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44676

Description

CALGB: 10201On-Study Form Daunorubicin and Cytarabine With or Without Oblimersen in Treating Older Patients With Previously Untreated Acute Myeloid Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AD838530-D422-2F4D-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AD838530-D422-2F4D-E034-0003BA12F5E7

Keywords

Versions (3)
  1. 9/19/12 9/19/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
  3. 9/27/21 9/27/21 -
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September 27, 2021

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Creative Commons BY-NC 3.0 Legacy
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    Leukemia NCT00085124 On-Study - CALGB: 10201On-Study Form - 2057573v3.0

    English

    Instructions: Complete and submit thie form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice. Print text in capital letters. Avoid contact with the edges of the boxes. Cirlce amended items and check "Amended data" box to teh right. If submitting by mail, retain a copy for your records and send the original form for mazimum clarity in transmission and fax to 919-416-4990. If submistting electronically, click the Send button when you have completed the PDF version of the form.

    1 forms  
    Calgb Form
    Description

    Calgb Form

    CALGB Study No.
    Description

    CALGBProtocolNumber

    Data type

    text

    CALGB Patient ID
    Description

    CALGBPatientID

    Data type

    text

    Are data amended?
    Description

    AmendedDataInd

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C25474 (undefined)
    UMLS 2011AA ObjectClass
    C1511726 (Data)
    NCI Thesaurus Property
    C25416 (undefined)
    UMLS 2011AA Property
    C1691222 (Amended)
    Patient's Initials (Last, First, Middle)
    Description

    Patient Initials

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191 (undefined)
    UMLS CUI-1
    C2986440 (Person Initials)
    NCI Thesaurus ObjectClass
    C16960 (undefined)
    NCI Thesaurus Property
    C25536 (undefined)
    Participating Group
    Description

    ParticipatingGroup

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C17005 (undefined)
    UMLS 2011AA ObjectClass
    C1257890 (Population Group)
    SNOMED
    389109008
    LOINC
    LA12078-4
    NCI Thesaurus Property
    C25364 (undefined)
    UMLS 2011AA Property
    C0600091 (Identifier)
    SNOMED
    118522005
    LOINC
    LP31795-5
    Patient Hospital Number
    Description

    PatientHospitalNumber

    Data type

    text

    Participating Group Protocol No.
    Description

    ParticipatingGroupProtocolNo.

    Data type

    text

    Main Member Institution/Adjunct
    Description

    MainMemberInstitution/Affiliate

    Data type

    text

    Participating Group Patient No.
    Description

    ParticipatingGroupPatientID

    Data type

    text

    Patient Description
    Description

    Patient Description

    Date of initial Pathologic Diagnosis (Enter test date for first diagnosis of AML)
    Description

    InitialDiagnosisDate

    Data type

    date

    Date of first abnormal bone marrow for antecedent myelodysplasia (MM DD YYYY)
    Description

    FirstAbnormalBoneMarrowPriorMyelodysplasticSyndromeFindingDate

    Data type

    date

    Alias
    NCI Thesaurus ObjectClass
    C25401 (undefined)
    UMLS 2011AA ObjectClass
    C0205161 (Abnormal)
    SNOMED
    263654008
    LOINC
    LP28764-6
    NCI Thesaurus ObjectClass-2
    C12431 (undefined)
    UMLS 2011AA ObjectClass-2
    C0005953 (Bone Marrow)
    SNOMED
    279729006
    LOINC
    LP7410-6
    NCI Thesaurus ObjectClass-3
    C25509 (undefined)
    UMLS 2011AA ObjectClass-3
    C1279901 (Firstly)
    SNOMED
    232714002
    NCI Thesaurus Property
    C3247 (undefined)
    UMLS 2011AA Property
    C3463824 (MYELODYSPLASTIC SYNDROME)
    SNOMED
    109995007
    NCI Thesaurus Property-2
    C25629 (undefined)
    UMLS 2011AA Property-2
    C0332152 (Before)
    SNOMED
    236874000
    NCI Thesaurus Property-3
    C61036 (undefined)
    UMLS 2011AA Property-3
    C0243095 (Finding)
    LOINC
    LA9042-8
    NCI Thesaurus ValueDomain
    C25164 (undefined)
    UMLS 2011AA ValueDomain
    C0011008 (Date in time)
    SNOMED
    410671006
    Leukemia
    Description

