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43498

Description

RTOG-00522 HP: Radiation Therapy Oncology Group Miscellaneous Patient Assessment Form NCT00265941 Radiation Therapy and Cisplatin With or Without Cetuximab in Treating Patients With Stage III or Stage IV Head and Neck Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=F5E8260F-4AEB-157F-E034-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=F5E8260F-4AEB-157F-E034-0003BA3F9857

Keywords

Versions (6)
  1. 9/19/12 9/19/12 -
  2. 8/11/14 8/11/14 - Martin Dugas
  3. 8/11/14 8/11/14 - Martin Dugas
  4. 1/9/15 1/9/15 - Martin Dugas
  5. 6/21/15 6/21/15 -
  6. 9/20/21 9/20/21 -
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September 20, 2021

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Creative Commons BY-NC 3.0 Legacy
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    RTOG-0522 HP: Radiation Therapy Oncology Group Miscellaneous Patient Assessment Form NCT00265941

    English

    No Instruction available.

    1 forms  
    1. StudyEvent: RTOG-0522 HP: Radiation Therapy Oncology Group Miscellaneous Patient Assessment Form
      1. No Instruction available.
    RTOG clinical trial administrative data
    Description

    RTOG clinical trial administrative data

    RTOG Study No.
    Description

    Protocol ID RTOG

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C3274381
    NCI Thesaurus ObjectClass
    C25320
    UMLS CUI-2
    C1514695
    NCI Thesaurus Property
    C19778
    NCI Thesaurus Property-2
    C25364
    Case #
    Description

    RadiationTherapyOncologyGroupPatientCaseIdentifierNumber

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus ObjectClass-2
    C19778
    UMLS 2011AA ObjectClass-2
    C1514695
    NCI Thesaurus Property
    C25364
    UMLS 2011AA Property
    C0600091
    NCI Thesaurus Property-2
    C49152
    UMLS 2011AA Property-2
    C1706256
    NCI Thesaurus ValueDomain
    C25337
    UMLS 2011AA ValueDomain
    C0237753
    Institution Name
    Description

    Institution Name

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C1301943
    NCI Thesaurus ObjectClass
    C21541
    NCI Thesaurus ValueDomain-2
    C21541
    NCI Thesaurus Property
    C25364
    Institution No.
    Description

    Institution Number

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C1301943
    NCI Thesaurus ObjectClass
    C21541
    UMLS CUI-2
    C0805701
    NCI Thesaurus Property
    C25364
    Patient Initials
    Description

    Patient Initials

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2986440
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25536
    RTOG Patient ID
    Description

    Trial subject ID RTOG

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2348585
    NCI Thesaurus ObjectClass
    C16960
    UMLS CUI-2
    C1514695
    NCI Thesaurus Property
    C19778
    NCI Thesaurus Property-2
    C25364
    Amended data
    Description

    Data amended

    Data type

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS CUI-1
    C0680532
    NCI Thesaurus ObjectClass
    C25474
    NCI Thesaurus Property
    C25416
    Miscellaneous Patient Assessment
    Description

    Miscellaneous Patient Assessment

    MOBILITY
    Description

    QOLMobilityAssessmentStatus

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C17047
    UMLS 2011AA ObjectClass
    C0518214
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus ValueDomain
    C25688
    UMLS 2011AA ValueDomain
    C0449438
    NCI Metathesaurus Property
    C0449580
    SELF CARE
    Description

    QualityofLifeSelfCareAssessmentStatus

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C17047
    UMLS 2011AA ObjectClass
    C0518214
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus ValueDomain
    C25688
    UMLS 2011AA ValueDomain
    C0449438
    NCI Thesaurus Property-2
    C15324
    UMLS 2011AA Property-2
    C0518889
    USUAL ACTIVITIES (e.g. work, study, housework, family, or leisure activities)
    Description

