ID
5614
Description
Gynecologic Oncology Group Smoking History Questionnaire (Form SHQ) Radiation Therapy With or Without Chemotherapy in Patients With Stage I or Stage II Cervical Cancer Who Previously Underwent Surgery Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=572CCDFB-3AD6-1370-E044-0003BA3F9857
Link
Keywords
Versions (3)
- 8/27/12 8/27/12 -
- 8/11/14 8/11/14 - Martin Dugas
- 1/9/15 1/9/15 - Martin Dugas
Uploaded on
August 11, 2014
DOI
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License
Creative Commons BY-NC 3.0 Legacy
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Cervical Cancer NCT01101451 Quality of Life - Gynecologic Oncology Group Smoking History Questionnaire (Form SHQ) - 2785914v1.0
No Instruction available.
- StudyEvent: Gynecologic Oncology Group Smoking History Questionnaire (Form SHQ)
Description
Smoking History Questionnaire
Description
Personal Smoking Section
Description
Smoking history
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25180
- UMLS CUI-1
- C1519384
- NCI Thesaurus Property
- C20989
- NCI Thesaurus ObjectClass
- C29719
Description
SmokingCessationNicotinePatchNicotineGumUseInd-2
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C17427
- UMLS 2011AA ObjectClass
- C0085134
- NCI Thesaurus Property
- C25340
- UMLS 2011AA Property
- C0457083
- NCI Thesaurus Property
- C17955
- UMLS 2011AA Property
- C0358855
- NCI Thesaurus Property
- C15663
- UMLS 2011AA Property
- C0068722
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Description
PatientInitialCigaretteSmokingAgeYearCount
Data type
double
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C25536
- UMLS 2011AA Property
- C1555582
- NCI Thesaurus Property
- C18270
- UMLS 2011AA Property
- C0700219
- NCI Thesaurus ValueDomain
- C29848
- UMLS 2011AA ValueDomain
- C0439234
- NCI Thesaurus ValueDomain
- C25463
- UMLS 2011AA ValueDomain
- C0750480
Description
CigaretteAverageDailyUseCount
Data type
double
Alias
- NCI Thesaurus ObjectClass
- C1802
- UMLS 2011AA ObjectClass
- C0677453
- NCI Thesaurus Property
- C25473
- UMLS 2011AA Property
- C0332173
- NCI Thesaurus Property
- C37917
- UMLS 2011AA Property
- C1510992
- NCI Thesaurus Property
- C25340
- UMLS 2011AA Property
- C0457083
- NCI Thesaurus ValueDomain
- C25463
- UMLS 2011AA ValueDomain
- C0750480
Description
PersonCigaretteWeekCurrentUseSmokingHistoryInd-2
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C25471
- UMLS 2011AA Property
- C0521116
- NCI Thesaurus Property
- C1802
- UMLS 2011AA Property
- C0677453
- NCI Thesaurus Property
- C29844
- UMLS 2011AA Property
- C0439230
- NCI Thesaurus Property
- C29719
- UMLS 2011AA Property
- C1519384
- NCI Thesaurus Property
- C25340
- UMLS 2011AA Property
- C0457083
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Description
PersonCigaretteSmokingCessationAgeYearCount
Data type
double
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C1802
- UMLS 2011AA Property
- C0677453
- NCI Thesaurus Property
- C17427
- UMLS 2011AA Property
- C0085134
- NCI Thesaurus Property
- C25150
- UMLS 2011AA Property
- C0001779
- NCI Thesaurus ValueDomain
- C29848
- UMLS 2011AA ValueDomain
- C0439234
- NCI Thesaurus ValueDomain
- C25463
- UMLS 2011AA ValueDomain
- C0750480
Description
Household Smoking Section
Description
PersonHouseholdYearPassiveSmokeExposureInd-2
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C29848
- UMLS 2011AA Property
- C0439234
- NCI Thesaurus Property
- C41194
- UMLS 2011AA Property
- C0020052
- NCI Thesaurus Property
- C17140
- UMLS 2011AA Property
- C0037370
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Description
PersonHouseholdYearPassiveSmokeExposureYearCount
Data type
double
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C29848
- UMLS 2011AA Property
- C0439234
- NCI Thesaurus Property
