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ID

43201

Descripción

CALGB 30506 Pre-Study/Surgical Resection Form Chemotherapy or Observation in Treating Patients With Early Stage Non-Small Cell Lung Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=5FE8C8A3-6705-BC07-E040-BB89AD4332A8

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=5FE8C8A3-6705-BC07-E040-BB89AD4332A8

Palabras clave

Versiones (4)
  1. 19-09-12 19-09-12 -
  2. 11-08-14 11-08-14 - Martin Dugas
  3. 09-01-15 09-01-15 - Martin Dugas
  4. 20-09-21 20-09-21 -
Subido en

20 september 2021

DOI

Para solicitar uno, por favor iniciar sesión.

Licencia

Creative Commons BY-NC 3.0 Legacy
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    Lung Cancer NCT00863512 Pre-Study - CALGB 30506 Pre-Study/Surgical Resection Form - 2821782v1.0

    Inglés

    INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice. Print text in capital letters. Avoid contact with the edges of the boxes

    1 formularios  
    Ccrr Module For Calgb 90202: Prostate Specific Antigen Form
    Descripción

    Ccrr Module For Calgb 90202: Prostate Specific Antigen Form

    CALGB Form
    Descripción

    Form ID CALGB

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C3262252
    NCI Thesaurus ObjectClass
    C19464
    UMLS CUI-2
    C1516238
    NCI Thesaurus Property
    C25364
    NCI Thesaurus ObjectClass-2
    C25442
    CALGB Study No.
    Descripción

    Protocol ID CALGB

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C3274381
    NCI Thesaurus ObjectClass
    C25320
    UMLS CUI-2
    C1516238
    NCI Thesaurus Property
    C25364
    NCI Thesaurus Property-2
    C25442
    CALGB Patient ID
    Descripción

    Trial subject ID CALGB

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2348585
    NCI Thesaurus ObjectClass
    C16960
    UMLS CUI-2
    C1516238
    NCI Thesaurus Property
    C25364
    NCI Thesaurus Property-2
    C25442
    Are data amended
    Descripción

    Data amended

    Tipo de datos

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS CUI-1
    C0680532
    NCI Thesaurus ObjectClass
    C25474
    NCI Thesaurus Property
    C25416
    Patient Initials (Last, First Middle)
    Descripción

    Patient Initials

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2986440
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25536
    Patient Hospital No.
    Descripción

    Medical Record Number

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C1301894
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25261
    NCI Thesaurus Property-2
    C25198
    Institution/Affiliate
    Descripción

    Institution Name

    Tipo de datos

    text

    Alias
    NCI Thesaurus ObjectClass
    C25454
    UMLS CUI-1
    C1301943
    NCI Thesaurus ObjectClass-2
    C21541
    NCI Thesaurus Property
    C25364
    NCI Thesaurus ValueDomain
    C25191
    NCI Thesaurus ValueDomain-2
    C21541
    Participating Group
    Descripción

    Participating Group

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2347449
    NCI Thesaurus ObjectClass
    C25608
    NCI Thesaurus ObjectClass-2
    C17005
    NCI Thesaurus Property
    C25364
    Participating Group Study No.
    Descripción

    Study Number Participating Group

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C3274381
    NCI Thesaurus ObjectClass
    C25320
    UMLS CUI-2
    C2347449
    NCI Thesaurus Property
    C25608
    NCI Thesaurus Property-2
    C25364
    Participating Group Patient ID
    Descripción

    Trial subject ID Participating Group

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2348585
    NCI Thesaurus ObjectClass
    C16960
    UMLS CUI-2
    C2347449
    NCI Thesaurus Property
    C25608
    NCI Thesaurus Property-2
    C25364
    Vital Status
    Descripción

    Vital Status

    ECOG Performance Status
    Descripción

    ECOG Performance Status

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25664
    UMLS CUI-1
    C1520224
    NCI Thesaurus Property
    C25367
    NCI Thesaurus ValueDomain-2
    C25491
    NCI Thesaurus ObjectClass
    C20641
    Prior Treatment (for this cancer within the past 5 years)
    Descripción

    CancerPriorTreatmentInd-3

    Tipo de datos

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS 2011AA ValueDomain
    C1512699
    NCI Thesaurus ObjectClass
    C9305
    UMLS 2011AA ObjectClass
    C0006826
    NCI Thesaurus Property
    C25629
    UMLS 2011AA Property
    C0332152
    NCI Thesaurus Property-2
    C15368
    Required Laboratory Values
    Descripción

    Required Laboratory Values

    WBC (x 10^3 microL)
    Descripción

    Leukocytes (WBC)

    Tipo de datos

    float

    Alias
    NCI Thesaurus ObjectClass
    C25294
    UMLS CUI-1
    C0023508
    NCI Thesaurus Property
    C12529
    NCI Thesaurus Property-2
    C20200
    NCI Thesaurus ValueDomain
    C38046
    NCI Thesaurus ValueDomain-2
    C25712
    ANC (x 10^3 microL)
    Descripción

    ANC

    Tipo de datos

    float

    Alias
    NCI Thesaurus ObjectClass
    C25294
    UMLS CUI-1
    C0948762
    NCI Thesaurus Property
    C20200
    NCI Thesaurus Property-2
    C63321
    NCI Thesaurus ValueDomain
    C38046
    NCI Thesaurus ValueDomain-2
    C25712
    Granulocytes (%)
    Descripción

