ID

43268

Description

Cardiac form for C3D 3.12 Adopters Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=014B7099-D329-3E1B-E044-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=014B7099-D329-3E1B-E044-0003BA3F9857

Keywords

Versions (3)
  1. 9/19/12 9/19/12 -
  2. 8/11/14 8/11/14 - Martin Dugas
  3. 9/20/21 9/20/21 -
Uploaded on

September 20, 2021

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Creative Commons BY-NC 3.0 Legacy
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On-Study - CARDIAC - 2406850v1.0

English

Dates will appear as 'DD-MON-YYYY'

1 forms  
Cardiac
Description

Cardiac

Course Number
Description

CourseNumber

Data type

double

Alias
NCI Thesaurus Property
C25337
UMLS 2011AA Property
C0237753
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C25379
UMLS 2011AA ObjectClass
C0750729
Course Day Number
Description

CourseDayNumber

Data type

double

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus Property
C25301
UMLS 2011AA Property
C0439228
NCI Thesaurus ObjectClass
C25379
UMLS 2011AA ObjectClass
C0750729
Evaluation Date
Description

EvaluationDate

Data type

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
Lab Collection Time
Description

LabCollectionTime

Data type

time

Alias
NCI Thesaurus Property
C25453
UMLS 2011AA Property
C1516698
NCI Thesaurus Property
C25207
UMLS 2011AA Property
C0040223
NCI Thesaurus ValueDomain
C25207
UMLS 2011AA ValueDomain
C0040223
NCI Thesaurus ObjectClass
C25294
UMLS 2011AA ObjectClass
C0022885
Procedure
Description

Procedure

Data type

text

Alias
NCI Thesaurus ObjectClass
C25218
UMLS CUI-1
C0184661
NCI Thesaurus ObjectClass
C71104
NCI Thesaurus Property
C42614
NCI Thesaurus ValueDomain
C42614
Cardiac Preejection Period Percentage
Description

CardiacPreejectionPeriodPercentage

Data type

double

Measurement units
  • %
Alias
NCI Thesaurus ObjectClass
C13306
UMLS 2011AA ObjectClass
C1522601
NCI Metathesaurus ObjectClass
C0392912
NCI Metathesaurus Property
CL235601
NCI Thesaurus ValueDomain
C25613
UMLS 2011AA ValueDomain
C0439165
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
%
LV Ejection Fraction
Description

EjectionFractionResultPercentageValue

Data type

double

Alias
NCI Thesaurus Property
C20200
UMLS 2011AA Property
C1274040
NCI Thesaurus ValueDomain
C25613
UMLS 2011AA ValueDomain
C0439165
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
LV Ejection Time
Description

LeftVentricularEjectionTimeMeasurementMillisecondNumber

Data type

double

Alias
NCI Thesaurus ObjectClass
C25207
UMLS 2011AA ObjectClass
C0040223
NCI Thesaurus ObjectClass
C37946
UMLS 2011AA ObjectClass
C2700377
NCI Thesaurus Property
C25209
UMLS 2011AA Property
C0242485
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ValueDomain
C25207
UMLS 2011AA ValueDomain
C0040223
NCI Thesaurus ValueDomain
C41140
UMLS 2011AA ValueDomain
C0439223
Comments
Description

Comments

Note Date
Description

NoteDate

Data type

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

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
UMLS 2011AA Property
C0282411
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Similar models

Dates will appear as 'DD-MON-YYYY'

