ID
43512
Descrição
USMCI 8214/Z6091: Tissue Sample Submission Form NCT01167725 Standard Therapy With or Without Surgery and Mitomycin C in Treating Patients With Advanced Limited Peritoneal Dissemination of Colon Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=62328DCB-01DD-B01D-E040-BB89AD435CDE
Link
Palavras-chave
Versões (4)
- 27/08/2012 27/08/2012 -
- 09/01/2015 09/01/2015 - Martin Dugas
- 21/06/2015 21/06/2015 -
- 20/09/2021 20/09/2021 -
Transferido a
20 de setembro de 2021
DOI
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Licença
Creative Commons BY-NC 3.0 Legacy
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USMCI 8214/Z6091: Tissue Sample Submission Form NCT01167725
INSTRUCTIONS: For patients in group 2 who consented to tissue specimen collection, submit form via RDC at time of cytoreductive surgery. Form must also accompany specimen. Complete all requested information for each tissue submitted
- StudyEvent: USMCI 8214/Z6091: Tissue Sample Submission Form
Descrição
Biopsy specimen
Descrição
SpecimenSubmittedType
Tipo de dados
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus ObjectClass
- C19157
- UMLS 2011AA ObjectClass
- C0370003
- NCI Thesaurus Property
- C25695
- UMLS 2011AA Property
- C1515023
Descrição
SpecimenMalignantNeoplasmSubmissionGastrointestinalType
Tipo de dados
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus Property
- C9305
- UMLS 2011AA Property
- C0006826
- NCI Thesaurus ObjectClass
- C19157
- UMLS 2011AA ObjectClass
- C0370003
- NCI Thesaurus Property-2
- C25695
- UMLS 2011AA Property-2
- C1515023
Descrição
SpecimenCollectedDate
Tipo de dados
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ObjectClass
- C19157
- UMLS 2011AA ObjectClass
- C0370003
- NCI Thesaurus Property
- C25452
- NCI Thesaurus Property-2
- C25275
- UMLS 2011AA Property
- C2745955
Descrição
SpecimenBlocksSlideSubmissionCount
Tipo de dados
float
Alias
- NCI Thesaurus ObjectClass
- C19157
- UMLS 2011AA ObjectClass
- C0370003
- NCI Thesaurus Property
- C25325
- UMLS 2011AA Property
- C1705201
- NCI Thesaurus Property-2
- C25436
- UMLS 2011AA Property-2
- C1533157
- NCI Thesaurus Property-3
- C25694
- UMLS 2011AA Property-3
- C1515022
- NCI Thesaurus ValueDomain
- C25463
- UMLS 2011AA ValueDomain
- C0750480
Descrição
SpecimenAccessionNumber
Tipo de dados
float
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
- NCI Thesaurus ObjectClass
- C19157
- UMLS 2011AA ObjectClass
- C0370003
- NCI Thesaurus Property
- C25402
- UMLS 2011AA Property
- C1510755
Descrição
SpecimenResectionWeightMeasurement
Tipo de dados
float
Unidades de medida
- gm
Alias
- NCI Thesaurus ValueDomain
- C25209
- UMLS 2011AA ValueDomain
- C0242485
- NCI Thesaurus Property
- C25208
- UMLS 2011AA Property
- C0043100
- NCI Thesaurus Property-2
- C15232
- UMLS 2011AA Property-2
- C0728940
- NCI Thesaurus ObjectClass
- C19157
- UMLS 2011AA ObjectClass
- C0370003
Descrição
Footern Module
Descrição
Person Completing Form First Name
Tipo de dados
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS CUI-1
- C1550483
- NCI Thesaurus ObjectClass-2
- C25657
- UMLS CUI-2
- C1443235
- NCI Thesaurus Property
- C25364
- NCI Thesaurus Property-2
- C25509
- NCI Thesaurus ValueDomain
- C25191
Descrição
Person Completing Form Last Name
Tipo de dados
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS CUI-1
- C1550483
- NCI Thesaurus ObjectClass-2
- C25657
- UMLS CUI-2
- C1301584
- NCI Thesaurus Property
- C25364
- NCI Thesaurus Property-2
- C25551
- NCI Thesaurus ValueDomain
- C25191
Descrição
SpecimenLabSubmittedDate
Tipo de dados
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus Property
- C25294
- UMLS 2011AA Property
- C0022885
- NCI Thesaurus ObjectClass
- C19157
- UMLS 2011AA ObjectClass
- C0370003
- NCI Thesaurus Property-2
- C25695
- UMLS 2011AA Property-2
- C1515023
Descrição
SpecimenSubmissionContactPersonE-mailAddressText
Tipo de dados
text
Alias
- NCI Thesaurus ObjectClass
- C19157
- UMLS 2011AA ObjectClass
- C0370003
- NCI Thesaurus ObjectClass-2
- C25461
- UMLS 2011AA ObjectClass-2
- C0337611
- NCI Thesaurus ObjectClass-3
- C25694
- UMLS 2011AA ObjectClass-3
- C1515022
- NCI Thesaurus Property
- C42775
- UMLS 2011AA Property
- C1705961
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
Descrição
Person Completing Form Phone
Tipo de dados
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS CUI-1
- C1550483
- NCI Thesaurus ObjectClass