    LaboratoryProcedureGranulocyteResultPercentageValue

    Tipo de datos

    float

    Unidades de medida
    • %
    Alias
    NCI Thesaurus Property
    C20200
    UMLS 2011AA Property
    C1274040
    NCI Thesaurus Property-2
    C12530
    UMLS 2011AA Property-2
    C0018183
    NCI Thesaurus ValueDomain
    C25613
    UMLS 2011AA ValueDomain
    C0439165
    NCI Thesaurus ObjectClass
    C25294
    UMLS 2011AA ObjectClass
    C0022885
    NCI Thesaurus ValueDomain-2
    C25712
    UMLS 2011AA ValueDomain-2
    C1522609
    %
    Platelets (PLT) (x 10^3 microL)
    Descripción

    Platelets

    Tipo de datos

    float

    Unidades de medida
    • 1000/uL
    Alias
    NCI Thesaurus Property
    C20200
    UMLS CUI-1
    C0005821
    NCI Thesaurus Property-2
    C12520
    NCI Thesaurus ObjectClass
    C25294
    NCI Thesaurus ValueDomain
    C25712
    1000/uL
    Bilirubin (mg/dl)
    Descripción

    LaboratoryProcedureTotalBilirubinResultValue

    Tipo de datos

    float

    Unidades de medida
    • mg/dL
    Alias
    NCI Thesaurus Property
    C20200
    UMLS 2011AA Property
    C1274040
    NCI Thesaurus ObjectClass
    C25294
    UMLS 2011AA ObjectClass
    C0022885
    NCI Thesaurus Property-2
    C38037
    UMLS 2011AA Property-2
    C0201913
    NCI Thesaurus ValueDomain
    C25712
    UMLS 2011AA ValueDomain
    C1522609
    mg/dL
    SGOT (AST) (UL)
    Descripción

    SGOT (AST)

    Tipo de datos

    float

    Alias
    NCI Thesaurus ObjectClass
    C25294
    UMLS CUI-1
    C0201899
    NCI Thesaurus Property
    C25202
    NCI Thesaurus Property-2
    C20200
    NCI Thesaurus ValueDomain
    C38046
    NCI Thesaurus ValueDomain-2
    C25712
    SGOT (AST) ULN (UL)
    Descripción

    LaboratoryProcedureSerumGlutamicOxaloaceticTransferaseResultUnspecifiedUpperLimitofNormalValue

    Tipo de datos

    float

    Alias
    NCI Thesaurus ObjectClass
    C25294
    UMLS 2011AA ObjectClass
    C0022885
    NCI Thesaurus Property
    C25202
    UMLS 2011AA Property
    C0242192
    NCI Thesaurus Property-2
    C20200
    UMLS 2011AA Property-2
    C1274040
    NCI Thesaurus ValueDomain
    C25712
    UMLS 2011AA ValueDomain
    C1522609
    NCI Thesaurus ValueDomain-2
    C25706
    UMLS 2011AA ValueDomain-2
    C1519815
    Serum creatinine (mg/dl)
    Descripción

    Creatinine, Serum

    Tipo de datos

    float

    Unidades de medida
    • mg/dL
    Alias
    NCI Thesaurus Property
    C20200
    UMLS CUI-1
    C0201976
    NCI Thesaurus Property-2
    C399
    NCI Thesaurus ObjectClass
    C25294
    NCI Thesaurus ValueDomain
    C25712
    mg/dL
    Serum Creatinine ULN
    Descripción

    Creatinine, serum ULN

    Tipo de datos

    float

    Unidades de medida
    • mg/dL
    Alias
    NCI Thesaurus ObjectClass
    C25294
    UMLS CUI-1
    C0201976
    NCI Thesaurus Property
    C20200
    UMLS CUI-2
    C1519815
    NCI Thesaurus Property-2
    C399
    NCI Thesaurus ValueDomain
    C25712
    NCI Thesaurus ValueDomain-2
    C25706
    mg/dL
    Unnamed3
    Descripción

    Unnamed3

    Smoking History
    Descripción

    Smoking history

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180
    UMLS CUI-1
    C1519384
    NCI Thesaurus ObjectClass
    C17934
    NCI Thesaurus Property
    C18772
    Number pack years smoked (If former or current smoker, Pack year = number of packs smoked / day x number of years smoked)
    Descripción

    CigaretteSmokingHistoryPackYearAmount

    Tipo de datos

    text

    Alias
    NCI Thesaurus ObjectClass
    C17934
    UMLS 2011AA ObjectClass
    C0453996
    NCI Thesaurus Property
    C18772
    UMLS 2011AA Property
    C0262926
    NCI Thesaurus ValueDomain
    C25417
    Pre-surgical Disease Status
    Descripción

    Pre-surgical Disease Status

    Date of Chest X-Ray or CT scan (MM DD YYYY)
    Descripción

    PatientChestRadiographyComputedTomographyAssessmentDate

    Tipo de datos

    date

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus Property-2
    C38103
    UMLS 2011AA Property-2
    C0039985
    NCI Thesaurus Property-3
    C17204
    UMLS 2011AA Property-3
    C0040405
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    Clinical Size of Tumor (on chest/upper abdominal CT scan cm)
    Descripción

    PrimaryTumorSizeMeasurement

    Tipo de datos

    float

    Alias
    NCI Thesaurus ValueDomain
    C25209
    UMLS 2011AA ValueDomain
    C0242485
    NCI Thesaurus ObjectClass
    C3262
    UMLS 2011AA ObjectClass
    C0027651
    NCI Thesaurus ObjectClass-2
    C25251
    UMLS 2011AA ObjectClass-2
    C0205225
    NCI Thesaurus Property
    C25681
    UMLS 2011AA Property
    C0456389
    Clinical T Stage
    Descripción