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Cardiac
CourseNumber
Item
Course Number
double
C25337 (NCI Thesaurus Property)
C0237753 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25379 (NCI Thesaurus ObjectClass)
C0750729 (UMLS 2011AA ObjectClass)
CourseDayNumber
Item
Course Day Number
double
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25301 (NCI Thesaurus Property)
C0439228 (UMLS 2011AA Property)
C25379 (NCI Thesaurus ObjectClass)
C0750729 (UMLS 2011AA ObjectClass)
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)
LabCollectionTime
Item
Lab Collection Time
time
C25453 (NCI Thesaurus Property)
C1516698 (UMLS 2011AA Property)
C25207 (NCI Thesaurus Property)
C0040223 (UMLS 2011AA Property)
C25207 (NCI Thesaurus ValueDomain)
C0040223 (UMLS 2011AA ValueDomain)
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
Item
Procedure
text
C25218 (NCI Thesaurus ObjectClass)
C0184661 (UMLS CUI-1)
C71104 (NCI Thesaurus ObjectClass)
C42614 (NCI Thesaurus Property)
C42614 (NCI Thesaurus ValueDomain)
CL.1
Code List
Procedure
CL Item
Apheresis (Apheresis)
C15191 (NCI Thesaurus)
C0005791 (UMLS 2011AA)
CL Item
Arteriogram (Arteriogram)
C20607 (NCI Thesaurus)
C0918037 (UMLS 2011AA)
CL Item
Arthroscopy (Arthroscopy)
C38033 (NCI Thesaurus)
C0003904 (UMLS 2011AA)
CL Item
Aspirate, Bone Marrow (Aspirate, Bone Marrow)
C15644 (NCI Thesaurus)
C0398523 (UMLS 2011AA)
CL Item
Aspirate, Ultrasound Guided (Aspirate, Us Guided)
C17230 (NCI Thesaurus)
C0041618 (UMLS 2011AA)
C13347 (NCI Thesaurus)
C0370199 (UMLS 2011AA)
CL Item
Audiogram (Audiogram)
C38036 (NCI Thesaurus)
C0004286 (UMLS 2011AA)
CL Item
Barium Enema (Barium Enema)
C1447 (NCI Thesaurus)
C0203075 (UMLS 2011AA)
CL Item
Barium Swallow (Barium Swallow)
C38112 (NCI Thesaurus)
C0203065 (UMLS 2011AA)
CL Item
Biopsy (Biopsy)
C15189 (NCI Thesaurus)
C0005558 (UMLS 2011AA)
CL Item
Biopsy, Core Needle (Biopsy, Core Needle)
C15680 (NCI Thesaurus)
C1318309 (UMLS 2011AA)
CL Item
Biopsy, Image Guided (Biopsy, Image Guided)
C15652 (NCI Thesaurus)
C0456852 (UMLS 2011AA)
CL Item
Bone Marrow Cellularity (BM Cellularity)
C12431 (NCI Thesaurus)
C0005953 (UMLS 2011AA)
C37923 (NCI Thesaurus)
C1516377 (UMLS 2011AA)
CL Item
Biopsy, Bone Marrow (Bone Marrow Biopsy)
C15193 (NCI Thesaurus)
C0005954 (UMLS 2011AA)
CL Item
Bone Mineral Density (Bone Mineral Density)
C61545 (NCI Thesaurus)
C0177804 (UMLS 2011AA)
CL Item
Bone Scan (Bone Scan)
C17646 (NCI Thesaurus)
C0203668 (UMLS 2011AA)
C17646 (NCI Thesaurus)
C0203668 (UMLS 2011AA)
CL Item
Bone Spectometry (Bone Spectometry)
C12366 (NCI Thesaurus)
C0262950 (UMLS 2011AA)
C62326 (NCI Thesaurus)
C0436196 (UMLS 2011AA)
CL Item
Bronchoalveolar Lavage (Bronchoalveolar Lavage)
C51913 (NCI Thesaurus)
C1535502 (UMLS 2011AA)
CL Item
Bronchogram (Bronchogram)
C16502 (NCI Thesaurus)
C0011923 (UMLS 2011AA)
C12683 (NCI Thesaurus)