    Leukemia/MDSClassification

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25372 (undefined)
    UMLS 2011AA ValueDomain
    C0683312 (Categories)
    LOINC
    MTHU018876
    NCI Thesaurus ObjectClass
    C3161 (undefined)
    UMLS 2011AA ObjectClass
    C0023418 (leukemia)
    SNOMED
    93143009
    NCI Thesaurus Property
    C25161 (undefined)
    UMLS 2011AA Property
    C0008902 (Classification)
    SNOMED
    73504009
    Other, specify (leukemia)
    Description

    LeukemiaClassification,Other

    Data type

    text

    Clinical Onset of AML
    Description

    Onset,AML

    Data type

    text

    Extramedullary Disease Involvement (mark all that apply)
    Description

    ExtramedullaryDisease

    Data type

    text

    Other, specify
    Description

    DiseaseInvolvementSite,Other

    Data type

    text

    Are Auer Rods present?
    Description

    BoneMarrowAuerrods

    Data type

    boolean

    Organ Involvement
    Description

    Organ Involvement

    Palpable Splenomegaly
    Description

    Splenomegaly,Palpation

    Data type

    text

    Alias
    NCI Thesaurus Property
    C16950 (undefined)
    UMLS 2011AA Property
    C0030247 (Palpation)
    SNOMED
    113011001
    LOINC
    LP6435-4
    NCI Thesaurus ObjectClass
    C3384 (undefined)
    UMLS 2011AA ObjectClass
    C0038002 (Splenomegaly)
    SNOMED
    16294009
    Splenomegaly by scan or x-ray
    Description

    Splenomegaly,Imaging

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C3384 (undefined)
    UMLS 2011AA ObjectClass
    C0038002 (Splenomegaly)
    SNOMED
    16294009
    NCI Thesaurus Property
    C19477 (undefined)
    UMLS 2011AA Property
    C1704254 (Medical Image)
    Palpable Heptomegaly
    Description

    Hepatomegaly,Palpation

    Data type

    text

    Alias
    NCI Thesaurus Property
    C16950 (undefined)
    UMLS 2011AA Property
    C0030247 (Palpation)
    SNOMED
    113011001
    LOINC
    LP6435-4
    NCI Thesaurus ObjectClass
    C3100 (undefined)
    UMLS 2011AA ObjectClass
    C0017924 (Glycogen Storage Disease Type V)
    SNOMED
    55912009
    Hepatomegaly by scan or x-ray
    Description

    Hepatomegaly,Imaging

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C3100 (undefined)
    UMLS 2011AA ObjectClass
    C0017924 (Glycogen Storage Disease Type V)
    SNOMED
    55912009
    NCI Thesaurus Property
    C19477 (undefined)
    UMLS 2011AA Property
    C1704254 (Medical Image)
    Palpable Lymphadenopathy
    Description

    Lymphadenopathy,Palpation

    Data type

    text

    Alias
    NCI Thesaurus Property
    C16950 (undefined)
    UMLS 2011AA Property
    C0030247 (Palpation)
    SNOMED
    113011001
    LOINC
    LP6435-4
    NCI Thesaurus ObjectClass
    C3206 (undefined)
    UMLS 2011AA ObjectClass
    C0024228 (Lymphatic Diseases)
    SNOMED
    3305006
    Lymphadenopathy by scan or x-ray
    Description

    Lymphadenopathy,Imaging

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C3206 (undefined)
    UMLS 2011AA ObjectClass
    C0024228 (Lymphatic Diseases)
    SNOMED
    3305006
    NCI Thesaurus Property
    C19477 (undefined)
    UMLS 2011AA Property
    C1704254 (Medical Image)
    Current Symptoms
    Description