    QOLPhyscialActivityAssessmentStatus

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C17047
    UMLS 2011AA ObjectClass
    C0518214
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus Property-2
    C17708
    UMLS 2011AA Property-2
    C0026606
    NCI Thesaurus ValueDomain
    C25688
    UMLS 2011AA ValueDomain
    C0449438
    PAIN/DISCOMFORT
    Description

    QOLPainAssessmentStatus

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C17047
    UMLS 2011AA ObjectClass
    C0518214
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus Property-2
    C3303
    UMLS 2011AA Property-2
    C0030193
    NCI Thesaurus ValueDomain
    C25688
    UMLS 2011AA ValueDomain
    C0449438
    ANXIETY/DEPRESSION
    Description

    QOLAnxietyAssessmentStatus

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C17047
    UMLS 2011AA ObjectClass
    C0518214
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus Property-2
    C26696
    UMLS 2011AA Property-2
    C0003467
    NCI Thesaurus ValueDomain
    C25688
    UMLS 2011AA ValueDomain
    C0449438
    Score (Best Imaginable Health State)
    Description

    PatientHealthScore

    Data type

    float

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25178
    UMLS 2011AA Property
    C0018684
    NCI Thesaurus ValueDomain
    C25338
    UMLS 2011AA ValueDomain
    C0449820
    HAVE YOU EXPERIENCED SERIOUS ILLNESS In yourself?
    Description

    PatientSeriousSicknessInd-2

    Data type

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C54035
    UMLS 2011AA Property
    C0205404
    NCI Metathesaurus Property
    C0221423
    HAVE YOU EXPERIENCED SERIOUS ILLNESS In your family?
    Description

    ImmediateSeriousSicknessInd-2

    Data type

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    NCI Thesaurus Property
    C54035
    UMLS 2011AA Property
    C0205404
    NCI Metathesaurus ObjectClass
    CL282488
    NCI Metathesaurus Property
    C0221423
    HAVE YOU EXPERIENCED SERIOUS ILLNESS In caring for others?
    Description

    CareAssistantPatientSeriousSicknessInd-2

    Data type

    boolean

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Metathesaurus ObjectClass
    CL259930
    NCI Thesaurus Property
    C54035
    UMLS 2011AA Property
    C0205404
    NCI Metathesaurus Property
    C0221423
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    WHAT IS YOUR AGE IN YEARS?
    Description

    PatientAgeYearCount

    Data type

    float

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus ValueDomain
    C29848
    UMLS 2011AA ValueDomain
    C0439234
    NCI Thesaurus ValueDomain-2
    C25463
    UMLS 2011AA ValueDomain-2
    C0750480
    NCI Thesaurus Property
    C25150
    UMLS 2011AA Property
    C0001779
    Are you
    Description

    QualityofLifePatientGenderAssessmentCategory

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C17047
    UMLS 2011AA ObjectClass
    C0518214
    NCI Thesaurus ObjectClass-2
    C16960
    UMLS 2011AA ObjectClass-2
    C0030705
    NCI Thesaurus ObjectClass-3
    C17357
    UMLS 2011AA ObjectClass-3
    C0079399
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus ValueDomain
    C25372
    UMLS 2011AA ValueDomain
    C0683312
    ARE YOU A current smoker
    Description

    Current Smoker

    Data type

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS CUI-1
    C3241966
    NCI Thesaurus Property
    C25471
    NCI Thesaurus ObjectClass
    C17934
    NCI Metathesaurus Property
    C0449865
    ARE YOU An ex-smoker
    Description

    Smoking use

    Data type

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS CUI-1
    C3241966
    NCI Thesaurus ObjectClass
    C17934
    NCI Thesaurus Property
    C25340
    ARE YOU A never smoker
    Description

    NoSmokingHistoryInd-2

    Data type

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    NCI Thesaurus ObjectClass
    C49487
    UMLS 2011AA ObjectClass
    C1298908
    NCI Thesaurus ObjectClass-2
    C17934
    UMLS 2011AA ObjectClass-2
    C0453996
    NCI Thesaurus Property
    C18772
    UMLS 2011AA Property
    C0262926
    DO YOU NOW, OR DID YOU EVER, WORK IN HEALTH OR SOCIAL SERVICES?
    Description