C0006255 (UMLS 2011AA)
CL Item
Bronchoscopy (Bronchoscopy)
C16366 (NCI Thesaurus)
C0006290 (UMLS 2011AA)
CL Item
Bronchoscopy/lavage (Bronchoscopy/Lavage)
C16366 (NCI Thesaurus)
C0006290 (UMLS 2011AA)
C51913 (NCI Thesaurus)
C1535502 (UMLS 2011AA)
CL Item
Cardiac Catheterization (Cardiac Catheterization)
C38044 (NCI Thesaurus)
C0018795 (UMLS 2011AA)
CL Item
Computerized Axial Tomography (CAT (CT))
C17204 (NCI Thesaurus)
C0040405 (UMLS 2011AA)
CL Item
Cathetergram (Cathetergram)
C16502 (NCI Thesaurus)
C0011923 (UMLS 2011AA)
C17446 (NCI Thesaurus)
C0085590 (UMLS 2011AA)
CL Item
Central Line Insertion (Central Line Insertion)
C17612 (NCI Thesaurus)
C1145640 (UMLS 2011AA)
C48685 (NCI Thesaurus)
C0441587 (UMLS 2011AA)
CL Item
Colonoscopy (Colonoscopy)
C16450 (NCI Thesaurus)
C0009378 (UMLS 2011AA)
CL Item
Culture Procedure (Culture)
C25300 (NCI Thesaurus)
C0430400 (UMLS 2011AA)
CL Item
Curative Surgery (Curative Surgery)
C15329 (NCI Thesaurus)
C0543467 (UMLS 2011AA)
C62220 (NCI Thesaurus)
C1880198 (UMLS 2011AA)
CL Item
X-ray, Chest (CXR)
C38103 (NCI Thesaurus)
C0039985 (UMLS 2011AA)
CL Item
Cystogram (Cystogram)
CL Item
Cystoscopy (Cystoscopy)
C16482 (NCI Thesaurus)
C0010702 (UMLS 2011AA)
CL Item
Cytology (Cytology)
C16491 (NCI Thesaurus)
C0010819 (UMLS 2011AA)
CL Item
Dental Examination (Dental Examination)
CL Item
Dental Procedure (Dental Procedure)
C25218 (NCI Thesaurus)
C1948041 (UMLS 2011AA)
C41136 (NCI Thesaurus)
C0226984 (UMLS 2011AA)
CL Item
Dissection (Dissection)
C15227 (NCI Thesaurus)
C0012737 (UMLS 2011AA)
CL Item
Doppler Study (Doppler)
CL Item
Electrocardiogram (ECG)
CL Item
Echocardiogram (Echocardiogram)
C37945 (NCI Thesaurus)
C2243117 (UMLS 2011AA)
CL Item
Electroencephalogram (EEG)
C0086205 (NCI Metathesaurus)
CL Item
Upper Endoscopy Esophagogastroduodenoscopy (EGD)
CL Item
Electrocardiogram (EKG)
CL Item
Electromyography (EMG)
CL Item
Endoscopy (Endoscopy)
C16546 (NCI Thesaurus)
C0014245 (UMLS 2011AA)
CL Item
Esophageal Dilation (Esophageal dilation)
CL Item
Esophagoscopy (Esophagoscopy)
CL Item
Examination Under Anesthesia (EUA)
CL Item
Excision (Excision)
C15232 (NCI Thesaurus)
C0728940 (UMLS 2011AA)
CL Item
Exercise Thallium (Exercise Thallium)
CL Item
Eye Exam (Eye Exam)
CL Item
Aspirate, Fine Needle (Fine Needle Aspiration)
CL Item
Flexible Fiberoptic Sigmoidoscopy (Flexible Fiberoptic Sigmoidoscopy)
C51588 (NCI Thesaurus)
C0016234 (UMLS 2011AA)
CL Item
Fluoroscopy (Fluoroscopy)
CL Item
Flow Cytometry (Flw Cyt)
C16585 (NCI Thesaurus)
C0016263 (UMLS 2011AA)
CL Item
Flow Cytometry, Blood (Flw Cyt Bld)
CL Item
Flow Cytometry, Bone Marrow (Flw Cyt BM)
CL Item
Holter Monitor (Holter Monitor)
CL Item
Hyperbaric Treatment(s) (Hyperbaric Treatment(s))
CL Item
Hyperthermia (Hyperthermia)
C50589 (NCI Thesaurus)
C0015967 (UMLS 2011AA)
CL Item
Hysterosonogram (Hysterosonogram)
CL Item
