ID
43243
Description
E1906 Registration Worksheet (step 1) Comparing Three Different Combination Chemotherapy Regimens in Treating Patients With Relapsed or Refractory Acute Myeloid Leukemia NCT00634244 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=580BE65D-2E90-52E8-E044-0003BA3F9857
Link
Keywords
Versions (4)
- 9/19/12 9/19/12 -
- 1/9/15 1/9/15 - Martin Dugas
- 1/23/15 1/23/15 - Martin Dugas
- 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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Registration Worksheet (step 1) AML (NCT00634244)
No Instruction available.
- StudyEvent: E1906 Registration Worksheet (step 1)
Description
Patient Demographics / Pre-treatment Characteristics
Alias
- UMLS CUI-1
- C1704791
Description
PatientSexCode
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C28421
- NCI Thesaurus ValueDomain
- C25162
- NCI Thesaurus ValueDomain-2
- C16960
- NCI Thesaurus ValueDomain-3
- C28421
- UMLS CUI-1
- C0079399
Description
Birth Date
Data type
date
Measurement units
- mm/yy
Alias
- NCI Thesaurus ValueDomain
- C25164
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25155
- UMLS CUI-1
- C0421451
Description
Racial Group
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25372
- UMLS CUI-1
- C0034510
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C17049
Description
AddressPostalCodeIdentifier
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C25407
- NCI Thesaurus Property
- C25621
- NCI Thesaurus ValueDomain
- C25364
- NCI Thesaurus ValueDomain-2
- C25407
- NCI Thesaurus ValueDomain-3
- C25621
- UMLS CUI-1
- C1521842
Description
Ethnic Group
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25372
- UMLS CUI-1
- C0015031
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C16564
Description
Medical Record Number
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS CUI-1
- C1301894
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25261
- NCI Thesaurus Property-2
- C25198
Description
Social Security Number
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS CUI-1
- C1301821
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25686
Description
PatientInternationalPaymentType
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25371
- NCI Thesaurus Property-2
- C25541
- UMLS CUI-1
- C0680264
Description
PatientAddressCountryCode
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25162
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25407
- UMLS CUI-1
- C3258975
Description
Research Comments
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS CUI-1
- C0947611
- NCI Thesaurus ObjectClass
- C15319
- NCI Thesaurus Property
- C25393
Description
I Have Reviewed The Above Data And Agree The Date Are Accurate And Correct
Description
TreatingPhysicianSignatureText
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- NCI Thesaurus Property
- C25678
- NCI Thesaurus ObjectClass
- C51883
- UMLS CUI-1
- C1527021
- UMLS CUI-2
- C1519316
- UMLS CUI-3
- C1710470
Description
TreatingPhysicianSignatureDate
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- NCI Thesaurus Property
- C25678
- NCI Thesaurus ObjectClass
- C51883
- UMLS CUI-1
- C0011008
- UMLS CUI-2
- C1519316
- UMLS CUI-3
- C1710470
Similar models
No Instruction available.