    Current Symptoms

    Current Infection (mark one with an X)
    Description

    CurrentInfection

    Data type

    text

    Bleeding/Hemorrage (mark one with an X)
    Description

    AdverseEventHemorrhageSymptomStatus

    Data type

    text

    Alias
    NCI Thesaurus Property
    C26791 (undefined)
    UMLS 2011AA Property
    C0019080 (Hemorrhage)
    SNOMED
    50960005
    LOINC
    LA7418-2
    NCI Thesaurus ObjectClass
    C41331 (undefined)
    UMLS 2011AA ObjectClass
    C0877248 (Adverse event)
    LOINC
    MTHU014542
    NCI Thesaurus Property-2
    C4876 (undefined)
    UMLS 2011AA Property-2
    C1457887 (Symptoms)
    LOINC
    MTHU021540
    NCI Thesaurus ValueDomain
    C25688 (undefined)
    UMLS 2011AA ValueDomain
    C0449438 (Status)
    SNOMED
    263490005
    LOINC
    LP73412-6
    Lab Data At Study Entry
    Description

    Lab Data At Study Entry

    Creatinine
    Description

    Lab,Renal,Creatinine

    Data type

    float

    Bilirubin
    Description

    Lab,Hepatic,Bilirubin

    Data type

    float

    Lacate Dehyrogenase (LDH)
    Description

    Lab,Chemistry,LactateDehydrogenase

    Data type

    float

    Upper Limit of Normal (LDH)
    Description

    Lab,Chemistry,LactateDehydrogenase,ULN

    Data type

    float

    SGOT
    Description

    Lab,Hepatic,SGOT

    Data type

    float

    Upper Limit of Normal (SGOT)
    Description

    SGOTLabUpperLimitNormalValue

    Data type

    float

    Alias
    NCI Thesaurus ValueDomain
    C25712 (undefined)
    UMLS 2011AA ValueDomain
    C1522609 (Numerical value)
    NCI Thesaurus ValueDomain-2
    C25706 (undefined)
    UMLS 2011AA ValueDomain-2
    C1519815 (Upper Limit of Normal)
    SGPT
    Description

    Lab,Hepatic,SGPT

    Data type

    float

    Upper Limit of Normal (SGPT)
    Description

    SGPTLabUpperLimitNormalValue

    Data type

    float

    Alias
    NCI Thesaurus ValueDomain
    C25712 (undefined)
    UMLS 2011AA ValueDomain
    C1522609 (Numerical value)
    NCI Thesaurus ValueDomain-2
    C25706 (undefined)
    UMLS 2011AA ValueDomain-2
    C1519815 (Upper Limit of Normal)
    Alkaline Phosphatase
    Description

    Lab,Hepatic,AlkalinePhosphatase

    Data type

    float

    Upper Limit of Normal (Alkaline Phosphatase)
    Description

    Alkaline Phosphatase ULN

    Data type

    float

    Alias
    NCI Thesaurus ObjectClass
    C25294 (undefined)
    UMLS CUI-1
    C0151420 (Alkaline phosphatase, high threshold of normal)
    NCI Thesaurus Property
    C20200 (undefined)
    NCI Thesaurus Property-2
    C16276 (undefined)
    NCI Thesaurus ValueDomain
    C25712 (undefined)
    NCI Thesaurus ValueDomain-2
    C25706 (undefined)
    %LVEF by MUGA
    Description

    %LVEFbyMUGA

    Data type

    text

    Completed by (Print or Type name)
    Description

    CompletedBy

    Data type

    text

    Date completed (MM DD YYYY)
    Description

    DateCompleted

    Data type

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164 (undefined)
    UMLS 2011AA ValueDomain
    C0011008 (Date in time)
    SNOMED
    410671006
    % LVEF by ECHO
    Description

    %LVEFbyECHO

    Data type

    text

    Ccrr Module For Calgb: 10201on-study Form
    Description

    Ccrr Module For Calgb: 10201on-study Form

    Back to the top of the page

    Similar models

    Instructions: Complete and submit thie form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice. Print text in capital letters. Avoid contact with the edges of the boxes. Cirlce amended items and check "Amended data" box to teh right. If submitting by mail, retain a copy for your records and send the original form for mazimum clarity in transmission and fax to 919-416-4990. If submistting electronically, click the Send button when you have completed the PDF version of the form.

