ID

43174

Description

Baseline Medical History form for C3D 3.12 Adopters Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FF0830C9-70C7-12CC-E034-0003BA3F9857

Lien

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FF0830C9-70C7-12CC-E034-0003BA3F9857

Mots-clés

Versions (2)
  1. 20/09/2012 20/09/2012 -
  2. 20/09/2021 20/09/2021 -
Téléchargé le

20 septembre 2021

DOI

Pour une demande vous connecter.

Licence

Creative Commons BY-NC 3.0 Legacy
Modèle Commentaires :

Ici, vous pouvez faire des commentaires sur le modèle. À partir des bulles de texte, vous pouvez laisser des commentaires spécifiques sur les groupes Item et les Item.

Retour au modèle Commentaires
Groupe Item commentaires pour :

Item commentaires pour :

Vous devez être connecté pour pouvoir télécharger des formulaires. Veuillez vous connecter ou s’inscrire gratuitement.

Pre-Study - BASELINE MEDICAL HISTORY - 2393057v1.0

Anglais

Dates will appear as 'DD-MON-YYYY'

1 Formulaires  
  1. StudyEvent: BASELINE MEDICAL HISTORY
    1. Dates will appear as 'DD-MON-YYYY'
Baseline Medical History
Description

Baseline Medical History

Evaluation Date
Description

EvaluationDate

Type de données

date

Alias
NCI Thesaurus Property
C25164
UMLS 2011AA Property
C0011008
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C25214
UMLS 2011AA ObjectClass
C0220825
Body System Type
Description

BodySystemType

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C13041
UMLS 2011AA ObjectClass
C1268086
NCI Thesaurus Property
C25700
UMLS 2011AA Property
C0449913
Medical History Description
Description

MedicalHistoryDescription

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus Property
C25401
UMLS 2011AA Property
C0205161
NCI Thesaurus Property
C18772
UMLS 2011AA Property
C0262926
NCI Thesaurus ObjectClass
C25261
UMLS 2011AA ObjectClass
C0205476
Comments
Description

Comments

Note Date
Description

NoteDate

Type de données

date

Alias
NCI Thesaurus Property
C25164
UMLS 2011AA Property
C0011008
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Metathesaurus ObjectClass
C1317574
Research Comments Text
Description

ResearchCommentsText

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
UMLS 2011AA Property
C0282411
Retour au début de la page

Similar models

Dates will appear as 'DD-MON-YYYY'