    SocialWorkHistoryInd-2

    Data type

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    NCI Thesaurus Property
    C18772
    UMLS 2011AA Property
    C0262926
    NCI Thesaurus ObjectClass
    C17142
    UMLS 2011AA ObjectClass
    C0037441
    IF SO, IN WHAT CAPACITY?
    Description

    SocialWorkHistoryRoleSpecify

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    UMLS 2011AA ValueDomain
    C1521902
    NCI Thesaurus Property
    C18772
    UMLS 2011AA Property
    C0262926
    NCI Thesaurus ObjectClass
    C17142
    UMLS 2011AA ObjectClass
    C0037441
    NCI Thesaurus ValueDomain-2
    C25199
    UMLS 2011AA ValueDomain-2
    C0035820
    WHICH OF THE FOLLOWING BEST DESCRIBES YOUR MAIN ACTIVITY?
    Description

    PersonOccupationType

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    NCI Thesaurus ObjectClass
    C25190
    UMLS 2011AA ObjectClass
    C0027361
    NCI Thesaurus Property
    C25193
    UMLS 2011AA Property
    C0028811
    Other
    Description

    PersonOccupationSpecify

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    UMLS 2011AA ValueDomain
    C1521902
    NCI Thesaurus ObjectClass
    C25190
    UMLS 2011AA ObjectClass
    C0027361
    NCI Thesaurus Property
    C25193
    UMLS 2011AA Property
    C0028811
    DID YOUR EDUCATION CONTINUE AFTER THE MINIMUM SCHOOL LEAVING AGE?
    Description

    ContinuedEducationMinimumAgeatLeavingSchoolInd-2

    Data type

    boolean

    Alias
    NCI Thesaurus ObjectClass
    C16529
    UMLS 2011AA ObjectClass
    C0013622
    NCI Metathesaurus ObjectClass
    C0750536
    NCI Thesaurus Property
    C25570
    UMLS 2011AA Property
    C1524031
    NCI Metathesaurus Property
    CL238333
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    DO YOU HAVE A DEGREE OR EQUIVALENT PROFESSIONAL QUALIFICATION?
    Description

    PatientEducationalStatusInd-2

    Data type

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Metathesaurus Property
    C0013658
    IF YOU KNOW YOUR POSTCODE, WOULD YOU PLEASE WRITE IT HERE
    Description

