0 Bedömningar

ID

43104

Beskrivning

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

Länk

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

Nyckelord

  1. 2014-12-16 2014-12-16 - Martin Dugas
  2. 2021-09-20 2021-09-20 -
Uppladdad den

20 september 2021

DOI

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Licens

Creative Commons BY-NC 3.0 Legacy

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    Lung Cancer null On-Study - E4599 On-Study Form - 2036140v3.0

    No Instruction available.

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

    On-study form

    Date of data transfer
    Beskrivning

    Dateofdatatransfer

    Datatyp

    text

    Transfer Method
    Beskrivning

    TransferMethod

    Datatyp

    text

    Specify other transfer method
    Beskrivning

    Specifyothertransfermethod

    Datatyp

    text

    Patient Name
    Beskrivning

    PatientName

    Datatyp

    text

    Particip. Group Protocol Number
    Beskrivning

    Particip.GroupProtocolNumber

    Datatyp

    double

    Patient Study ID, Participating Group
    Beskrivning

    PatientStudyID,ParticipatingGroup

    Datatyp

    text

    Institution Name
    Beskrivning

    InstitutionName

    Datatyp

    text

    Affiliate Name
    Beskrivning

    AffiliateName

    Datatyp

    text

    Patient Height
    Beskrivning

    Patient Height

    Datatyp

    integer

    Måttenheter
    • cm
    Alias
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25347
    UMLS CUI-1
    C0489786
    cm
    Body Surface Area
    Beskrivning

    Body Surface Area

    Datatyp

    float

    Måttenheter
    • m2
    Alias
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25157
    UMLS CUI-1
    C0005902
    m2
    Patient Weight
    Beskrivning

    Patient Weight

    Datatyp

    float

    Måttenheter
    • kg
    Alias
    UMLS CUI-1
    C1305866
    kg
    Performance Status
    Beskrivning

    PerformanceStatus

    Datatyp

    text

    Urine dipstick result
    Beskrivning

    Urinedipstickresult

    Datatyp

    text

    Date of urine dipstick
    Beskrivning

    Dateofurinedipstick

    Datatyp

    text

    Date of 24 hour urine for protein
    Beskrivning

    Dateof24hoururineforprotein

    Datatyp

    text

    Weight Loss Prior Six Months
    Beskrivning

    Weight Loss past 6 months

    Datatyp

    float

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

    Proteininurine(mg/24hr)

    Datatyp

    text

    Stage Grouping
    Beskrivning

    StageGrouping

    Datatyp

    text

    Histologic Type
    Beskrivning

    HistologicType

    Datatyp

    text

    Histologic Type, Other Name
    Beskrivning

    HistologicType,OtherName

    Datatyp

    text

    Disease Assessment, Measurable Ind
    Beskrivning

    DiseaseAssessment,MeasurableInd

    Datatyp

    text

    Disease Assessment, Non-measurable Ind
    Beskrivning

    DiseaseAssessment,Non-measurableInd

    Datatyp

    text

    Metastatic Site
    Beskrivning

    MetastaticSite

    Datatyp

    text

    Metastatic Site Indicator
    Beskrivning

    MetastaticSiteIndicator

    Datatyp

    text

    Pleural Effusion Ind
    Beskrivning

    PleuralEffusionInd

    Datatyp

    text

    Pleural Effusion, Malignant Ind
    Beskrivning

    PleuralEffusion,MalignantInd

    Datatyp

    text

    Lab Unit Type
    Beskrivning

    LabUnitType

    Datatyp

    text

    Assessment Type, Target
    Beskrivning

    AssessmentType

    Datatyp

    text

    Lab, Chemistry, Albumin
    Beskrivning

    Lab,Chemistry,Albumin

    Datatyp

    double

    Date Albumin Obtained
    Beskrivning

    DateAlbuminObtained

    Datatyp

    text

    LDH LLN
    Beskrivning

    LDHLLN

    Datatyp

    text

    Lab, Chemistry, Lactate Dehydrogenase
    Beskrivning

    Lab,Chemistry,LactateDehydrogenase

    Datatyp

    double

    Date LDH Obtained
    Beskrivning

    DateLDHObtained

    Datatyp

    text

    Prior Surgery Ind
    Beskrivning

    PriorSurgeryInd

    Datatyp

    text

    Prior Chemotherapy Ind
    Beskrivning

    PriorChemotherapyInd

    Datatyp

    text

    Prior RT Ind
    Beskrivning

    PriorRTInd

    Datatyp

    text

    Prior other systemic therapy
    Beskrivning

    Prior Other Systemic Therapy

    Datatyp

    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
    Beskrivning

    PriorRTEndDate

    Datatyp

    date

    Other systemic therapy, specify
    Beskrivning

    Othersystemictherapy,specify

    Datatyp

    text

    Date of last dose
    Beskrivning

    Last Dose Date

    Datatyp

    date

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

    Comments

    Datatyp

    text

    Comments2
    Beskrivning

    Comments2

    Datatyp

    text

    Patient Race/Ethnicity
    Beskrivning

    Patient Race

    Datatyp

    text

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

    PaymentMethod

    Datatyp

    text

    Amended Data Ind
    Beskrivning

    AmendedDataInd

    Datatyp

    text

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

    StepNumber

    Datatyp

    text

    Similar models

    No Instruction available.

    1. StudyEvent: E4599 On-Study Form
      1. No Instruction available.
    Name
    Typ
    Description | Question | Decode (Coded Value)
    Datatyp
    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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