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5524

Description

Record the patient's Vital Signs while on study. Please note that if Vital Signs are taken as a part of protocol specific Physical Exam, record those Vital Signs on the Physical Exam eCRF. Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AD24E1F2-5206-264F-E040-BB89AD430ED7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AD24E1F2-5206-264F-E040-BB89AD430ED7

Keywords

Versions (3)
  1. 5/25/12 5/25/12 -
  2. 8/8/14 8/8/14 - Martin Dugas
  3. 8/8/14 8/8/14 - Martin Dugas
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August 8, 2014

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Creative Commons BY-NC 3.0 Legacy
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    Vital Signs - 3281249v1.0

    English

    No Instruction available.

    1 forms  
    1. StudyEvent: Vital Signs
      1. No Instruction available.
    Vital Signs
    Description

    Vital Signs

    Visit Date
    Description

    FormCompletionDate

    Data type

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ObjectClass
    C40988
    UMLS 2011AA ObjectClass
    C1516308
    NCI Thesaurus Property
    C25250
    UMLS 2011AA Property
    C0205197
    Course #
    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
    Day in Course (Cycle)
    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
    Date (Enter the date the vital signs were taken.)
    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
    Time (Enter the time the vital signs were taken.)
    Description

    ProcedureTime

    Data type

    time

    Alias
    NCI Thesaurus ObjectClass
    C25218
    UMLS 2011AA ObjectClass
    C1948041
    NCI Thesaurus ValueDomain
    C25207
    UMLS 2011AA ValueDomain
    C0040223
    NCI Thesaurus ObjectClass
    C71104
    UMLS 2011AA ObjectClass
    C0008976
    NCI Thesaurus Property
    C42614
    UMLS 2011AA Property
    C0027365
    Notes (If necessary, enter some brief notes.)
    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
    Performance Status (Karnofsky) (Select a value from the Karnofsky performance status scale.)
    Description

    KarnofskyPerformanceStatusScore

    Data type

    text

    Alias
    NCI Thesaurus Property
    C25367
    NCI Thesaurus ObjectClass
    C20641
    UMLS 2011AA ObjectClass
    C1518965
    NCI Thesaurus ValueDomain
    C25338
    UMLS 2011AA ValueDomain
    C0449820
    Performance Status (Zubrod) (Select a value from the Zubrod/ECOG performance status scale.)
    Description

    ZubrodPerformanceStatusScore

    Data type

    text

    Alias
    NCI Thesaurus Property
    C25367
    NCI Thesaurus ObjectClass
    C20641
    UMLS 2011AA ObjectClass
    C1518965
    NCI Thesaurus ValueDomain
    C25338
    UMLS 2011AA ValueDomain
    C0449820
    Performance Status (Lansky) (Select a value from the Lansky performance status scale.)
    Description

    LanskyPerformanceStatusScore

    Data type

    text

    Alias
    NCI Thesaurus Property
    C25367
    NCI Thesaurus ObjectClass
    C20641
    UMLS 2011AA ObjectClass
    C1518965
    NCI Thesaurus ValueDomain
    C25338
    UMLS 2011AA ValueDomain
    C0449820
    Body Weight (Enter the patient's weight only in kilograms. Use decimal places only for patients under 10kg.)
    Description

    BodyWeightinKilograms

    Data type

    double

    Measurement units
    • Kg
    Alias
    NCI Thesaurus ValueDomain
    C25209
    UMLS 2011AA ValueDomain
    C0242485
    NCI Thesaurus ObjectClass
    C13041
    UMLS 2011AA ObjectClass
    C1268086
    NCI Thesaurus Property
    C25208
    UMLS 2011AA Property
    C0043100
    Kg
    Height (Enter the patient's height only in centimeters, to one decimal place.)
    Description

    PersonHeightMeasurement

    Data type

    double

    Measurement units
    • cm
    Alias
    NCI Thesaurus ValueDomain
    C25209
    UMLS 2011AA ValueDomain
    C0242485
    NCI Thesaurus ObjectClass
    C25190
    UMLS 2011AA ObjectClass
    C0027361
    NCI Thesaurus Property
    C25347
    UMLS 2011AA Property
    C0489786
    cm
    BSA (Enter the patient's body surface area in m2 to two decimal places if needed for the calculation of study medication dose level.)
    Description

