Información:
Error:
ID
6171
Descripción
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
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Versiones (2)
- 19/9/12 19/9/12 -
- 12/12/14 12/12/14 - Martin Dugas
Subido en
12 de diciembre de 2014
DOI
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Licencia
Creative Commons BY-NC 3.0 Legacy
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Lung Cancer null Follow-Up - E4599 Long-Term Follow-up Form - 2036056v3.0
No Instruction available.
- StudyEvent: E4599 Long-Term Follow-up Form
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- StudyEvent: E4599 Long-Term Follow-up Form
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
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)
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)
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)
C0011008 (UMLS 2011AA ValueDomain)
Non-ProtocolTherapyDate,First
Item
Non-Protocol Therapy Date, First
date