    T Stage clinical

    Tipo de datos

    text

    Alias
    NCI Thesaurus ObjectClass
    C3262
    UMLS CUI-1
    C0475455
    NCI Thesaurus ObjectClass-2
    C12468
    UMLS CUI-2
    C0205210
    NCI Thesaurus Property
    C25398
    NCI Thesaurus Property-2
    C25728
    NCI Thesaurus ValueDomain
    C16899
    Clinical N Stage
    Descripción

    N Stage clinical

    Tipo de datos

    text

    Alias
    NCI Thesaurus ObjectClass
    C3262
    UMLS CUI-1
    C0456532
    NCI Thesaurus ObjectClass-2
    C12468
    UMLS CUI-2
    C0205210
    NCI Thesaurus Property
    C25398
    NCI Thesaurus Property-2
    C25580
    NCI Thesaurus ValueDomain
    C16899
    MedDRA disease code
    Descripción

    MedDRACode

    Tipo de datos

    float

    Alias
    NCI Thesaurus ValueDomain
    C25162
    UMLS 2011AA ValueDomain
    C0805701
    NCI Thesaurus Property
    C25364
    UMLS 2011AA Property
    C0600091
    NCI Metathesaurus ObjectClass
    CL104089
    How were positive nodes ruled out (If nodes were suspicious for malignancy > 1 cm on pre-op CT or positive on PET scan)
    Descripción

    LymphNodeNegativeAssessmentType

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus ObjectClass
    C12745
    UMLS 2011AA ObjectClass
    C0024204
    NCI Thesaurus Property-2
    C38757
    UMLS 2011AA Property-2
    C1513916
    Surgical Disease Status
    Descripción

    Surgical Disease Status

    Did patient undergo surgical resection?
    Descripción

    SurgicalProcedureExcisionPerformedInd-2

    Tipo de datos

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    NCI Thesaurus Property
    C38000
    UMLS 2011AA Property
    C0884358
    NCI Thesaurus ObjectClass
    C15329
    UMLS 2011AA ObjectClass
    C0543467
    NCI Thesaurus Property-2
    C15232
    UMLS 2011AA Property-2
    C0728940
    Date of Resection (MM DD YYYY)
    Descripción

    PatientSurgicalResectionDate

    Tipo de datos

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25698
    NCI Thesaurus Property-2
    C15232
    UMLS 2011AA Property
    C0728940
    Specify reason (If no Mark all that apply with an X.)
    Descripción

    LungIncompleteSurgicalProcedureReasonType

    Tipo de datos

    text

    Alias
    NCI Thesaurus ObjectClass
    C49160
    UMLS 2011AA ObjectClass
    C0205257
    NCI Thesaurus ObjectClass-2
    C12468
    UMLS 2011AA ObjectClass-2
    C0024109
    NCI Thesaurus ObjectClass-3
    C15329
    UMLS 2011AA ObjectClass-3
    C0543467
    NCI Thesaurus Property
    C25638
    UMLS 2011AA Property
    C0392360
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    Other, specify
    Descripción

    LungIncompleteSurgicalProcedureReasonSpecify

    Tipo de datos

    text

    Alias
    NCI Thesaurus ObjectClass
    C49160
    UMLS 2011AA ObjectClass
    C0205257
    NCI Thesaurus ObjectClass-2
    C12468
    UMLS 2011AA ObjectClass-2
    C0024109
    NCI Thesaurus ObjectClass-3
    C15329
    UMLS 2011AA ObjectClass-3
    C0543467
    NCI Thesaurus Property
    C25638
    UMLS 2011AA Property
    C0392360
    NCI Thesaurus ValueDomain
    C25685
    UMLS 2011AA ValueDomain
    C1521902
    Histology (Mark one with an X.)
    Descripción

    Histologic Type

    Tipo de datos

    text

    Alias
    NCI Thesaurus ObjectClass
    C3262
    UMLS CUI-1
    C0449574
    NCI Thesaurus ObjectClass-2
    C12468
    NCI Thesaurus Property
    C25526
    NCI Thesaurus Property-2
    C25161
    NCI Thesaurus ValueDomain
    C25372
    NCI Thesaurus ValueDomain-2
    C25526
    Other specify
    Descripción

    Histologic Type, other

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    UMLS CUI-1
    C1299220
    NCI Thesaurus ObjectClass
    C3262
    NCI Thesaurus Property
    C25526
    NCI Thesaurus Property-2
    C25161
    Pathologic Primary Tumor Size (on path report cm)
    Descripción

    PathologicTumorPrimarySizeMeasurement

    Tipo de datos

    float

    Alias
    NCI Thesaurus ObjectClass
    C3262
    UMLS 2011AA ObjectClass
    C0027651
    NCI Thesaurus ObjectClass-2
    C25610
    UMLS 2011AA ObjectClass-2
    C1521733
    NCI Thesaurus Property
    C25251
    UMLS 2011AA Property
    C0205225
    NCI Thesaurus Property-2
    C25681
    UMLS 2011AA Property-2
    C0456389
    NCI Thesaurus ValueDomain
    C25209
    UMLS 2011AA ValueDomain
    C0242485
    T stage (Patients with tumors < 1.7 cm, T3-4 or N1-2 disease should NOT be registered to study)
    Descripción

    PatientLungPathologicTStageClinicalTrialEligibilityCriteriaStatus

    Tipo de datos

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25610
    UMLS 2011AA Property
    C1521733
    NCI Thesaurus Property-2
    C12468
    UMLS 2011AA Property-2
    C0024109
    NCI Thesaurus Property-3
    C16112
    UMLS 2011AA Property-3
    C1516637
    NCI Thesaurus Property-4
    C25728
    UMLS 2011AA Property-4
    C0475455
    NCI Thesaurus ValueDomain
    C25688
    UMLS 2011AA ValueDomain
    C0449438
    N stage (Patients with tumors < 1.7 cm, T3-4 or N1-2 disease should NOT be registered to study)
    Descripción