    QualityofLifePatientAddressPostalCode

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C17047
    UMLS 2011AA ObjectClass
    C0518214
    NCI Thesaurus ObjectClass-2
    C16960
    UMLS 2011AA ObjectClass-2
    C0030705
    NCI Metathesaurus ObjectClass
    C1442065
    NCI Thesaurus Property
    C25621
    UMLS 2011AA Property
    C1514254
    NCI Thesaurus ValueDomain
    C25162
    UMLS 2011AA ValueDomain
    C0805701
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    1 forms
    1. StudyEvent: RTOG-0522 HP: Radiation Therapy Oncology Group Miscellaneous Patient Assessment Form
      1. No Instruction available.
    Name
    Type
    Description | Question | Decode (Coded Value)
    Data type
    Alias
    Item Group
    RTOG clinical trial administrative data
    Protocol ID RTOG
    Item
    RTOG Study No.
    text
    C25337 (NCI Thesaurus ValueDomain)
    C3274381 (UMLS CUI-1)
    C25320 (NCI Thesaurus ObjectClass)
    C1514695 (UMLS CUI-2)
    C19778 (NCI Thesaurus Property)
    C25364 (NCI Thesaurus Property-2)
    RadiationTherapyOncologyGroupPatientCaseIdentifierNumber
    Item
    Case #
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C19778 (NCI Thesaurus ObjectClass-2)
    C1514695 (UMLS 2011AA ObjectClass-2)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    C49152 (NCI Thesaurus Property-2)
    C1706256 (UMLS 2011AA Property-2)
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    Institution Name
    Item
    Institution Name
    text
    C25191 (NCI Thesaurus ValueDomain)
    C1301943 (UMLS CUI-1)
    C21541 (NCI Thesaurus ObjectClass)
    C21541 (NCI Thesaurus ValueDomain-2)
    C25364 (NCI Thesaurus Property)
    Institution Number
    Item
    Institution No.
    text
    C25337 (NCI Thesaurus ValueDomain)
    C1301943 (UMLS CUI-1)
    C21541 (NCI Thesaurus ObjectClass)
    C0805701 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    Patient Initials
    Item
    Patient Initials
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2986440 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25536 (NCI Thesaurus Property)
    Trial subject ID RTOG
    Item
    RTOG Patient ID
    text
    C25337 (NCI Thesaurus ValueDomain)
    C2348585 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C1514695 (UMLS CUI-2)
    C19778 (NCI Thesaurus Property)
    C25364 (NCI Thesaurus Property-2)
    Data amended
    Item
    Amended data
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C0680532 (UMLS CUI-1)
    C25474 (NCI Thesaurus ObjectClass)
    C25416 (NCI Thesaurus Property)
    Item Group
    Miscellaneous Patient Assessment
    Item
    MOBILITY
    text
    C17047 (NCI Thesaurus ObjectClass)
    C0518214 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C25688 (NCI Thesaurus ValueDomain)
    C0449438 (UMLS 2011AA ValueDomain)
    C0449580 (NCI Metathesaurus Property)
    CL.2
    Code List
    MOBILITY
    CL Item
    I Have No Problems In Walking About (I have no problems in walking about)
    CL Item
    I Have Some Problems In Walking About (I have some problems in walking about)
    CL Item
    I Am Confined To Bed (I am confined to bed)
    Item
    SELF CARE
    text
    C17047 (NCI Thesaurus ObjectClass)
    C0518214 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C25688 (NCI Thesaurus ValueDomain)
    C0449438 (UMLS 2011AA ValueDomain)
    C15324 (NCI Thesaurus Property-2)
    C0518889 (UMLS 2011AA Property-2)
    CL.3
    Code List
    SELF CARE
    CL Item
    I Have No Problems With Self Care (I have no problems with self care)
    CL Item
    I Have Some Problems Washing Or Dressing Myself (I have some problems washing or dressing myself)
    CL Item
    I Am Unable To Wash Or Dress Myself (I am unable to wash or dress myself)
    Item
    USUAL ACTIVITIES (e.g. work, study, housework, family, or leisure activities)
    text