- StudyEvent: E1906 Registration Worksheet (step 1)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C0205435 (UMLS CUI-2)
C25536 (NCI Thesaurus Property)
C25509 (NCI Thesaurus Property-2)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1517741 (UMLS CUI-2)
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C25551 (NCI Thesaurus Property-2)
C25250 (NCI Thesaurus Property)
C25171 (NCI Thesaurus ObjectClass)
C49073 (NCI Thesaurus Property-2)
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C25171 (NCI Thesaurus Property)
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C2985782 (UMLS CUI-1)
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C25679 (NCI Thesaurus Property)
C0012621 (NCI Metathesaurus Property)
C45258 (NCI Thesaurus Property-2)
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C0600593 (UMLS CUI-1)
C0680281 (UMLS CUI-2)
C0011008 (UMLS CUI-3)
C25509 (NCI Thesaurus ObjectClass-2)
C25275 (NCI Thesaurus Property)
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C25190 (NCI Thesaurus ObjectClass)
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C19157 (NCI Thesaurus Property-2)
C25460 (NCI Thesaurus Property-3)
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C19157 (NCI Thesaurus Property-3)
C25460 (NCI Thesaurus Property-4)
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C0040288 (UMLS CUI-1)
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C25460 (NCI Thesaurus Property-3)
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C0040288 (UMLS CUI-1)
C0242481 (UMLS CUI-2)
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C25406 (NCI Thesaurus Property-2)
C25460 (NCI Thesaurus Property-3)
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C1511481 (UMLS CUI-1)
C2051501 (UMLS CUI-2)
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C37984 (NCI Thesaurus ObjectClass-2)
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C0010802 (UMLS CUI-2)
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C1515945 (UMLS 2011AA)
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C1513907 (UMLS 2011AA)
C1706613 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C0007457 (UMLS 2011AA)
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C25364 (NCI Thesaurus ValueDomain)
C25407 (NCI Thesaurus ValueDomain-2)
C25621 (NCI Thesaurus ValueDomain-3)
C1521842 (UMLS CUI-1)
C0015031 (UMLS CUI-1)
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C0003023 (UMLS 2011AA)
C0454691 (UMLS 2011AA)
C0003761 (UMLS 2011AA)
C0242536 (UMLS 2011AA)
C0004348 (UMLS 2011AA)
C0004340 (UMLS 2011AA)
C0282379 (UMLS 2011AA)
C0006036 (UMLS 2011AA)
C0004739 (UMLS 2011AA)
C0004732 (UMLS 2011AA)
C0004950 (UMLS 2011AA)
C0006409 (UMLS 2011AA)
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C0006448 (UMLS 2011AA)
C0005126 (UMLS 2011AA)
C0006320 (UMLS 2011AA)
C0005918 (UMLS 2011AA)
C0006137 (UMLS 2011AA)
C0004683 (UMLS 2011AA)
C0005341 (UMLS 2011AA)
C1511278 (UMLS 2011AA)
C0006041 (UMLS 2011AA)
C0006539 (UMLS 2011AA)
C0004952 (UMLS 2011AA)
C0006823 (UMLS 2011AA)
C0009738 (UMLS 2011AA)
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C0021247 (UMLS 2011AA)
C0022067 (UMLS 2011AA)
C0022271 (UMLS 2011AA)
C0021201 (UMLS 2011AA)
C0022066 (UMLS 2011AA)
C0022065 (UMLS 2011AA)
C0020750 (UMLS 2011AA)
C0022277 (UMLS 2011AA)
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C0022418 (UMLS 2011AA)
C0022341 (UMLS 2011AA)
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C0006797 (UMLS 2011AA)
C0017550 (UMLS 2011AA)
C0009490 (UMLS 2011AA)
C0022804 (UMLS 2011AA)
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C0023668 (UMLS 2011AA)
C0038088 (UMLS 2011AA)
C0023617 (UMLS 2011AA)
C0023879 (UMLS 2011AA)
C0024176 (UMLS 2011AA)
C0023128 (UMLS 2011AA)
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C0026405 (UMLS 2011AA)
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C0024403 (UMLS 2011AA)
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C0026655 (UMLS 2011AA)
C0027366 (UMLS 2011AA)
C0028074 (UMLS 2011AA)
C0028366 (UMLS 2011AA)
C0028075 (UMLS 2011AA)
C0028002 (UMLS 2011AA)
C0027778 (UMLS 2011AA)
C0028423 (UMLS 2011AA)
C0027689 (UMLS 2011AA)
C0027496 (UMLS 2011AA)
C0028219 (UMLS 2011AA)
C0027978 (UMLS 2011AA)
C0028971 (UMLS 2011AA)
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C0031238 (UMLS 2011AA)
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C0032729 (UMLS 2011AA)
C0242397 (UMLS 2011AA)
C0030428 (UMLS 2011AA)
C0034366 (UMLS 2011AA)
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C0035978 (UMLS 2011AA)
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