    PatientLungPathologicNStageClinicalTrialEligibilityCriteriaStatus

    Tipo de datos

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25610
    UMLS 2011AA Property
    C1521733
    NCI Thesaurus Property-2
    C12468
    UMLS 2011AA Property-2
    C0024109
    NCI Thesaurus Property-3
    C16112
    UMLS 2011AA Property-3
    C1516637
    NCI Thesaurus Property-4
    C25580
    UMLS 2011AA Property-4
    C0456532
    NCI Thesaurus ValueDomain
    C25688
    UMLS 2011AA ValueDomain
    C0449438
    Planned Treatment
    Descripción

    Planned Treatment

    Assigned Treatment Arm
    Descripción

    Protocol Treatment Arm

    Tipo de datos

    text

    Alias
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus ObjectClass-2
    C42651
    UMLS CUI-1
    C1522541
    NCI Thesaurus Property
    C32141
    NCI Thesaurus Property-2
    C25426
    NCI Thesaurus ValueDomain
    C25284
    Specify
    Descripción

    PatientNoRandomizationSpecify

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    UMLS 2011AA ValueDomain
    C1521902
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C49487
    UMLS 2011AA Property
    C1298908
    NCI Thesaurus Property-2
    C25196
    UMLS 2011AA Property-2
    C0034656
    Contact Information
    Descripción

    Contact Information

    Medical oncologist's name
    Descripción

    MedicalOncologistPersonIdentifierName

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS 2011AA ValueDomain
    C1547383
    NCI Thesaurus ObjectClass
    C25190
    UMLS 2011AA ObjectClass
    C0027361
    NCI Thesaurus Property
    C25364
    UMLS 2011AA Property
    C0600091
    NCI Thesaurus ObjectClass-2
    C17838
    UMLS 2011AA ObjectClass-2
    C1555767
    Surgeon Name
    Descripción

    SurgeonName

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS 2011AA ValueDomain
    C1547383
    NCI Thesaurus Property
    C25364
    UMLS 2011AA Property
    C0600091
    NCI Thesaurus ObjectClass
    C18071
    UMLS 2011AA ObjectClass
    C0582175
    E-mail
    Descripción

    TreatingPhysicianPersonEmailAddressText

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704
    UMLS 2011AA ValueDomain
    C1527021
    NCI Thesaurus ObjectClass
    C25190
    UMLS 2011AA ObjectClass
    C0027361
    NCI Thesaurus ObjectClass-2
    C51883
    UMLS 2011AA ObjectClass-2
    C1710470
    NCI Thesaurus Property
    C42775
    UMLS 2011AA Property
    C1705961
    Phone
    Descripción

    TreatingPhysicianPhoneNumber

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS 2011AA ValueDomain
    C0237753
    NCI Thesaurus ObjectClass
    C25741
    UMLS 2011AA ObjectClass
    C0031831
    NCI Thesaurus Property
    C25395
    UMLS 2011AA Property
    C0039457
    NCI Thesaurus ObjectClass-2
    C25705
    UMLS 2011AA ObjectClass-2
    C1522326
    Footer Module
    Descripción

    Footer Module

    Completed by
    Descripción

    Person Completing Form

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C1550483
    NCI Thesaurus ObjectClass
    C25657
    NCI Thesaurus Property
    C25364
    Date Form Originally Completed (MM DD YYYY)
    Descripción

    Form Completion Date

    Tipo de datos

    date

    Alias
    NCI Thesaurus ObjectClass
    C19464
    UMLS CUI-1
    C1549507
    NCI Thesaurus Property
    C25250
    NCI Thesaurus Property-2
    C25604
    NCI Thesaurus ValueDomain
    C25164
    NCI Thesaurus ValueDomain-2
    C25367
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    INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice. Print text in capital letters. Avoid contact with the edges of the boxes