- C41194
- UMLS 2011AA Property
- C0020052
- NCI Thesaurus Property
- C17140
- UMLS 2011AA Property
- C0037370
- NCI Thesaurus ValueDomain
- C29848
- UMLS 2011AA ValueDomain
- C0439234
- NCI Thesaurus ValueDomain
- C25463
- UMLS 2011AA ValueDomain
- C0750480
Description
PersonCurrentHouseholdCigarettePassiveSmokeExposureInd-2
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C25471
- UMLS 2011AA Property
- C0521116
- NCI Thesaurus Property
- C1802
- UMLS 2011AA Property
- C0677453
- NCI Thesaurus Property
- C41194
- UMLS 2011AA Property
- C0020052
- NCI Thesaurus Property
- C17140
- UMLS 2011AA Property
- C0037370
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Description
PersonCurrentHouseholdCigarettePassiveSmokeExposureDayCount
Data type
double
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C25471
- UMLS 2011AA Property
- C0521116
- NCI Thesaurus Property
- C1802
- UMLS 2011AA Property
- C0677453
- NCI Thesaurus Property
- C41194
- UMLS 2011AA Property
- C0020052
- NCI Thesaurus Property
- C17140
- UMLS 2011AA Property
- C0037370
- NCI Thesaurus ValueDomain
- C25301
- UMLS 2011AA ValueDomain
- C0439228
- NCI Thesaurus ValueDomain
- C25463
- UMLS 2011AA ValueDomain
- C0750480
Description
Second Hand Smoking Section
Description
PersonCurrentExternalHouseholdCigarettePassiveSmokeExposureInd-2
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C25471
- UMLS 2011AA Property
- C0521116
- NCI Thesaurus Property
- C1802
- UMLS 2011AA Property
- C0677453
- NCI Thesaurus Property
- C44280
- UMLS 2011AA Property
- C0205101
- NCI Thesaurus Property
- C41194
- UMLS 2011AA Property
- C0020052
- NCI Thesaurus Property
- C17140
- UMLS 2011AA Property
- C0037370
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Description
PersonCurrentExternalHouseholdCigaretteHourWeekPassiveSmokeExposureCount
Data type
double
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C25471
- UMLS 2011AA Property
- C0521116
- NCI Thesaurus Property
- C1802
- UMLS 2011AA Property
- C0677453
- NCI Thesaurus Property
- C44280
- UMLS 2011AA Property
- C0205101
- NCI Thesaurus Property
- C25529
- UMLS 2011AA Property
- C0439227
- NCI Thesaurus Property
- C29844
- UMLS 2011AA Property
- C0439230
- NCI Thesaurus Property
- C41194
- UMLS 2011AA Property
- C0020052
- NCI Thesaurus Property
- C17140
- UMLS 2011AA Property
- C0037370
- NCI Thesaurus ValueDomain
- C25463
- UMLS 2011AA ValueDomain
- C0750480
Description
Comments
Similar models
No Instruction available.
- StudyEvent: Gynecologic Oncology Group Smoking History Questionnaire (Form SHQ)
C0376315 (UMLS 2011AA ObjectClass)
C25250 (NCI Thesaurus Property)
C0205197 (UMLS 2011AA Property)
C25604 (NCI Thesaurus Property)
C0205313 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain)
C0376315 (UMLS 2011AA ObjectClass)
C25250 (NCI Thesaurus Property)
C0205197 (UMLS 2011AA Property)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C1547383 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25551 (NCI Thesaurus Property)
C1517741 (UMLS 2011AA Property)
C1547383 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25509 (NCI Thesaurus Property)
C1279901 (UMLS 2011AA Property)
C0237753 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25521 (NCI Thesaurus Property)
C1512288 (UMLS 2011AA Property)
C0027361 (UMLS 2011AA ObjectClass)
C25657 (NCI Thesaurus ObjectClass)
C1273518 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25551 (NCI Thesaurus Property)
C1517741 (UMLS 2011AA Property)
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C17934 (NCI Thesaurus ObjectClass)
C0453996 (UMLS 2011AA ObjectClass)
C18772 (NCI Thesaurus Property)
C0262926 (UMLS 2011AA Property)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C1519384 (UMLS CUI-1)
C20989 (NCI Thesaurus Property)