- C25190
- UMLS CUI-2
- C1515258
- NCI Thesaurus ObjectClass-2
- C25657
- NCI Thesaurus Property
- C25395
Descrição
ResponsiblePersonFaxNumber
Tipo de dados
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus ObjectClass-2
- C25657
- UMLS 2011AA ObjectClass-2
- C1273518
- NCI Thesaurus Property
- C25210
- UMLS 2011AA Property
- C0085205
Descrição
SpecimenLaboratoryReceivedDate
Tipo de dados
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus Property
- C25639
- UMLS 2011AA Property
- C1514756
- NCI Thesaurus Property-2
- C37984
- UMLS 2011AA Property-2
- C0022877
- NCI Thesaurus ObjectClass
- C19157
- UMLS 2011AA ObjectClass
- C0370003
Similar models
INSTRUCTIONS: For patients in group 2 who consented to tissue specimen collection, submit form via RDC at time of cytoreductive surgery. Form must also accompany specimen. Complete all requested information for each tissue submitted
- StudyEvent: USMCI 8214/Z6091: Tissue Sample Submission Form
C0332307 (UMLS 2011AA ValueDomain)
C25616 (NCI Thesaurus Property)
C1948053 (UMLS 2011AA Property)
C19712 (NCI Thesaurus ObjectClass)
C1515944 (UMLS 2011AA ObjectClass)
C25716 (NCI Thesaurus ObjectClass-2)
C0545082 (UMLS 2011AA ObjectClass-2)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25462 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass)
C0805701 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass)
C21541 (NCI Thesaurus ValueDomain-2)
C25364 (NCI Thesaurus Property)
C1512698 (UMLS 2011AA ValueDomain)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C52349 (NCI Thesaurus Property)
C1301820 (UMLS 2011AA Property)
C1527021 (UMLS 2011AA ValueDomain)
C25594 (NCI Thesaurus Property)
C1518422 (UMLS 2011AA Property)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C25452 (NCI Thesaurus Property-2)
C0332307 (UMLS 2011AA ValueDomain)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C25695 (NCI Thesaurus Property)
C1515023 (UMLS 2011AA Property)
C0332307 (UMLS 2011AA ValueDomain)
C9305 (NCI Thesaurus Property)
C0006826 (UMLS 2011AA Property)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C25695 (NCI Thesaurus Property-2)
C1515023 (UMLS 2011AA Property-2)
C0011008 (UMLS 2011AA ValueDomain)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C25452 (NCI Thesaurus Property)
C25275 (NCI Thesaurus Property-2)
C2745955 (UMLS 2011AA Property)
C0370003 (UMLS 2011AA ObjectClass)
C25325 (NCI Thesaurus Property)
C1705201 (UMLS 2011AA Property)
C25436 (NCI Thesaurus Property-2)
C1533157 (UMLS 2011AA Property-2)
C25694 (NCI Thesaurus Property-3)
C1515022 (UMLS 2011AA Property-3)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C25402 (NCI Thesaurus Property)
C1510755 (UMLS 2011AA Property)
C0242485 (UMLS 2011AA ValueDomain)
C25208 (NCI Thesaurus Property)
C0043100 (UMLS 2011AA Property)
C15232 (NCI Thesaurus Property-2)
C0728940 (UMLS 2011AA Property-2)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C1550483 (UMLS CUI-1)
C25657 (NCI Thesaurus ObjectClass-2)
C1443235 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25509 (NCI Thesaurus Property-2)
C25191 (NCI Thesaurus ValueDomain)
C1550483 (UMLS CUI-1)
C25657 (NCI Thesaurus ObjectClass-2)
C1301584 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25551 (NCI Thesaurus Property-2)
C25191 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25294 (NCI Thesaurus Property)
C0022885 (UMLS 2011AA Property)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C25695 (NCI Thesaurus Property-2)
C1515023 (UMLS 2011AA Property-2)
C0370003 (UMLS 2011AA ObjectClass)
C25461 (NCI Thesaurus ObjectClass-2)
C0337611 (UMLS 2011AA ObjectClass-2)
C25694 (NCI Thesaurus ObjectClass-3)
C1515022 (UMLS 2011AA ObjectClass-3)
C42775 (NCI Thesaurus Property)
C1705961 (UMLS 2011AA Property)
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C1550483 (UMLS CUI-1)
C25190 (NCI Thesaurus ObjectClass)
C1515258 (UMLS CUI-2)
C25657 (NCI Thesaurus ObjectClass-2)
C25395 (NCI Thesaurus Property)
C0237753 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25657 (NCI Thesaurus ObjectClass-2)
C1273518 (UMLS 2011AA ObjectClass-2)
C25210 (NCI Thesaurus Property)
C0085205 (UMLS 2011AA Property)
C0011008 (UMLS 2011AA ValueDomain)
C25639 (NCI Thesaurus Property)
C1514756 (UMLS 2011AA Property)
C37984 (NCI Thesaurus Property-2)
C0022877 (UMLS 2011AA Property-2)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
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