    1 formularios
    Name
    Tipo
    Description | Question | Decode (Coded Value)
    Tipo de datos
    Alias
    Item Group
    Ccrr Module For Calgb 90202: Prostate Specific Antigen Form
    Form ID CALGB
    Item
    CALGB Form
    text
    C25337 (NCI Thesaurus ValueDomain)
    C3262252 (UMLS CUI-1)
    C19464 (NCI Thesaurus ObjectClass)
    C1516238 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25442 (NCI Thesaurus ObjectClass-2)
    Protocol ID CALGB
    Item
    CALGB Study No.
    text
    C25337 (NCI Thesaurus ValueDomain)
    C3274381 (UMLS CUI-1)
    C25320 (NCI Thesaurus ObjectClass)
    C1516238 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25442 (NCI Thesaurus Property-2)
    Trial subject ID CALGB
    Item
    CALGB Patient ID
    text
    C25337 (NCI Thesaurus ValueDomain)
    C2348585 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C1516238 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25442 (NCI Thesaurus Property-2)
    Data amended
    Item
    Are data amended
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C0680532 (UMLS CUI-1)
    C25474 (NCI Thesaurus ObjectClass)
    C25416 (NCI Thesaurus Property)
    Patient Initials
    Item
    Patient Initials (Last, First Middle)
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2986440 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25536 (NCI Thesaurus Property)
    Medical Record Number
    Item
    Patient Hospital No.
    text
    C25337 (NCI Thesaurus ValueDomain)
    C1301894 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25261 (NCI Thesaurus Property)
    C25198 (NCI Thesaurus Property-2)
    Institution Name
    Item
    Institution/Affiliate
    text
    C25454 (NCI Thesaurus ObjectClass)
    C1301943 (UMLS CUI-1)
    C21541 (NCI Thesaurus ObjectClass-2)
    C25364 (NCI Thesaurus Property)
    C25191 (NCI Thesaurus ValueDomain)
    C21541 (NCI Thesaurus ValueDomain-2)
    Participating Group
    Item
    Participating Group
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2347449 (UMLS CUI-1)
    C25608 (NCI Thesaurus ObjectClass)
    C17005 (NCI Thesaurus ObjectClass-2)
    C25364 (NCI Thesaurus Property)
    Study Number Participating Group
    Item
    Participating Group Study No.
    text
    C25337 (NCI Thesaurus ValueDomain)
    C3274381 (UMLS CUI-1)
    C25320 (NCI Thesaurus ObjectClass)
    C2347449 (UMLS CUI-2)
    C25608 (NCI Thesaurus Property)
    C25364 (NCI Thesaurus Property-2)
    Trial subject ID Participating Group
    Item
    Participating Group Patient ID
    text
    C25337 (NCI Thesaurus ValueDomain)
    C2348585 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C2347449 (UMLS CUI-2)
    C25608 (NCI Thesaurus Property)
    C25364 (NCI Thesaurus Property-2)
    Item Group
    Vital Status
    Item
    ECOG Performance Status
    text
    C25664 (NCI Thesaurus ValueDomain)
    C1520224 (UMLS CUI-1)
    C25367 (NCI Thesaurus Property)
    C25491 (NCI Thesaurus ValueDomain-2)
    C20641 (NCI Thesaurus ObjectClass)
    CL.2
    Code List
    ECOG Performance Status
    CL Item
    Fully Active, Able To Carry On All Pre-disease Performance Without Restriction. (0)
    CL Item
    Restricted In Physically Strenuous Activity But Ambulatory And Able To Carry Out Work Of A Light Or Sedentary Nature, E.g., Light Housework, Office Work. (1)
    CancerPriorTreatmentInd-3
    Item
    Prior Treatment (for this cancer within the past 5 years)
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C1512699 (UMLS 2011AA ValueDomain)
    C9305 (NCI Thesaurus ObjectClass)
    C0006826 (UMLS 2011AA ObjectClass)
    C25629 (NCI Thesaurus Property)
    C0332152 (UMLS 2011AA Property)
    C15368 (NCI Thesaurus Property-2)
    Item Group
    Required Laboratory Values
    Leukocytes (WBC)
    Item
    WBC (x 10^3 microL)
    float
    C25294 (NCI Thesaurus ObjectClass)
    C0023508 (UMLS CUI-1)
    C12529 (NCI Thesaurus Property)
    C20200 (NCI Thesaurus Property-2)
    C38046 (NCI Thesaurus ValueDomain)
    C25712 (NCI Thesaurus ValueDomain-2)
    ANC
    Item
    ANC (x 10^3 microL)
    float
    C25294 (NCI Thesaurus ObjectClass)
    C0948762 (UMLS CUI-1)
    C20200 (NCI Thesaurus Property)
    C63321 (NCI Thesaurus Property-2)
    C38046 (NCI Thesaurus ValueDomain)
    C25712 (NCI Thesaurus ValueDomain-2)
    LaboratoryProcedureGranulocyteResultPercentageValue
    Item
    Granulocytes (%)
    float
    C20200 (NCI Thesaurus Property)
    C1274040 (UMLS 2011AA Property)
    C12530 (NCI Thesaurus Property-2)
    C0018183 (UMLS 2011AA Property-2)
    C25613 (NCI Thesaurus ValueDomain)
    C0439165 (UMLS 2011AA ValueDomain)
    C25294 (NCI Thesaurus ObjectClass)
    C0022885 (UMLS 2011AA ObjectClass)
    C25712 (NCI Thesaurus ValueDomain-2)
    C1522609 (UMLS 2011AA ValueDomain-2)
    Platelets
    Item
    Platelets (PLT) (x 10^3 microL)
    float