    C17047 (NCI Thesaurus ObjectClass)
    C0518214 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C17708 (NCI Thesaurus Property-2)
    C0026606 (UMLS 2011AA Property-2)
    C25688 (NCI Thesaurus ValueDomain)
    C0449438 (UMLS 2011AA ValueDomain)
    CL.4
    Code List
    USUAL ACTIVITIES (e.g. work, study, housework, family, or leisure activities)
    CL Item
    I Have No Problems With Performing My Usual Activities (I have no problems with performing my usual activities)
    CL Item
    I Have Some Problems With Performing My Usual Activities (I have some problems with performing my usual activities)
    CL Item
    I Am Unable To Perform My Usual Activities (I am unable to perform my usual activities)
    Item
    PAIN/DISCOMFORT
    text
    C17047 (NCI Thesaurus ObjectClass)
    C0518214 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C3303 (NCI Thesaurus Property-2)
    C0030193 (UMLS 2011AA Property-2)
    C25688 (NCI Thesaurus ValueDomain)
    C0449438 (UMLS 2011AA ValueDomain)
    CL.5
    Code List
    PAIN/DISCOMFORT
    CL Item
    I Have No Pain Or Discomfort (I have no pain or discomfort)
    CL Item
    I Have Moderate Pain Or Discomfort (I have moderate pain or discomfort)
    CL Item
    I Have Extreme Pain Or Discomfort (I have extreme pain or discomfort)
    Item
    ANXIETY/DEPRESSION
    text
    C17047 (NCI Thesaurus ObjectClass)
    C0518214 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C26696 (NCI Thesaurus Property-2)
    C0003467 (UMLS 2011AA Property-2)
    C25688 (NCI Thesaurus ValueDomain)
    C0449438 (UMLS 2011AA ValueDomain)
    CL.6
    Code List
    ANXIETY/DEPRESSION
    CL Item
    I Am Not Anxious Or Depressed (I am not anxious or depressed)
    CL Item
    I Am Moderately Anxious Or Depressed (I am moderately anxious or depressed)
    CL Item
    I Am Extremely Anxious Or Depressed (I am extremely anxious or depressed)
    PatientHealthScore
    Item
    Score (Best Imaginable Health State)
    float
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25178 (NCI Thesaurus Property)
    C0018684 (UMLS 2011AA Property)
    C25338 (NCI Thesaurus ValueDomain)
    C0449820 (UMLS 2011AA ValueDomain)
    PatientSeriousSicknessInd-2
    Item
    HAVE YOU EXPERIENCED SERIOUS ILLNESS In yourself?
    boolean
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C54035 (NCI Thesaurus Property)
    C0205404 (UMLS 2011AA Property)
    C0221423 (NCI Metathesaurus Property)
    ImmediateSeriousSicknessInd-2
    Item
    HAVE YOU EXPERIENCED SERIOUS ILLNESS In your family?
    boolean
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    C54035 (NCI Thesaurus Property)
    C0205404 (UMLS 2011AA Property)
    CL282488 (NCI Metathesaurus ObjectClass)
    C0221423 (NCI Metathesaurus Property)
    CareAssistantPatientSeriousSicknessInd-2
    Item
    HAVE YOU EXPERIENCED SERIOUS ILLNESS In caring for others?
    boolean
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    CL259930 (NCI Metathesaurus ObjectClass)
    C54035 (NCI Thesaurus Property)
    C0205404 (UMLS 2011AA Property)
    C0221423 (NCI Metathesaurus Property)
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    PatientAgeYearCount
    Item
    WHAT IS YOUR AGE IN YEARS?
    float
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C29848 (NCI Thesaurus ValueDomain)
    C0439234 (UMLS 2011AA ValueDomain)
    C25463 (NCI Thesaurus ValueDomain-2)
    C0750480 (UMLS 2011AA ValueDomain-2)
    C25150 (NCI Thesaurus Property)
    C0001779 (UMLS 2011AA Property)
    Item
    Are you
    text
    C17047 (NCI Thesaurus ObjectClass)
    C0518214 (UMLS 2011AA ObjectClass)
    C16960 (NCI Thesaurus ObjectClass-2)
    C0030705 (UMLS 2011AA ObjectClass-2)
    C17357 (NCI Thesaurus ObjectClass-3)
    C0079399 (UMLS 2011AA ObjectClass-3)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C25372 (NCI Thesaurus ValueDomain)