Incision & Drainage (I&D)
CL Item
Laser Doppler Imaging (Imaging, Laser Doppler)
CL Item
Multispectral Imaging (Imaging, Multispectral)
CL Item
Near Infrared Imaging (Imaging, Near Infrared)
CL Item
Immunohistochemical Detection/staining (Immunohistochemical Detection)
CL Item
Infrared (Infrared)
CL Item
Irrigation (Irrigation)
CL Item
Intravenous Pyelogram (IVP)
CL Item
X-ray, Abdominal (KUB)
CL Item
Lymphangiogram (LAG)
C16805 (NCI Thesaurus)
C0024219 (UMLS 2011AA)
CL Item
Laparoscopy (Laparoscopy)
C16969 (NCI Thesaurus)
C0031150 (UMLS 2011AA)
CL Item
Laryngoscopy (Laryngoscopy)
CL Item
Leukapheresis (Leukopheresis)
C15269 (NCI Thesaurus)
C0023416 (UMLS 2011AA)
CL Item
Lower Gastrointestinal Series (Lower GI)
CL Item
Lumbar Puncture (LP)
CL Item
Lumpectomy (Lumpectomy)
C15755 (NCI Thesaurus)
C0024885 (UMLS 2011AA)
CL Item
Lymphadenectomy (Lymphadenectomy)
CL Item
Lymphocyte Harvest (Lymphocyte Harvest)
CL Item
Lymphocyte Infusion (Lymphocyte Infusion)
CL Item
Lymphopheresis With Scda Solution (Lymphopheresis w/SCDA)
CL Item
Mammogram (Mammogram)
C20178 (NCI Thesaurus)
C0024671 (UMLS 2011AA)
CL Item
Mammogram, Birad (Mammogram, BIRAD)
CL Item
Mammogram, Digitized (Mammogram, DIGITIZED)
CL Item
Mammogram, Wolfe (Mammogram, WOLFE)
CL Item
Mastectomy (Mastectomy)
C15277 (NCI Thesaurus)
C0024881 (UMLS 2011AA)
CL Item
Magnetic Resonance Imaging (MRI)
C16809 (NCI Thesaurus)
C0024485 (UMLS 2011AA)
CL Item
Magnetic Resonance Spectroscopy (MRS)
CL Item
Multi-gated Acquisition Scan (MUGA)
CL Item
Nasopharyngeal Laryngoscopy (Nasopharyngeal Laryngoscopy)
CL Item
Nasopharyngoscopy (Nasopharyngoscopy)
CL Item
Nipple Suction Aspirate (Nipple Suction Aspirate)
CL Item
Ommaya Resevoir Tap (Ommaya Resevoir Tap)
CL Item
Papanicolaou Test (PAP)
CL Item
Paracentesis (Paracentesis)
C15310 (NCI Thesaurus)
C0034115 (UMLS 2011AA)
CL Item
Physical Examination (PE)
C20989 (NCI Thesaurus)
C0031809 (UMLS 2011AA)
CL Item
Pelvic Exam (Pelvic Exam)
CL Item
Peritoneoscopy (Peritoneoscopy)
CL Item
Positron Emission Tomography (PET)
C17007 (NCI Thesaurus)
C0032743 (UMLS 2011AA)
CL Item
Positron Emission Tomography Computerized Tomography (PET CT)
CL Item
Positron Emission Tomography With Fdg (PET, FDG)
CL Item
Positron Emission Tomography With O-15 Water (h2o15) (PET, H2O15)
CL Item
Pulmonary Function Test Interpretation (PFT Interpretation)
CL Item
Pulmonary Function Test/carbon Monoxide Diffusing Capability (PFT/DLCO)
CL Item
Pulmonary Function Test/forced Expiratory Volume 1 (PFT/FEV1)
CL Item
Pulmonary Function Test/ Inspired Oxygen Fraction (PFT/FIO2)
CL Item
Photography (Photography)
CL Item
Pleurodesis (Pleurodesis)
C0189557 (NCI Metathesaurus)
CL Item
Portacath Placement (Portacath Placement)
CL Item
Percutaneous Transluminal Coronary Angioplasty (PTCA)
C38078 (NCI Thesaurus)
C2936173 (UMLS 2011AA)
CL Item
Pulse Oximetry (Pulse Oximetry)