    C20200 (NCI Thesaurus Property)
    C0005821 (UMLS CUI-1)
    C12520 (NCI Thesaurus Property-2)
    C25294 (NCI Thesaurus ObjectClass)
    C25712 (NCI Thesaurus ValueDomain)
    LaboratoryProcedureTotalBilirubinResultValue
    Item
    Bilirubin (mg/dl)
    float
    C20200 (NCI Thesaurus Property)
    C1274040 (UMLS 2011AA Property)
    C25294 (NCI Thesaurus ObjectClass)
    C0022885 (UMLS 2011AA ObjectClass)
    C38037 (NCI Thesaurus Property-2)
    C0201913 (UMLS 2011AA Property-2)
    C25712 (NCI Thesaurus ValueDomain)
    C1522609 (UMLS 2011AA ValueDomain)
    SGOT (AST)
    Item
    SGOT (AST) (UL)
    float
    C25294 (NCI Thesaurus ObjectClass)
    C0201899 (UMLS CUI-1)
    C25202 (NCI Thesaurus Property)
    C20200 (NCI Thesaurus Property-2)
    C38046 (NCI Thesaurus ValueDomain)
    C25712 (NCI Thesaurus ValueDomain-2)
    LaboratoryProcedureSerumGlutamicOxaloaceticTransferaseResultUnspecifiedUpperLimitofNormalValue
    Item
    SGOT (AST) ULN (UL)
    float
    C25294 (NCI Thesaurus ObjectClass)
    C0022885 (UMLS 2011AA ObjectClass)
    C25202 (NCI Thesaurus Property)
    C0242192 (UMLS 2011AA Property)
    C20200 (NCI Thesaurus Property-2)
    C1274040 (UMLS 2011AA Property-2)
    C25712 (NCI Thesaurus ValueDomain)
    C1522609 (UMLS 2011AA ValueDomain)
    C25706 (NCI Thesaurus ValueDomain-2)
    C1519815 (UMLS 2011AA ValueDomain-2)
    Creatinine, Serum
    Item
    Serum creatinine (mg/dl)
    float
    C20200 (NCI Thesaurus Property)
    C0201976 (UMLS CUI-1)
    C399 (NCI Thesaurus Property-2)
    C25294 (NCI Thesaurus ObjectClass)
    C25712 (NCI Thesaurus ValueDomain)
    Creatinine, serum ULN
    Item
    Serum Creatinine ULN
    float
    C25294 (NCI Thesaurus ObjectClass)
    C0201976 (UMLS CUI-1)
    C20200 (NCI Thesaurus Property)
    C1519815 (UMLS CUI-2)
    C399 (NCI Thesaurus Property-2)
    C25712 (NCI Thesaurus ValueDomain)
    C25706 (NCI Thesaurus ValueDomain-2)
    Item Group
    Unnamed3
    Item
    Smoking History
    text
    C25180 (NCI Thesaurus ValueDomain)
    C1519384 (UMLS CUI-1)
    C17934 (NCI Thesaurus ObjectClass)
    C18772 (NCI Thesaurus Property)
    CL.4
    Code List
    Smoking History
    CL Item
    Never Smoked (Never smoked)
    CL Item
    Smoked In The Past (Smoked in the past)
    CL Item
    Currently Smoking (Currently smoking)
    CigaretteSmokingHistoryPackYearAmount
    Item
    Number pack years smoked (If former or current smoker, Pack year = number of packs smoked / day x number of years smoked)
    text
    C17934 (NCI Thesaurus ObjectClass)
    C0453996 (UMLS 2011AA ObjectClass)
    C18772 (NCI Thesaurus Property)
    C0262926 (UMLS 2011AA Property)
    C25417 (NCI Thesaurus ValueDomain)
    Item Group
    Pre-surgical Disease Status
    PatientChestRadiographyComputedTomographyAssessmentDate
    Item
    Date of Chest X-Ray or CT scan (MM DD YYYY)
    date
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C38103 (NCI Thesaurus Property-2)
    C0039985 (UMLS 2011AA Property-2)
    C17204 (NCI Thesaurus Property-3)
    C0040405 (UMLS 2011AA Property-3)
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    PrimaryTumorSizeMeasurement
    Item
    Clinical Size of Tumor (on chest/upper abdominal CT scan cm)
    float
    C25209 (NCI Thesaurus ValueDomain)
    C0242485 (UMLS 2011AA ValueDomain)
    C3262 (NCI Thesaurus ObjectClass)
    C0027651 (UMLS 2011AA ObjectClass)
    C25251 (NCI Thesaurus ObjectClass-2)
    C0205225 (UMLS 2011AA ObjectClass-2)
    C25681 (NCI Thesaurus Property)
    C0456389 (UMLS 2011AA Property)
    Item
    Clinical T Stage
    text
    C3262 (NCI Thesaurus ObjectClass)
    C0475455 (UMLS CUI-1)
    C12468 (NCI Thesaurus ObjectClass-2)
    C0205210 (UMLS CUI-2)
    C25398 (NCI Thesaurus Property)
    C25728 (NCI Thesaurus Property-2)
    C16899 (NCI Thesaurus ValueDomain)
    CL.5
    Code List
    Clinical T Stage
    CL Item
    Tumor 3 Cm Or Less In Greatest Dimension, Surrounded By Lung Or Visceral Pleura, Invasion More Proximal Than The Lobar Bronchus, (i.e., Not In The Main Bronchus) (T1)
    CL Item
    Tumor With Any Of The Following Features Of Size Or Extent: More Than 3cm In Greatest Dimension; Invades The Visceral Pleura; Associated With Atelectasis Or Obstructive Pneumonitis That Extends To The Hilar Region But Does Not Involve The Entire Lung (T2)
    Item
    Clinical N Stage
    text
    C3262 (NCI Thesaurus ObjectClass)
    C0456532 (UMLS CUI-1)
    C12468 (NCI Thesaurus ObjectClass-2)
    C0205210 (UMLS CUI-2)
    C25398 (NCI Thesaurus Property)
    C25580 (NCI Thesaurus Property-2)
    C16899 (NCI Thesaurus ValueDomain)
    CL.6
    Code List
    Clinical N Stage
    CL Item
    No Regional Lymph Node Metastasis (N0)
    CL Item
    Metastasis To Ipsilateral Peribronchial And/or Ipsilateral Hilar Lymph Nodes, And Intrapulmonary Nodes Including Involvement By Direct Extension Of The Primary Tumor (N1)
