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ID

43328

Descrição

Physical Exam Screening form for C3D 3.12 Adopters Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FEF2E3DC-3E2D-329B-E034-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FEF2E3DC-3E2D-329B-E034-0003BA3F9857

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Versões (2)
  1. 19/09/2012 19/09/2012 -
  2. 20/09/2021 20/09/2021 -
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20 de setembro de 2021

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Creative Commons BY-NC 3.0 Legacy
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    On-Study - PHYSICAL EXAM SCREEN - 2390964v1.0

    Inglês

    Dates will appear as 'DD-MON-YYYY'

    1 Formulários  
    1. StudyEvent: PHYSICAL EXAM SCREEN
      1. Dates will appear as 'DD-MON-YYYY'
    Physical Exam--screening
    Descrição

    Physical Exam--screening

    Evaluation Date
    Descrição

    EvaluationDate

    Tipo de dados

    date

    Alias
    NCI Thesaurus Property
    C25164 (undefined)
    UMLS 2011AA Property
    C0011008 (Date in time)
    SNOMED
    410671006
    NCI Thesaurus ValueDomain
    C25164 (undefined)
    UMLS 2011AA ValueDomain
    C0011008 (Date in time)
    SNOMED
    410671006
    NCI Thesaurus ObjectClass
    C25214 (undefined)
    UMLS 2011AA ObjectClass
    C0220825 (Evaluation)
    LOINC
    LP36377-7
    Body System Type
    Descrição

    BodySystemType

    Tipo de dados

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284 (undefined)
    UMLS 2011AA ValueDomain
    C0332307 (Type - attribute)
    SNOMED
    261664005
    NCI Thesaurus ObjectClass
    C13041 (undefined)
    UMLS 2011AA ObjectClass
    C1268086 (Body structure)
    SNOMED
    123037004
    LOINC
    LP28569-9
    NCI Thesaurus Property
    C25700 (undefined)
    UMLS 2011AA Property
    C0449913 (System)
    SNOMED
    246333005
    Finding Results Indicator
    Descrição

    FindingResultIndicator

    Tipo de dados

    text

    Alias
    NCI Thesaurus ValueDomain
    C20200 (undefined)
    UMLS 2011AA ValueDomain
    C1274040 (Result)
    SNOMED
    394617004
    NCI Thesaurus ObjectClass
    C3367 (undefined)
    UMLS 2011AA ObjectClass
    C0037088 (Signs and Symptoms)
    SNOMED
    404684003
    LOINC
    LP185402-7
    NCI Metathesaurus Property
    CL282989 (undefined)
    Comment Change From Baseline Text
    Descrição

    CommentChangeFromBaselineText

    Tipo de dados

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704 (undefined)
    UMLS 2011AA ValueDomain
    C1527021 (Text)
    LOINC
    LP6885-0
    NCI Thesaurus ObjectClass
    C25213 (undefined)
    UMLS 2011AA ObjectClass
    C1442488 (Baseline)
    LOINC
    LA16758-7
    NCI Thesaurus ObjectClass
    C25446 (undefined)
    UMLS 2011AA ObjectClass
    C0392747 (Changing)
    SNOMED
    18307000
    NCI Metathesaurus Property
    C0947611 (Comment)
    LOINC
    LP72293-1
    Comments
    Descrição

    Comments

    Note Date
    Descrição

    NoteDate

    Tipo de dados

    date

    Alias
    NCI Thesaurus Property
    C25164 (undefined)
    UMLS 2011AA Property
    C0011008 (Date in time)
    SNOMED
    410671006
    NCI Thesaurus ValueDomain
    C25164 (undefined)
    UMLS 2011AA ValueDomain
    C0011008 (Date in time)
    SNOMED
    410671006
    NCI Metathesaurus ObjectClass
    C1317574 (Note (document))
    LOINC
    LP72988-6
    Research Comments Text
    Descrição

    ResearchCommentsText

    Tipo de dados

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704 (undefined)
    UMLS 2011AA ValueDomain
    C1527021 (Text)
    LOINC
    LP6885-0
    NCI Thesaurus ObjectClass
    C15319 (undefined)
    NCI Thesaurus Property
    C25393 (undefined)
    UMLS 2011AA Property
    C0282411 (Published Comment)
    LOINC
    MTHU018874
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    Similar models

    Dates will appear as 'DD-MON-YYYY'

    1 Formulários
    1. StudyEvent: PHYSICAL EXAM SCREEN
      1. Dates will appear as 'DD-MON-YYYY'
    Name
    Tipo
    Description | Question | Decode (Coded Value)
    Tipo de dados
    Alias
    Item Group
    Physical Exam--screening
    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)
    Item
    Finding Results Indicator
    text
    C20200 (NCI Thesaurus ValueDomain)
    C1274040 (UMLS 2011AA ValueDomain)
    C3367 (NCI Thesaurus ObjectClass)
    C0037088 (UMLS 2011AA ObjectClass)
    CL282989 (NCI Metathesaurus Property)
    CL.2
    Code List
    Finding Results Indicator
    CL Item
    Abnormal (A)
    C25401 (NCI Thesaurus)
    C0205161 (UMLS 2011AA)
    CL Item
    No Change (C)
    CL Item
    Equivocal (E)
    C86071 (NCI Thesaurus)
    C0332241 (UMLS 2011AA)
    CL Item
    Negative (G)
    C25247 (NCI Thesaurus)
    C0205160 (UMLS 2011AA)
    CL Item
    Improving (I)
    C94226 (NCI Thesaurus)
    CL Item
    Not Applicable (L)
    C48660 (NCI Thesaurus)
    C1272460 (UMLS 2011AA)
    CL Item
    Normal (N)
    C14165 (NCI Thesaurus)
    C0205307 (UMLS 2011AA)
    CL Item
    No Source Data (O)
    C53269 (NCI Thesaurus)
    C1546437 (UMLS 2011AA)
    CL Item
    Positive (P)
    C25246 (NCI Thesaurus)
    C1446409 (UMLS 2011AA)
    CL Item
    Stable (S)
    C30103 (NCI Thesaurus)
    C0205360 (UMLS 2011AA)
    CL Item
    Unstable (U)
    CL Item
    Not Evaluable (V)
    CL Item
    Worse (W)
    C71686 (NCI Thesaurus)
    C1457868 (UMLS 2011AA)
    CL Item
    Not Examined (X)
    CommentChangeFromBaselineText
    Item
    Comment Change From Baseline Text
    text
    C25704 (NCI Thesaurus ValueDomain)
    C1527021 (UMLS 2011AA ValueDomain)
    C25213 (NCI Thesaurus ObjectClass)
    C1442488 (UMLS 2011AA ObjectClass)
    C25446 (NCI Thesaurus ObjectClass)
    C0392747 (UMLS 2011AA ObjectClass)
    C0947611 (NCI Metathesaurus Property)
    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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