ID
6175
Description
Quality of Life Module for Trial 24-02 (Form 24-QLM) Brain Function in Premenopausal Women Receiving Tamoxifen With or Without Ovarian Function Suppression for Early-Stage Breast Cancer on Clinical Trial IBCSG-2402 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B0EA5B57-DF0D-6356-E034-0003BA12F5E7
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Keywords
Versions (1)
- 12/15/14 12/15/14 - Martin Dugas
Uploaded on
December 15, 2014
DOI
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License
Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT00659373 Quality of Life - Quality of Life Module for Trial 24-02 (Form 24-QLM) - 2073726v3.0
QUALITY OF LIFE MODULE FOR TRIAL 24-02 (Form 24-QLM) Patient Instructions: We would like to know how strongly you are affected by your illness and treatment. Please answer the following questions by placing a vertical mark on the line depending on how you assess yourself. (See the example on the Quality of Life Core Questionnaire.) Your information will be treated as strictly confidential. Thank you for replying!
- StudyEvent: Quality of Life Module for Trial 24-02 (Form 24-QLM)
Description
Ccrr Module For Quality Of Life Module For Trial 24-02 (form 24-qlm)
Description
Patient ID Number (Study No.)
Data type
text
Alias
- UMLS CUI-1
- C1549740
Description
Patient Initials
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25536
- UMLS CUI-1
- C2986440
Description
Patient's Date of Birth (day)
Data type
date
Alias
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25275
- UMLS CUI-1
- C0421451
Description
Participating Center/Affiliate
Data type
text
Description
Center Code
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25162
- UMLS CUI-1
- C0565990
Similar models
QUALITY OF LIFE MODULE FOR TRIAL 24-02 (Form 24-QLM) Patient Instructions: We would like to know how strongly you are affected by your illness and treatment. Please answer the following questions by placing a vertical mark on the line depending on how you assess yourself. (See the example on the Quality of Life Core Questionnaire.) Your information will be treated as strictly confidential. Thank you for replying!
- StudyEvent: Quality of Life Module for Trial 24-02 (Form 24-QLM)
C0022107 (UMLS CUI-1)
C0038990 (UMLS CUI-1)
C0227791 (UMLS CUI-1)
C34661 (NCI Thesaurus ObjectClass)
C25688 (NCI Thesaurus ValueDomain)
C0018681 (UMLS CUI-1)
C0151825 (UMLS CUI-1)
C0003862 (UMLS CUI-2)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
C2986440 (UMLS CUI-1)
C25275 (NCI Thesaurus Property)
C0421451 (UMLS CUI-1)
C0565990 (UMLS CUI-1)