    PersonBodySurfaceAreaValue

    Data type

    double

    Measurement units
    • m2
    Alias
    NCI Thesaurus ObjectClass
    C25190
    UMLS 2011AA ObjectClass
    C0027361
    NCI Thesaurus ValueDomain
    C25712
    UMLS 2011AA ValueDomain
    C1522609
    NCI Thesaurus Property
    C25157
    UMLS 2011AA Property
    C0005902
    m2
    Temperature (Enter the patient's temperature only in Celsius, to one decimal place.)
    Description

    TemperatureCelsiusScaleValue

    Data type

    double

    Alias
    NCI Thesaurus ObjectClass
    C25206
    UMLS 2011AA ObjectClass
    C0039476
    NCI Thesaurus ValueDomain
    C25712
    UMLS 2011AA ValueDomain
    C1522609
    NCI Thesaurus Property
    C41151
    UMLS 2011AA Property
    C1516378
    NCI Thesaurus ValueDomain
    C41151
    UMLS 2011AA ValueDomain
    C1516378
    Pulse (Enter the patient's pulse rate.)
    Description

    PulseRateMeasurementValue

    Data type

    double

    Alias
    NCI Thesaurus ObjectClass
    C25190
    UMLS 2011AA ObjectClass
    C0027361
    NCI Thesaurus ObjectClass
    C25749
    UMLS 2011AA ObjectClass
    C0391850
    NCI Thesaurus Property
    C25636
    UMLS 2011AA Property
    C1521828
    NCI Thesaurus ValueDomain
    C25209
    UMLS 2011AA ValueDomain
    C0242485
    NCI Thesaurus ValueDomain
    C25749
    UMLS 2011AA ValueDomain
    C0391850
    Respiration Rate (Enter the patient's respiration rate.)
    Description

    PersonVitalSignsRespiratoryRatePhysicalExaminationValue

    Data type

    double

    Alias
    NCI Thesaurus ObjectClass
    C25190
    UMLS 2011AA ObjectClass
    C0027361
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus Property
    C49672
    UMLS 2011AA Property
    C1704752
    NCI Thesaurus Property
    C49678
    UMLS 2011AA Property
    C0231832
    NCI Thesaurus ValueDomain
    C25712
    UMLS 2011AA ValueDomain
    C1522609
    Systolic BP (Enter the patient's systolic blood pressure.)
    Description

    SystolicBloodPressureValue

    Data type

    double

    Measurement units
    • mmHg
    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS 2011AA ValueDomain
    C0237753
    NCI Thesaurus ObjectClass
    C25190
    UMLS 2011AA ObjectClass
    C0027361
    NCI Thesaurus Property
    C25367
    NCI Thesaurus ObjectClass
    C54706
    UMLS 2011AA ObjectClass
    C0005823
    mmHg
    Diastolic BP (Enter the patient's diastolic blood pressure.)
    Description

    Diastolic blood pressure

    Data type

    double

    Measurement units
    • mmHg
    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C0428883
    NCI Thesaurus ObjectClass
    C25190
    NCI Thesaurus Property
    C25367
    NCI Thesaurus ObjectClass
    C54706
    mmHg
    Pulse Ox (Enter the patient's pulse oximetry reading.)
    Description