    C0683312 (UMLS 2011AA ValueDomain)
    CL.10
    Code List
    Are you
    CL Item
    Female (FEMALE)
    C46110 (NCI Thesaurus)
    C0086287 (UMLS 2011AA)
    CL Item
    Male (MALE)
    C46109 (NCI Thesaurus)
    C1706180 (UMLS 2011AA)
    Current Smoker
    Item
    ARE YOU A current smoker
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C3241966 (UMLS CUI-1)
    C25471 (NCI Thesaurus Property)
    C17934 (NCI Thesaurus ObjectClass)
    C0449865 (NCI Metathesaurus Property)
    Smoking use
    Item
    ARE YOU An ex-smoker
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C3241966 (UMLS CUI-1)
    C17934 (NCI Thesaurus ObjectClass)
    C25340 (NCI Thesaurus Property)
    NoSmokingHistoryInd-2
    Item
    ARE YOU A never smoker
    boolean
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    C49487 (NCI Thesaurus ObjectClass)
    C1298908 (UMLS 2011AA ObjectClass)
    C17934 (NCI Thesaurus ObjectClass-2)
    C0453996 (UMLS 2011AA ObjectClass-2)
    C18772 (NCI Thesaurus Property)
    C0262926 (UMLS 2011AA Property)
    SocialWorkHistoryInd-2
    Item
    DO YOU NOW, OR DID YOU EVER, WORK IN HEALTH OR SOCIAL SERVICES?
    boolean
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    C18772 (NCI Thesaurus Property)
    C0262926 (UMLS 2011AA Property)
    C17142 (NCI Thesaurus ObjectClass)
    C0037441 (UMLS 2011AA ObjectClass)
    SocialWorkHistoryRoleSpecify
    Item
    IF SO, IN WHAT CAPACITY?
    text
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    C18772 (NCI Thesaurus Property)
    C0262926 (UMLS 2011AA Property)
    C17142 (NCI Thesaurus ObjectClass)
    C0037441 (UMLS 2011AA ObjectClass)
    C25199 (NCI Thesaurus ValueDomain-2)
    C0035820 (UMLS 2011AA ValueDomain-2)
    Item
    WHICH OF THE FOLLOWING BEST DESCRIBES YOUR MAIN ACTIVITY?
    text
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    C25190 (NCI Thesaurus ObjectClass)
    C0027361 (UMLS 2011AA ObjectClass)
    C25193 (NCI Thesaurus Property)
    C0028811 (UMLS 2011AA Property)
    CL.15
    Code List
    WHICH OF THE FOLLOWING BEST DESCRIBES YOUR MAIN ACTIVITY?
    CL Item
    Employed (In employment or self employment)
    CL Item
    Homemaker (Housework)
    C0555052 (NCI Metathesaurus)
    CL Item
    Other (Other)
    C17649 (NCI Thesaurus)
    C0205394 (UMLS 2011AA)
    CL Item
    Retired (Retired)
    CL Item
    Unemployed (Seeking work)
    C0425086 (NCI Metathesaurus)
    CL Item
    Student (Student)
    PersonOccupationSpecify
    Item
    Other
    text
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    C25190 (NCI Thesaurus ObjectClass)
    C0027361 (UMLS 2011AA ObjectClass)
    C25193 (NCI Thesaurus Property)
    C0028811 (UMLS 2011AA Property)
    ContinuedEducationMinimumAgeatLeavingSchoolInd-2
    Item
    DID YOUR EDUCATION CONTINUE AFTER THE MINIMUM SCHOOL LEAVING AGE?
    boolean
    C16529 (NCI Thesaurus ObjectClass)
    C0013622 (UMLS 2011AA ObjectClass)
    C0750536 (NCI Metathesaurus ObjectClass)
    C25570 (NCI Thesaurus Property)
    C1524031 (UMLS 2011AA Property)
    CL238333 (NCI Metathesaurus Property)
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    PatientEducationalStatusInd-2
    Item
    DO YOU HAVE A DEGREE OR EQUIVALENT PROFESSIONAL QUALIFICATION?
    boolean
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C0013658 (NCI Metathesaurus Property)
    QualityofLifePatientAddressPostalCode
    Item
    IF YOU KNOW YOUR POSTCODE, WOULD YOU PLEASE WRITE IT HERE
    text
    C17047 (NCI Thesaurus ObjectClass)
    C0518214 (UMLS 2011AA ObjectClass)
    C16960 (NCI Thesaurus ObjectClass-2)
    C0030705 (UMLS 2011AA ObjectClass-2)
    C1442065 (NCI Metathesaurus ObjectClass)
    C25621 (NCI Thesaurus Property)
    C1514254 (UMLS 2011AA Property)
    C25162 (NCI Thesaurus ValueDomain)
    C0805701 (UMLS 2011AA ValueDomain)
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