    1 forms
    Name
    Type
    Description | Question | Decode (Coded Value)
    Data type
    Alias
    Item Group
    Calgb Form
    CALGBProtocolNumber
    Item
    CALGB Study No.
    text
    CALGBPatientID
    Item
    CALGB Patient ID
    text
    AmendedDataInd
    Item
    Are data amended?
    text
    C25474 (NCI Thesaurus ObjectClass)
    C1511726 (UMLS 2011AA ObjectClass)
    C25416 (NCI Thesaurus Property)
    C1691222 (UMLS 2011AA Property)
    Patient Initials
    Item
    Patient's Initials (Last, First, Middle)
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2986440 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25536 (NCI Thesaurus Property)
    ParticipatingGroup
    Item
    Participating Group
    text
    C17005 (NCI Thesaurus ObjectClass)
    C1257890 (UMLS 2011AA ObjectClass)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    PatientHospitalNumber
    Item
    Patient Hospital Number
    text
    ParticipatingGroupProtocolNo.
    Item
    Participating Group Protocol No.
    text
    MainMemberInstitution/Affiliate
    Item
    Main Member Institution/Adjunct
    text
    ParticipatingGroupPatientID
    Item
    Participating Group Patient No.
    text
    Item Group
    Patient Description
    InitialDiagnosisDate
    Item
    Date of initial Pathologic Diagnosis (Enter test date for first diagnosis of AML)
    date
    FirstAbnormalBoneMarrowPriorMyelodysplasticSyndromeFindingDate
    Item
    Date of first abnormal bone marrow for antecedent myelodysplasia (MM DD YYYY)
    date
    C25401 (NCI Thesaurus ObjectClass)
    C0205161 (UMLS 2011AA ObjectClass)
    C12431 (NCI Thesaurus ObjectClass-2)
    C0005953 (UMLS 2011AA ObjectClass-2)
    C25509 (NCI Thesaurus ObjectClass-3)
    C1279901 (UMLS 2011AA ObjectClass-3)
    C3247 (NCI Thesaurus Property)
    C3463824 (UMLS 2011AA Property)
    C25629 (NCI Thesaurus Property-2)
    C0332152 (UMLS 2011AA Property-2)
    C61036 (NCI Thesaurus Property-3)
    C0243095 (UMLS 2011AA Property-3)
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    Item
    Leukemia
    text
    C25372 (NCI Thesaurus ValueDomain)
    C0683312 (UMLS 2011AA ValueDomain)
    C3161 (NCI Thesaurus ObjectClass)
    C0023418 (UMLS 2011AA ObjectClass)
    C25161 (NCI Thesaurus Property)
    C0008902 (UMLS 2011AA Property)
    CL.1
    Code List
    Leukemia
    CL Item
    Disease Classified As Undifferentiated Acute Myeloid Leukemia (fab M0) (Undifferentiated acute myeloid leukemia)
    CL Item
    Disease Classified As Acute Myeloid Leukemia W/o Maturation (fab M1) (Acute meyloid leukemia without maturation)
    CL Item
    Disease Classified As Acute Promyelocytic Leukemia (fab M3) (Acute promyelocytic leukemia)
    CL Item
    Disease Classified As Acute Myelomonocytic Leukemia (fab M4) (Acute myelomonocytic leukemia)
    CL Item
    Disease Classified As Acute Monocytic Leukemia (fab M5) (Acute monocytic leukemia)
    CL Item
    Disease Classified As Acute Erythroblastic Leukemia (fab M6) (Acute erythroblastic leukemia)
    CL Item
    Acute megakaryoblastic leukemia (Acute megakaryoblastic leukemia)
    CL Item
    Disease Classified As Aml, Not Otherwise Specified (nos) (AML, not otherwise specified)
    CL Item
    Disease Is An Unclassifiable Acute Leukemia (Unclassifiable acute leukemia)
    CL Item