    PulseOximetryValue

    Data type

    double

    Measurement units
    • %
    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS 2011AA ValueDomain
    C0237753
    NCI Thesaurus ObjectClass
    C25749
    UMLS 2011AA ObjectClass
    C0391850
    NCI Metathesaurus Property
    C0040656
    %
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    1 forms
    1. StudyEvent: Vital Signs
      1. No Instruction available.
    Name
    Type
    Description | Question | Decode (Coded Value)
    Data type
    Alias
    Item Group
    Vital Signs
    FormCompletionDate
    Item
    Visit Date
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C40988 (NCI Thesaurus ObjectClass)
    C1516308 (UMLS 2011AA ObjectClass)
    C25250 (NCI Thesaurus Property)
    C0205197 (UMLS 2011AA Property)
    CourseNumber
    Item
    Course #
    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
    Day in Course (Cycle)
    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
    Date (Enter the date the vital signs were taken.)
    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)
    ProcedureTime
    Item
    Time (Enter the time the vital signs were taken.)
    time
    C25218 (NCI Thesaurus ObjectClass)
    C1948041 (UMLS 2011AA ObjectClass)
    C25207 (NCI Thesaurus ValueDomain)
    C0040223 (UMLS 2011AA ValueDomain)
    C71104 (NCI Thesaurus ObjectClass)
    C0008976 (UMLS 2011AA ObjectClass)
    C42614 (NCI Thesaurus Property)
    C0027365 (UMLS 2011AA Property)
    ResearchCommentsText
    Item
    Notes (If necessary, enter some brief notes.)
    text
    C25704 (NCI Thesaurus ValueDomain)
    C1527021 (UMLS 2011AA ValueDomain)
    C15319 (NCI Thesaurus ObjectClass)
    C25393 (NCI Thesaurus Property)
    C0282411 (UMLS 2011AA Property)
    Item
    Performance Status (Karnofsky) (Select a value from the Karnofsky performance status scale.)
    text
    C25367 (NCI Thesaurus Property)
    C20641 (NCI Thesaurus ObjectClass)
    C1518965 (UMLS 2011AA ObjectClass)
    C25338 (NCI Thesaurus ValueDomain)
    C0449820 (UMLS 2011AA ValueDomain)
    CL.1
    Code List
    Performance Status (Karnofsky) (Select a value from the Karnofsky performance status scale.)
    CL Item
    Dead (0)
    CL Item
    Moribund, Fatal Processes Progressing Rapidly (10)
    CL Item
    Very Sick, Hospitalization Indicated. Death Not Imminent (20)
    CL Item
    Severely Disabled, Hospitalization Indicated. Death Not Imminent (30)
    CL Item
    Disabled, Requires Special Care And Assistance (40)
    CL Item
    Requires Considerable Assistance And Frequent Medical Care (50)
    CL Item
    Requires Occasional Assistance, But Is Able To Care For Most Of His/her Needs (60)
    CL Item
    Cares For Self, Unable To Carry On Normal Activity Or To Do Active Work (70)
    CL Item
    Normal Activity With Effort; Some Signs Or Symptoms Of Disease (80)
    CL Item
    Able To Carry On Normal Activity; Minor Signs Or Symptoms Of Disease (90)
    CL Item
    Normal, No Complaints, No Evidence Of Disease (100)
    Item
    Performance Status (Zubrod) (Select a value from the Zubrod/ECOG performance status scale.)
    text
    C25367 (NCI Thesaurus Property)
    C20641 (NCI Thesaurus ObjectClass)
    C1518965 (UMLS 2011AA ObjectClass)
    C25338 (NCI Thesaurus ValueDomain)
    C0449820 (UMLS 2011AA ValueDomain)
    CL.2
    Code List
    Performance Status (Zubrod) (Select a value from the Zubrod/ECOG performance status scale.)
    CL Item
    Normal Activity (0)
    CL Item
    Symptoms, But Nearly Fully Ambulatory (1)
    CL Item
    Some Bed Time, But Needs To Be In Bed <50% Of Normal Daytime (2)
    CL Item
    Needs To Be In Bed > 50% Of Normal Daytime (3)
    CL Item
    Unable To Get Out Of Bed (4)
    Item
    Performance Status (Lansky) (Select a value from the Lansky performance status scale.)
    text
    C25367 (NCI Thesaurus Property)
    C20641 (NCI Thesaurus ObjectClass)
    C1518965 (UMLS 2011AA ObjectClass)
    C25338 (NCI Thesaurus ValueDomain)
    C0449820 (UMLS 2011AA ValueDomain)
    CL.3
    Code List
    Performance Status (Lansky) (Select a value from the Lansky performance status scale.)
    CL Item
    Unresponsive (0)
    CL Item
    No Play; Does Not Get Out Of Bed. (10)