CL Item
Renogram (Renogram)
CL Item
Resection (Resection)
CL Item
Radiofrequency Ablation (RFA)
C0850292 (NCI Metathesaurus)
CL Item
Imaging Scan (Scan)
CL Item
Scan, Blood Oxygenated Level Dependant (bold) (Scan, BOLD)
CL Item
Scan, Dynamic Contrast-enhanced Magnetic Resonance Imaging (Scan, DCE MRI)
CL Item
Scan, Dual-energy X-ray Absorpitometry (Scan, DEXA)
CL Item
Scan, Gallium (Scan, Gallium)
CL Item
Scan, Iodine 123 Uptake (Scan, I 123 Uptake)
CL Item
Scan, I 131 Uptake (Scan, I 131 Uptake)
CL Item
Scan, Indium (Scan, Indium WBC)
CL Item
Scan, Lung Perfusion (Scan, Lung Perfusion)
CL Item
Scan, Sestamibi (Scan, Sestamibi)
CL Item
Scan, Spiral Ct (Scan, Spiral CT)
CL Item
Ventilation-perfusion Scan (Scan, VQ)
CL Item
Scraping (Scraping)
CL Item
Sigmoidoscopy (Sigmoidoscopy)
CL Item
Skeletal Survey (Skeletal Survey)
CL Item
Skin Test (Skin Test)
CL Item
Splenectomy (Splenectomy)
CL Item
Stress Thallium Test (Stress Thallium Test)
CL Item
Swallow Evaluation (Swallow Evaluation)
CL Item
Thoracentesis (Thoracentesis)
C15392 (NCI Thesaurus)
C0189477 (UMLS 2011AA)
CL Item
Tomogram (Tomogram)
CL Item
Transrectal Ultrasound (Transrect US)
C18315 (NCI Thesaurus)
C0373345 (UMLS 2011AA)
CL Item
Upper Gastrointestinal Series (UGI)
CL Item
Upper Gastrointestinal Series W/small Bowel Follow Through (UGI/w sm bowel f/t)
CL Item
Ultrasound (Ultrasound)
C64384 (NCI Thesaurus)
C1456803 (UMLS 2011AA)
CL Item
Urine Casts (Urine Casts)
CL Item
Vascular Access Device Placement (VAD Placement)
CL Item
Vaginogram (Vaginogram)
CL Item
Venacavagrm (Venacavagrm)
CL Item
Venogram (Venogram)
CL Item
X-ray (X-Ray)
C17262 (NCI Thesaurus)
C0017011 (UMLS 2011AA)
CardiacPreejectionPeriodPercentage
Item
Cardiac Preejection Period Percentage
double
C13306 (NCI Thesaurus ObjectClass)
C1522601 (UMLS 2011AA ObjectClass)
C0392912 (NCI Metathesaurus ObjectClass)
CL235601 (NCI Metathesaurus Property)
C25613 (NCI Thesaurus ValueDomain)
C0439165 (UMLS 2011AA ValueDomain)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
EjectionFractionResultPercentageValue
Item
LV Ejection Fraction
double
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C25613 (NCI Thesaurus ValueDomain)
C0439165 (UMLS 2011AA ValueDomain)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
LeftVentricularEjectionTimeMeasurementMillisecondNumber
Item
LV Ejection Time
double
C25207 (NCI Thesaurus ObjectClass)
C0040223 (UMLS 2011AA ObjectClass)
C37946 (NCI Thesaurus ObjectClass)
C2700377 (UMLS 2011AA ObjectClass)
C25209 (NCI Thesaurus Property)
C0242485 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25207 (NCI Thesaurus ValueDomain)
C0040223 (UMLS 2011AA ValueDomain)
C41140 (NCI Thesaurus ValueDomain)
C0439223 (UMLS 2011AA ValueDomain)
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)
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