ID

6171

Description

E4599 Long-Term Follow-up Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A13401E7-87EA-64C7-E034-080020C9C0E0

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A13401E7-87EA-64C7-E034-080020C9C0E0

Keywords

Versions (2)
  1. 9/19/12 9/19/12 -
  2. 12/12/14 12/12/14 - Martin Dugas
Uploaded on

December 12, 2014

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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Lung Cancer null Follow-Up - E4599 Long-Term Follow-up Form - 2036056v3.0

English

No Instruction available.

1 forms  
  1. StudyEvent: E4599 Long-Term Follow-up Form
    1. No Instruction available.
Follow-Up
Description

Follow-Up

Alias
UMLS CUI-1
C1522577
Date of data transfer
Description

Dateofdatatransfer

Data type

text

Transfer Method
Description

TransferMethod

Data type

text

Specify other transfer method
Description

Specifyothertransfermethod

Data type

text

Amended Data
Description

Amended data

Data type

text

Alias
NCI Thesaurus ObjectClass
C25474
NCI Thesaurus Property
C25416
UMLS CUI-1
C0680532
Step No.
Description

StepNo.

Data type

text

Patient Name
Description

PatientName

Data type

text

Particip. Group Protocol Number
Description

Particip.GroupProtocolNumber

Data type

text

Patient Study ID, Participating Group
Description

PatientStudyID,ParticipatingGroup

Data type

text

Institution Name
Description

InstitutionName

Data type

text

Affiliate Name
Description

AffiliateName

Data type

text

Interval Report From Date
Description

IntervalReportFromDate

Data type

date

Interval Report To Date
Description

IntervalReportToDate

Data type

date

Patient's Vital Status
Description

Patient'sVitalStatus

Data type

text

Death Reason
Description

Death reason

Data type

text

Alias
UMLS CUI-1
C0007465
Death Date/Last Contact Date
Description

DeathDate/LastContactDate

Data type

date

Death Reason, Specify
Description

DeathReason,Specify

Data type

text

Cancer Follow-up Status Ind
Description

CancerFollow-upStatusInd

Data type

text

Cancer Follow-up Status Date
Description

CancerFollow-upStatusDate

Data type

date

Alias
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus Property
C25365
UMLS 2011AA Property
C0678257
Progression Ind
Description

ProgressionInd

Data type

text

Progression Date
Description

ProgressionDate

Data type

date

Formal Progressive Disease Diagnosis
Description

FormalProgressiveDiseaseDiagnosis

Data type

text

Progression Site
Description

ProgressionSite

Data type

text

New Primary Cancer Ind
Description

NewPrimaryCancerInd

Data type

text

New Primary Site
Description

NewPrimarySite

Data type

text

Late Adverse Event Ind
Description

LateAdverseEventInd

Data type

text

Non protocol therapy prior to first progression
Description

Nonprotocoltherapypriortofirstprogression

Data type

text

Second line therapy
Description

Secondlinetherapy

Data type

text

Type of Second Line Therapy
Description

TypeofSecondLineTherapy

Data type

text

Type of Second Line Chemotherapy
Description

TypeofSecondLineChemotherapy

Data type

text

Comments
Description

Comments

Data type

text

Comments2
Description

Comments2

Data type

text

New Primary Cancer Date
Description

NewPrimaryCancerDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
Non-Protocol Therapy Date, First
Description

Non-ProtocolTherapyDate,First

Data type

date

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Similar models

No Instruction available.

1 forms
  1. StudyEvent: E4599 Long-Term Follow-up Form
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Follow-Up
C1522577 (UMLS CUI-1)
Dateofdatatransfer
Item
Date of data transfer
text
TransferMethod
Item
Transfer Method
text
Specifyothertransfermethod
Item
Specify other transfer method
text
Amended data
Item
Amended Data
text
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)
C0680532 (UMLS CUI-1)
StepNo.
Item
Step No.
text
PatientName
Item
Patient Name
text
Particip.GroupProtocolNumber
Item
Particip. Group Protocol Number
text
PatientStudyID,ParticipatingGroup
Item
Patient Study ID, Participating Group
text
InstitutionName
Item
Institution Name
text
AffiliateName
Item
Affiliate Name
text
IntervalReportFromDate
Item
Interval Report From Date
date
IntervalReportToDate
Item
Interval Report To Date
date
Patient'sVitalStatus
Item
Patient's Vital Status
text
Death reason
Item
Death Reason
text
C0007465 (UMLS CUI-1)
DeathDate/LastContactDate
Item
Death Date/Last Contact Date
date
DeathReason,Specify
Item
Death Reason, Specify
text
CancerFollow-upStatusInd
Item
Cancer Follow-up Status Ind
text
CancerFollow-upStatusDate
Item
Cancer Follow-up Status Date
date
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
ProgressionInd
Item
Progression Ind
text
ProgressionDate
Item
Progression Date
date
FormalProgressiveDiseaseDiagnosis
Item
Formal Progressive Disease Diagnosis
text
ProgressionSite
Item
Progression Site
text
NewPrimaryCancerInd
Item
New Primary Cancer Ind
text
NewPrimarySite
Item
New Primary Site
text
LateAdverseEventInd
Item
Late Adverse Event Ind
text
Nonprotocoltherapypriortofirstprogression
Item
Non protocol therapy prior to first progression
text
Secondlinetherapy
Item
Second line therapy
text
TypeofSecondLineTherapy
Item
Type of Second Line Therapy
text
TypeofSecondLineChemotherapy
Item
Type of Second Line Chemotherapy
text
Comments
Item
Comments
text
Comments2
Item
Comments2
text
NewPrimaryCancerDate
Item
New Primary Cancer Date
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
Non-ProtocolTherapyDate,First
Item
Non-Protocol Therapy Date, First
date
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