1 Formulaires
  1. StudyEvent: BASELINE MEDICAL HISTORY
    1. Dates will appear as 'DD-MON-YYYY'
Name
Type
Description | Question | Decode (Coded Value)
Type de données
Alias
Item Group
Baseline Medical History
EvaluationDate
Item
Evaluation Date
date
C25164 (NCI Thesaurus Property)
C0011008 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25214 (NCI Thesaurus ObjectClass)
C0220825 (UMLS 2011AA ObjectClass)
Item
Body System Type
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C13041 (NCI Thesaurus ObjectClass)
C1268086 (UMLS 2011AA ObjectClass)
C25700 (NCI Thesaurus Property)
C0449913 (UMLS 2011AA Property)
CL.1
Code List
Body System Type
CL Item
Abdomen (ABDOMEN)
C12664 (NCI Thesaurus)
C0230168 (UMLS 2011AA)
CL Item
Allergy Or Drug Sensitivity History (Allergy/Drug Sensitivity)
CL Item
Appearance (Appearance)
CL Item
Body As A Whole (Body as a Whole)
CL Item
Breasts (BREASTS)
C12971 (NCI Thesaurus)
C0006141 (UMLS 2011AA)
CL Item
Cardiovascular (CARDIOVASCULAR)
C25292 (NCI Thesaurus)
C0007226 (UMLS 2011AA)
CL Item
Central Nervous System (Central Nervous System)
C12438 (NCI Thesaurus)
C3714787 (UMLS 2011AA)
CL Item
Chest (Chest)
C25389 (NCI Thesaurus)
C0817096 (UMLS 2011AA)
CL Item
Constitutional (Constitutional)
C37931 (NCI Thesaurus)
C1511487 (UMLS 2011AA)
CL Item
Dermatologic (DERMATOLOGIC)
C0205489 (NCI Metathesaurus)
CL Item
Endocrine/metabolic (ENDOCRINE/METABOLIC)
CL Item
Extremities (Extremities)
C30140 (NCI Thesaurus)
CL Item
Gastrointestinal (GASTROINTESTINAL)
C13359 (NCI Thesaurus)
C0521362 (UMLS 2011AA)
CL Item
Genitalia (GENITALIA)
C25177 (NCI Thesaurus)
C0017420 (UMLS 2011AA)
CL Item
Genitourinary (Genitourinary)
CL Item
H/e/e/n/t (H/E/E/N/T)
CL Item
Hematologic (HEMATOLOGIC)
C0205488 (NCI Metathesaurus)
CL Item
Hematopoietic/lymph (HEMATOPOIETIC/LYMPH)
C12745 (NCI Thesaurus)
C0024204 (UMLS 2011AA)
CL Item
Hepatic (Hepatic)
C13308 (NCI Thesaurus)
C0205054 (UMLS 2011AA)
CL Item
Immune (IMMUNE)
C17997 (NCI Thesaurus)
C0439662 (UMLS 2011AA)
CL Item
Integumentary/hair (Integumentary/Hair)
CL Item
Musculoskeletal (MUSCULOSKELETAL)
C25348 (NCI Thesaurus)
C0497254 (UMLS 2011AA)
CL Item
Neck (NECK)
C13063 (NCI Thesaurus)
C0027530 (UMLS 2011AA)
CL Item
Neurologic (NEUROLOGIC)
C25262 (NCI Thesaurus)
C0205494 (UMLS 2011AA)
CL Item
Other (OTHER)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
CL Item
Pelvis (PELVIS)
C12767 (NCI Thesaurus)
C0030797 (UMLS 2011AA)
CL Item
Peripheral Vascular System (Peripheral Vascular)
C0225806 (NCI Metathesaurus)
CL Item
Psychologic (PSYCHOLOGIC)
CL Item
Pulmonary (Pulmonary)
C13304 (NCI Thesaurus)
C2709248 (UMLS 2011AA)
CL Item
Rectal (Rectal)
C25224 (NCI Thesaurus)
C0205052 (UMLS 2011AA)
CL Item
Renal (Renal)
C25225 (NCI Thesaurus)
C0022646 (UMLS 2011AA)
CL Item
Reproductive History (Reproductive History)
C17655 (NCI Thesaurus)
C0206076 (UMLS 2011AA)
CL Item
Respiratory (RESPIRATORY)
C25656 (NCI Thesaurus)
C0521346 (UMLS 2011AA)
CL Item
Spleen (Spleen)
C12432 (NCI Thesaurus)
C0037993 (UMLS 2011AA)
CL Item
Substance Abuse/dependency (Substance abuse/Dependency)
CL Item
Transfusion History (Transfusion History)
C30142 (NCI Thesaurus)
C1519604 (UMLS 2011AA)
CL Item
Urinary (URINARY)
C25711 (NCI Thesaurus)
C1524119 (UMLS 2011AA)
MedicalHistoryDescription
Item
Medical History Description
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25401 (NCI Thesaurus Property)
C0205161 (UMLS 2011AA Property)
C18772 (NCI Thesaurus Property)
C0262926 (UMLS 2011AA Property)
C25261 (NCI Thesaurus ObjectClass)
C0205476 (UMLS 2011AA ObjectClass)
Item Group
Comments
NoteDate
Item
Note Date
date
C25164 (NCI Thesaurus Property)
C0011008 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C1317574 (NCI Metathesaurus ObjectClass)
ResearchCommentsText
Item
Research Comments Text
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0282411 (UMLS 2011AA Property)
Retour au début de la page 

Contact

Utilisez ce formulaire pour les retours, les questions et les améliorations suggérées.

Les champs marqués d’un * sont obligatoires.

Aide

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