patient Race/Ethnicity
text
C16960 (NCI Thesaurus ObjectClass)
C17049 (NCI Thesaurus Property)
C0034510 (UMLS CUI-1)
PaymentMethod
Item
Payment Method
text
AmendedDataInd
Item
Amended Data Ind
text
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
StepNumber
Item
Step Number
text
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