    Disease Classified As Acute Undifferentiated Leukemia (aul) (Acute undifferentiated leukemia)
    CL Item
    Disease Is A Mixed Lineage Acute Leukemia (Mixed lineage acute leukemia)
    CL Item
    Disease Classified As Specified Other Leukemia (Other, specify)
    LeukemiaClassification,Other
    Item
    Other, specify (leukemia)
    text
    Item
    Clinical Onset of AML
    text
    CL.2
    Code List
    Clinical Onset of AML
    CL Item
    Aml Without Prior Clinical History Of Mds Or Potentially Leukemogenic Treatment (de novo)
    CL Item
    Aml Related To/associated With Prior Clinical History Of Potentially Leukemogenic Treatment (Therapy related)
    CL Item
    Aml Related To/associated With Prior Clinical History Of Mds (Following primary MDS)
    Item
    Extramedullary Disease Involvement (mark all that apply)
    text
    CL.3
    Code List
    Extramedullary Disease Involvement (mark all that apply)
    CL Item
    Pathology Or Disease Involving The Central Nervous System Present (Central Nervous System)
    CL Item
    Pathology Or Disease Involving The Peripheral Nervous System Present (Peripheral Nervous System)
    CL Item
    Gingival Hypertrophy Present (Gingival Hypertrophy)
    CL Item
    Mediastinal Mass Present (Mediastinal Mass)
    CL Item
    Skin (Skin)
    CL Item
    Other (Other)
    DiseaseInvolvementSite,Other
    Item
    Other, specify
    text
    BoneMarrowAuerrods
    Item
    Are Auer Rods present?
    boolean
    Item Group
    Organ Involvement
    Item
    Palpable Splenomegaly
    text
    C16950 (NCI Thesaurus Property)
    C0030247 (UMLS 2011AA Property)
    C3384 (NCI Thesaurus ObjectClass)
    C0038002 (UMLS 2011AA ObjectClass)
    CL.5
    Code List
    Palpable Splenomegaly
    CL Item
    Palpation Performed And Splenomegaly Absent (No)
    CL Item
    Palpation Performed And Splenomegaly Present (Yes)
    CL Item
    Palpation Of Spleen Not Performed (Not examined)
    CL Item
    Surgically absent (Surgically absent)
    Item
    Splenomegaly by scan or x-ray
    text
    C3384 (NCI Thesaurus ObjectClass)
    C0038002 (UMLS 2011AA ObjectClass)
    C19477 (NCI Thesaurus Property)
    C1704254 (UMLS 2011AA Property)
    CL.6
    Code List
    Splenomegaly by scan or x-ray
    CL Item
    Imaging Performed And Splenomegaly Absent (No)
    CL Item
    Imaging Performed And Splenomegaly Present (Yes)
    CL Item
    Imaging Of Spleen Not Performed (Not examined)
    CL Item
    Spleen Removed Via Prior Surgery (Surgically absent)
    Item
    Palpable Heptomegaly
    text
    C16950 (NCI Thesaurus Property)
    C0030247 (UMLS 2011AA Property)
    C3100 (NCI Thesaurus ObjectClass)
    C0017924 (UMLS 2011AA ObjectClass)
    CL.7
    Code List
    Palpable Heptomegaly
    CL Item
    No (No)
    CL Item
    Yes (Yes)
    CL Item
    Not examined (Not examined)
    Item
    Hepatomegaly by scan or x-ray
    text
    C3100 (NCI Thesaurus ObjectClass)
    C0017924 (UMLS 2011AA ObjectClass)
    C19477 (NCI Thesaurus Property)
    C1704254 (UMLS 2011AA Property)
    CL.8
    Code List
    Hepatomegaly by scan or x-ray
    CL Item
    No (No)
    CL Item
    Yes (Yes)
    CL Item
    Not examined (Not examined)
    Item
    Palpable Lymphadenopathy
    text
    C16950 (NCI Thesaurus Property)
    C0030247 (UMLS 2011AA Property)
    C3206 (NCI Thesaurus ObjectClass)
    C0024228 (UMLS 2011AA ObjectClass)