    MedDRACode
    Item
    MedDRA disease code
    float
    C25162 (NCI Thesaurus ValueDomain)
    C0805701 (UMLS 2011AA ValueDomain)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    CL104089 (NCI Metathesaurus ObjectClass)
    Item
    How were positive nodes ruled out (If nodes were suspicious for malignancy > 1 cm on pre-op CT or positive on PET scan)
    text
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C12745 (NCI Thesaurus ObjectClass)
    C0024204 (UMLS 2011AA ObjectClass)
    C38757 (NCI Thesaurus Property-2)
    C1513916 (UMLS 2011AA Property-2)
    CL.7
    Code List
    How were positive nodes ruled out (If nodes were suspicious for malignancy > 1 cm on pre-op CT or positive on PET scan)
    CL Item
    Anterior Mediatinoscopy (chamberlain) (Anterior Mediatinoscopy (Chamberlain))
    CL Item
    Ebus-fna (EBUS-FNA)
    CL Item
    Eus-fna (EUS-FNA)
    CL Item
    Mediastinoscopy (Mediastinoscopy)
    C16829 (NCI Thesaurus)
    C0025065 (UMLS 2011AA)
    CL Item
    Thoracotomy (Open thoracotomy)
    CL Item
    Transbronchial Aspirate; No Ebus (Transbronchial aspirate; No EBUS)
    CL Item
    Ttnb (TTNB)
    CL Item
    Vats Node Biopsy (VATS node biopsy)
    Item Group
    Surgical Disease Status
    SurgicalProcedureExcisionPerformedInd-2
    Item
    Did patient undergo surgical resection?
    boolean
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    C38000 (NCI Thesaurus Property)
    C0884358 (UMLS 2011AA Property)
    C15329 (NCI Thesaurus ObjectClass)
    C0543467 (UMLS 2011AA ObjectClass)
    C15232 (NCI Thesaurus Property-2)
    C0728940 (UMLS 2011AA Property-2)
    PatientSurgicalResectionDate
    Item
    Date of Resection (MM DD YYYY)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25698 (NCI Thesaurus Property)
    C15232 (NCI Thesaurus Property-2)
    C0728940 (UMLS 2011AA Property)
    Item
    Specify reason (If no Mark all that apply with an X.)
    text
    C49160 (NCI Thesaurus ObjectClass)
    C0205257 (UMLS 2011AA ObjectClass)
    C12468 (NCI Thesaurus ObjectClass-2)
    C0024109 (UMLS 2011AA ObjectClass-2)
    C15329 (NCI Thesaurus ObjectClass-3)
    C0543467 (UMLS 2011AA ObjectClass-3)
    C25638 (NCI Thesaurus Property)
    C0392360 (UMLS 2011AA Property)
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    CL.9
    Code List
    Specify reason (If no Mark all that apply with an X.)
    CL Item
    Positive Nodes (Positive nodes)
    CL Item
    Benign Mass (Benign mass)
    CL Item
    Carcinoid Tumor (Carcinoid)
    C2915 (NCI Thesaurus)
    C0007095 (UMLS 2011AA)
    CL Item
    Tumor < 1.70 Cm (Tumor < 1.70 cm)
    CL Item
    Other (Other)
    C17649 (NCI Thesaurus)
    C0205394 (UMLS 2011AA)
    LungIncompleteSurgicalProcedureReasonSpecify
    Item
    Other, specify
    text
    C49160 (NCI Thesaurus ObjectClass)
    C0205257 (UMLS 2011AA ObjectClass)
    C12468 (NCI Thesaurus ObjectClass-2)
    C0024109 (UMLS 2011AA ObjectClass-2)
    C15329 (NCI Thesaurus ObjectClass-3)
    C0543467 (UMLS 2011AA ObjectClass-3)
    C25638 (NCI Thesaurus Property)
    C0392360 (UMLS 2011AA Property)
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    Item
    Histology (Mark one with an X.)
    text
    C3262 (NCI Thesaurus ObjectClass)
    C0449574 (UMLS CUI-1)
    C12468 (NCI Thesaurus ObjectClass-2)
    C25526 (NCI Thesaurus Property)
    C25161 (NCI Thesaurus Property-2)
    C25372 (NCI Thesaurus ValueDomain)
    C25526 (NCI Thesaurus ValueDomain-2)
    CL.10
    Code List
    Histology (Mark one with an X.)
    CL Item
    Non-small Cell Lung Cancer (nsclc), Nos (Non-small cell lung cancer NOS)
    CL Item
    Adenocarcinoma (Adenocarcinoma)
    C2852 (NCI Thesaurus)
    C0001418 (UMLS 2011AA)
    CL Item
    Squamous Cell Carcinoma (Squamous cell carcinoma)
    C2929 (NCI Thesaurus)
    C0007137 (UMLS 2011AA)
    CL Item
    Adenosquamous Carcinoma (Adenosquamous)
    C3727 (NCI Thesaurus)
    C0206623 (UMLS 2011AA)
    CL Item
    Other (Other specify)
    C17649 (NCI Thesaurus)
    C0205394 (UMLS 2011AA)
    C17649 (NCI Thesaurus-3)
    C0205394 (UMLS 2011AA-4)
    Histologic Type, other
    Item
    Other specify
    text
    C25685 (NCI Thesaurus ValueDomain)
    C1299220 (UMLS CUI-1)
    C3262 (NCI Thesaurus ObjectClass)
    C25526 (NCI Thesaurus Property)
    C25161 (NCI Thesaurus Property-2)
    PathologicTumorPrimarySizeMeasurement
    Item
    Pathologic Primary Tumor Size (on path report cm)
    float
    C3262 (NCI Thesaurus ObjectClass)
    C0027651 (UMLS 2011AA ObjectClass)
    C25610 (NCI Thesaurus ObjectClass-2)
    C1521733 (UMLS 2011AA ObjectClass-2)
    C25251 (NCI Thesaurus Property)
    C0205225 (UMLS 2011AA Property)
    C25681 (NCI Thesaurus Property-2)
    C0456389 (UMLS 2011AA Property-2)
    C25209 (NCI Thesaurus ValueDomain)
    C0242485 (UMLS 2011AA ValueDomain)