C29719 (NCI Thesaurus ObjectClass)
C1298908 (UMLS 2011AA)
C0085134 (UMLS 2011AA ObjectClass)
C25340 (NCI Thesaurus Property)
C0457083 (UMLS 2011AA Property)
C17955 (NCI Thesaurus Property)
C0358855 (UMLS 2011AA Property)
C15663 (NCI Thesaurus Property)
C0068722 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0030705 (UMLS 2011AA ObjectClass)
C25536 (NCI Thesaurus Property)
C1555582 (UMLS 2011AA Property)
C18270 (NCI Thesaurus Property)
C0700219 (UMLS 2011AA Property)
C29848 (NCI Thesaurus ValueDomain)
C0439234 (UMLS 2011AA ValueDomain)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C0677453 (UMLS 2011AA ObjectClass)
C25473 (NCI Thesaurus Property)
C0332173 (UMLS 2011AA Property)
C37917 (NCI Thesaurus Property)
C1510992 (UMLS 2011AA Property)
C25340 (NCI Thesaurus Property)
C0457083 (UMLS 2011AA Property)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C0027361 (UMLS 2011AA ObjectClass)
C25471 (NCI Thesaurus Property)
C0521116 (UMLS 2011AA Property)
C1802 (NCI Thesaurus Property)
C0677453 (UMLS 2011AA Property)
C29844 (NCI Thesaurus Property)
C0439230 (UMLS 2011AA Property)
C29719 (NCI Thesaurus Property)
C1519384 (UMLS 2011AA Property)
C25340 (NCI Thesaurus Property)
C0457083 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0027361 (UMLS 2011AA ObjectClass)
C1802 (NCI Thesaurus Property)
C0677453 (UMLS 2011AA Property)
C17427 (NCI Thesaurus Property)
C0085134 (UMLS 2011AA Property)
C25150 (NCI Thesaurus Property)
C0001779 (UMLS 2011AA Property)
C29848 (NCI Thesaurus ValueDomain)
C0439234 (UMLS 2011AA ValueDomain)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C0027361 (UMLS 2011AA ObjectClass)
C29848 (NCI Thesaurus Property)
C0439234 (UMLS 2011AA Property)
C41194 (NCI Thesaurus Property)
C0020052 (UMLS 2011AA Property)
C17140 (NCI Thesaurus Property)
C0037370 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0027361 (UMLS 2011AA ObjectClass)
C29848 (NCI Thesaurus Property)
C0439234 (UMLS 2011AA Property)
C41194 (NCI Thesaurus Property)
C0020052 (UMLS 2011AA Property)
C17140 (NCI Thesaurus Property)
C0037370 (UMLS 2011AA Property)
C29848 (NCI Thesaurus ValueDomain)
C0439234 (UMLS 2011AA ValueDomain)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C0027361 (UMLS 2011AA ObjectClass)
C25471 (NCI Thesaurus Property)
C0521116 (UMLS 2011AA Property)
C1802 (NCI Thesaurus Property)
C0677453 (UMLS 2011AA Property)
C41194 (NCI Thesaurus Property)
C0020052 (UMLS 2011AA Property)
C17140 (NCI Thesaurus Property)
C0037370 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0027361 (UMLS 2011AA ObjectClass)
C25471 (NCI Thesaurus Property)
C0521116 (UMLS 2011AA Property)
C1802 (NCI Thesaurus Property)
C0677453 (UMLS 2011AA Property)
C41194 (NCI Thesaurus Property)
C0020052 (UMLS 2011AA Property)
C17140 (NCI Thesaurus Property)
C0037370 (UMLS 2011AA Property)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C0027361 (UMLS 2011AA ObjectClass)
C25471 (NCI Thesaurus Property)
C0521116 (UMLS 2011AA Property)
C1802 (NCI Thesaurus Property)
C0677453 (UMLS 2011AA Property)
C44280 (NCI Thesaurus Property)
C0205101 (UMLS 2011AA Property)
C41194 (NCI Thesaurus Property)
C0020052 (UMLS 2011AA Property)
C17140 (NCI Thesaurus Property)
C0037370 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0027361 (UMLS 2011AA ObjectClass)
C25471 (NCI Thesaurus Property)
C0521116 (UMLS 2011AA Property)
C1802 (NCI Thesaurus Property)
C0677453 (UMLS 2011AA Property)
C44280 (NCI Thesaurus Property)
C0205101 (UMLS 2011AA Property)
C25529 (NCI Thesaurus Property)
C0439227 (UMLS 2011AA Property)
C29844 (NCI Thesaurus Property)
C0439230 (UMLS 2011AA Property)
C41194 (NCI Thesaurus Property)
C0020052 (UMLS 2011AA Property)
C17140 (NCI Thesaurus Property)
C0037370 (UMLS 2011AA Property)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0282411 (UMLS 2011AA Property)