ID

43174

Descrição

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

Link

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

Palavras-chave

Versões (2)
  1. 20/09/2012 20/09/2012 -
  2. 20/09/2021 20/09/2021 -
Transferido a

20 de setembro de 2021

DOI

Para um pedido faça login.

Licença

Creative Commons BY-NC 3.0 Legacy
Comentários do modelo :

Aqui pode comentar o modelo. Pode comentá-lo especificamente através dos balões de texto nos grupos de itens e itens.

Voltar para os comentários do modelo
Comentários do grupo de itens para :

Comentários do item para :

Para descarregar formulários, precisa de ter uma sessão iniciada. Por favor faça login ou registe-se gratuitamente.

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

Inglês

Dates will appear as 'DD-MON-YYYY'

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

Baseline Medical History

Evaluation Date
Descrição

EvaluationDate

Tipo de dados

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
Descrição

BodySystemType

Tipo de dados

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
Descrição

MedicalHistoryDescription

Tipo de dados

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
Descrição

Comments

Note Date
Descrição

NoteDate

Tipo de dados

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
Descrição

ResearchCommentsText

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
UMLS 2011AA Property
C0282411
Voltar ao início da página

Similar models

Dates will appear as 'DD-MON-YYYY'

1 Formulários
  1. StudyEvent: BASELINE MEDICAL HISTORY
    1. Dates will appear as 'DD-MON-YYYY'
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de dados
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)
Voltar ao início da página 

Contacto

Use este formulário para feedback, perguntas e sugestões de aperfeiçoamento.

Campos marcados com * são obrigatórios.

Ajuda

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