    CL Item
    Often Sleeping; Play Entirely Limited To Very Passive Activities. (20)
    CL Item
    In Bed; Needs Assistance Even For Quiet Play. (30)
    CL Item
    Mostly In Bed; Participates In Quiet Activities. (40)
    CL Item
    Gets Dressed, But Lies Around Much Of The Day; No Active Play, Able To Participate In All Quiet Play And Activities. (50)
    CL Item
    Up And Around, But Minimal Active Play; Keeps Busy With Quieter Activities. (60)
    CL Item
    Both Greater Restriction Of And Less Time Spent In Play Activity (70)
    CL Item
    Active, But Tires More Quickly (80)
    CL Item
    Minor Restrictions In Physically Strenuous Activity (90)
    CL Item
    Fully Active, Normal (100)
    BodyWeightinKilograms
    Item
    Body Weight (Enter the patient's weight only in kilograms. Use decimal places only for patients under 10kg.)
    double
    C25209 (NCI Thesaurus ValueDomain)
    C0242485 (UMLS 2011AA ValueDomain)
    C13041 (NCI Thesaurus ObjectClass)
    C1268086 (UMLS 2011AA ObjectClass)
    C25208 (NCI Thesaurus Property)
    C0043100 (UMLS 2011AA Property)
    PersonHeightMeasurement
    Item
    Height (Enter the patient's height only in centimeters, to one decimal place.)
    double
    C25209 (NCI Thesaurus ValueDomain)
    C0242485 (UMLS 2011AA ValueDomain)
    C25190 (NCI Thesaurus ObjectClass)
    C0027361 (UMLS 2011AA ObjectClass)
    C25347 (NCI Thesaurus Property)
    C0489786 (UMLS 2011AA Property)
    PersonBodySurfaceAreaValue
    Item
    BSA (Enter the patient's body surface area in m2 to two decimal places if needed for the calculation of study medication dose level.)
    double
    C25190 (NCI Thesaurus ObjectClass)
    C0027361 (UMLS 2011AA ObjectClass)
    C25712 (NCI Thesaurus ValueDomain)
    C1522609 (UMLS 2011AA ValueDomain)
    C25157 (NCI Thesaurus Property)
    C0005902 (UMLS 2011AA Property)
    TemperatureCelsiusScaleValue
    Item
    Temperature (Enter the patient's temperature only in Celsius, to one decimal place.)
    double
    C25206 (NCI Thesaurus ObjectClass)
    C0039476 (UMLS 2011AA ObjectClass)
    C25712 (NCI Thesaurus ValueDomain)
    C1522609 (UMLS 2011AA ValueDomain)
    C41151 (NCI Thesaurus Property)
    C1516378 (UMLS 2011AA Property)
    C41151 (NCI Thesaurus ValueDomain)
    C1516378 (UMLS 2011AA ValueDomain)
    PulseRateMeasurementValue
    Item
    Pulse (Enter the patient's pulse rate.)
    double
    C25190 (NCI Thesaurus ObjectClass)
    C0027361 (UMLS 2011AA ObjectClass)
    C25749 (NCI Thesaurus ObjectClass)
    C0391850 (UMLS 2011AA ObjectClass)
    C25636 (NCI Thesaurus Property)
    C1521828 (UMLS 2011AA Property)
    C25209 (NCI Thesaurus ValueDomain)
    C0242485 (UMLS 2011AA ValueDomain)
    C25749 (NCI Thesaurus ValueDomain)
    C0391850 (UMLS 2011AA ValueDomain)
    PersonVitalSignsRespiratoryRatePhysicalExaminationValue
    Item
    Respiration Rate (Enter the patient's respiration rate.)
    double
    C25190 (NCI Thesaurus ObjectClass)
    C0027361 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C49672 (NCI Thesaurus Property)
    C1704752 (UMLS 2011AA Property)
    C49678 (NCI Thesaurus Property)
    C0231832 (UMLS 2011AA Property)
    C25712 (NCI Thesaurus ValueDomain)
    C1522609 (UMLS 2011AA ValueDomain)
    SystolicBloodPressureValue
    Item
    Systolic BP (Enter the patient's systolic blood pressure.)
    double
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    C25190 (NCI Thesaurus ObjectClass)
    C0027361 (UMLS 2011AA ObjectClass)
    C25367 (NCI Thesaurus Property)
    C54706 (NCI Thesaurus ObjectClass)
    C0005823 (UMLS 2011AA ObjectClass)
    Diastolic blood pressure
    Item
    Diastolic BP (Enter the patient's diastolic blood pressure.)
    double
    C25337 (NCI Thesaurus ValueDomain)
    C0428883 (UMLS CUI-1)
    C25190 (NCI Thesaurus ObjectClass)
    C25367 (NCI Thesaurus Property)
    C54706 (NCI Thesaurus ObjectClass)
    PulseOximetryValue
    Item
    Pulse Ox (Enter the patient's pulse oximetry reading.)
    double
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    C25749 (NCI Thesaurus ObjectClass)
    C0391850 (UMLS 2011AA ObjectClass)
    C0040656 (NCI Metathesaurus Property)
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