    Item
    T stage (Patients with tumors < 1.7 cm, T3-4 or N1-2 disease should NOT be registered to study)
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25610 (NCI Thesaurus Property)
    C1521733 (UMLS 2011AA Property)
    C12468 (NCI Thesaurus Property-2)
    C0024109 (UMLS 2011AA Property-2)
    C16112 (NCI Thesaurus Property-3)
    C1516637 (UMLS 2011AA Property-3)
    C25728 (NCI Thesaurus Property-4)
    C0475455 (UMLS 2011AA Property-4)
    C25688 (NCI Thesaurus ValueDomain)
    C0449438 (UMLS 2011AA ValueDomain)
    CL.11
    Code List
    T stage (Patients with tumors < 1.7 cm, T3-4 or N1-2 disease should NOT be registered to study)
    CL Item
    T1 (T1)
    C1179687 (NCI Metathesaurus)
    CL Item
    T2 (T2)
    CL Item
    T3-4 (T3-4)
    Item
    N stage (Patients with tumors < 1.7 cm, T3-4 or N1-2 disease should NOT be registered to study)
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25610 (NCI Thesaurus Property)
    C1521733 (UMLS 2011AA Property)
    C12468 (NCI Thesaurus Property-2)
    C0024109 (UMLS 2011AA Property-2)
    C16112 (NCI Thesaurus Property-3)
    C1516637 (UMLS 2011AA Property-3)
    C25580 (NCI Thesaurus Property-4)
    C0456532 (UMLS 2011AA Property-4)
    C25688 (NCI Thesaurus ValueDomain)
    C0449438 (UMLS 2011AA ValueDomain)
    CL.12
    Code List
    N stage (Patients with tumors < 1.7 cm, T3-4 or N1-2 disease should NOT be registered to study)
    CL Item
    N0 (N0)
    CL Item
    N1 (N1)
    CL Item
    N2 (N2)
    Item Group
    Planned Treatment
    Item
    Assigned Treatment Arm
    text
    C15368 (NCI Thesaurus ObjectClass)
    C42651 (NCI Thesaurus ObjectClass-2)
    C1522541 (UMLS CUI-1)
    C32141 (NCI Thesaurus Property)
    C25426 (NCI Thesaurus Property-2)
    C25284 (NCI Thesaurus ValueDomain)
    CL.13
    Code List
    Assigned Treatment Arm
    CL Item
    Regimen 1: Vinorelbine And Cisplatin (Regimen 1: Vinorelbine and Cisplatin)
    CL Item
    Regimen 2: Docetaxel And Cisplatin (Regimen 2: Docetaxel and Cisplatin)
    CL Item
    Regimen 3: Gemcitabine And Cisplatin (Regimen 3: Gemcitabine and Cisplatin)
    CL Item
    Randomized To Observation (Randomized to observation)
    CL Item
    Patient Refused To Be Randomized (Patient refused to be randomized)
    CL Item
    Patient Refused Assigned Treatment After Randomization (Patient refused assigned treatment after randomization)
    CL Item
    Patient Not Randomized Due To Ineligibility (Patient not randomized due to ineligibility)
    CL Item
    Patient Not Randomized For Other Reason (Patient not randomized for other reason)
    PatientNoRandomizationSpecify
    Item
    Specify
    text
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C49487 (NCI Thesaurus Property)
    C1298908 (UMLS 2011AA Property)
    C25196 (NCI Thesaurus Property-2)
    C0034656 (UMLS 2011AA Property-2)
    Item Group
    Contact Information
    MedicalOncologistPersonIdentifierName
    Item
    Medical oncologist's name
    text
    C25191 (NCI Thesaurus ValueDomain)
    C1547383 (UMLS 2011AA ValueDomain)
    C25190 (NCI Thesaurus ObjectClass)
    C0027361 (UMLS 2011AA ObjectClass)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    C17838 (NCI Thesaurus ObjectClass-2)
    C1555767 (UMLS 2011AA ObjectClass-2)
    SurgeonName
    Item
    Surgeon Name
    text
    C25191 (NCI Thesaurus ValueDomain)
    C1547383 (UMLS 2011AA ValueDomain)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    C18071 (NCI Thesaurus ObjectClass)
    C0582175 (UMLS 2011AA ObjectClass)
    TreatingPhysicianPersonEmailAddressText
    Item
    E-mail
    text
    C25704 (NCI Thesaurus ValueDomain)
    C1527021 (UMLS 2011AA ValueDomain)
    C25190 (NCI Thesaurus ObjectClass)
    C0027361 (UMLS 2011AA ObjectClass)
    C51883 (NCI Thesaurus ObjectClass-2)
    C1710470 (UMLS 2011AA ObjectClass-2)
    C42775 (NCI Thesaurus Property)
    C1705961 (UMLS 2011AA Property)
    TreatingPhysicianPhoneNumber
    Item
    Phone
    text
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    C25741 (NCI Thesaurus ObjectClass)
    C0031831 (UMLS 2011AA ObjectClass)
    C25395 (NCI Thesaurus Property)
    C0039457 (UMLS 2011AA Property)
    C25705 (NCI Thesaurus ObjectClass-2)
    C1522326 (UMLS 2011AA ObjectClass-2)
    Item Group
    Footer Module
    Person Completing Form
    Item
    Completed by
    text
    C25191 (NCI Thesaurus ValueDomain)
    C1550483 (UMLS CUI-1)
    C25657 (NCI Thesaurus ObjectClass)
    C25364 (NCI Thesaurus Property)
    Form Completion Date
    Item
    Date Form Originally Completed (MM DD YYYY)
    date
    C19464 (NCI Thesaurus ObjectClass)
    C1549507 (UMLS CUI-1)
    C25250 (NCI Thesaurus Property)
    C25604 (NCI Thesaurus Property-2)
    C25164 (NCI Thesaurus ValueDomain)
    C25367 (NCI Thesaurus ValueDomain-2)
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