    CL.9
    Code List
    Palpable Lymphadenopathy
    CL Item
    No (No)
    CL Item
    Yes (Yes)
    CL Item
    Not examined (Not examined)
    Item
    Lymphadenopathy by scan or x-ray
    text
    C3206 (NCI Thesaurus ObjectClass)
    C0024228 (UMLS 2011AA ObjectClass)
    C19477 (NCI Thesaurus Property)
    C1704254 (UMLS 2011AA Property)
    CL.10
    Code List
    Lymphadenopathy by scan or x-ray
    CL Item
    No (No)
    CL Item
    Yes (Yes)
    CL Item
    Not examined (Not examined)
    Item Group
    Current Symptoms
    Item
    Current Infection (mark one with an X)
    text
    CL.11
    Code List
    Current Infection (mark one with an X)
    CL Item
    None (None)
    C41132 (NCI Thesaurus)
    C0549184 (UMLS 2011AA)
    CL Item
    Mild (Mild)
    C70666 (NCI Thesaurus)
    C2945599 (UMLS 2011AA)
    CL Item
    Moderate (Moderate)
    CL Item
    Severe (Severe)
    CL Item
    Life-threatening (Life-threatening)
    Item
    Bleeding/Hemorrage (mark one with an X)
    text
    C26791 (NCI Thesaurus Property)
    C0019080 (UMLS 2011AA Property)
    C41331 (NCI Thesaurus ObjectClass)
    C0877248 (UMLS 2011AA ObjectClass)
    C4876 (NCI Thesaurus Property-2)
    C1457887 (UMLS 2011AA Property-2)
    C25688 (NCI Thesaurus ValueDomain)
    C0449438 (UMLS 2011AA ValueDomain)
    CL.12
    Code List
    Bleeding/Hemorrage (mark one with an X)
    CL Item
    None (None)
    C41132 (NCI Thesaurus)
    C0549184 (UMLS 2011AA)
    CL Item
    Mild, Not Requiring Transfusion (Mild, not requiring transfusion)
    CL Item
    Active, Requiring Transfusion (Active, requiring transfusion)
    Item Group
    Lab Data At Study Entry
    Lab,Renal,Creatinine
    Item
    Creatinine
    float
    Lab,Hepatic,Bilirubin
    Item
    Bilirubin
    float
    Lab,Chemistry,LactateDehydrogenase
    Item
    Lacate Dehyrogenase (LDH)
    float
    Lab,Chemistry,LactateDehydrogenase,ULN
    Item
    Upper Limit of Normal (LDH)
    float
    Lab,Hepatic,SGOT
    Item
    SGOT
    float
    SGOTLabUpperLimitNormalValue
    Item
    Upper Limit of Normal (SGOT)
    float
    C25712 (NCI Thesaurus ValueDomain)
    C1522609 (UMLS 2011AA ValueDomain)
    C25706 (NCI Thesaurus ValueDomain-2)
    C1519815 (UMLS 2011AA ValueDomain-2)
    Lab,Hepatic,SGPT
    Item
    SGPT
    float
    SGPTLabUpperLimitNormalValue
    Item
    Upper Limit of Normal (SGPT)
    float
    C25712 (NCI Thesaurus ValueDomain)
    C1522609 (UMLS 2011AA ValueDomain)
    C25706 (NCI Thesaurus ValueDomain-2)
    C1519815 (UMLS 2011AA ValueDomain-2)
    Lab,Hepatic,AlkalinePhosphatase
    Item
    Alkaline Phosphatase
    float
    Alkaline Phosphatase ULN
    Item
    Upper Limit of Normal (Alkaline Phosphatase)
    float
    C25294 (NCI Thesaurus ObjectClass)
    C0151420 (UMLS CUI-1)
    C20200 (NCI Thesaurus Property)
    C16276 (NCI Thesaurus Property-2)
    C25712 (NCI Thesaurus ValueDomain)
    C25706 (NCI Thesaurus ValueDomain-2)
    %LVEFbyMUGA
    Item
    %LVEF by MUGA
    text
    CompletedBy
    Item
    Completed by (Print or Type name)
    text
    DateCompleted
    Item
    Date completed (MM DD YYYY)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    %LVEFbyECHO
    Item
    % LVEF by ECHO
    text
    Item Group
    Ccrr Module For Calgb: 10201on-study Form
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