ID

6179

Descripción

A0 Form - 1014 Ph II 3D-CRT Recurrent Breast Form Radiation Therapy in Treating Women With Locally Recurrent Breast Cancer Previously Treated With Repeat Breast-Preserving Surgery Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=8876AA44-3947-792F-E040-BB89AD434A3F

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=8876AA44-3947-792F-E040-BB89AD434A3F

Palabras clave

Versiones (3)
  1. 15/12/14 15/12/14 - Martin Dugas
  2. 9/1/15 9/1/15 - Martin Dugas
  3. 17/9/21 17/9/21 -
Subido en

15 de diciembre de 2014

DOI

Para solicitar uno, por favor iniciar sesión.

Licencia

Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT01082211 Demographic - A0 Form - 1014 Ph II 3D-CRT Recurrent Breast Form - 3107774v1.0

Inglés

No Instruction available.

1 formularios  
  1. StudyEvent: A0 Form - 1014 Ph II 3D-CRT Recurrent Breast Form
    1. No Instruction available.
Module 1
Descripción

Module 1

Institutional person randomizing case
Descripción

RandomizationPersonName

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ObjectClass
C25196
UMLS 2011AA ObjectClass
C0034656
Has the eligibility checklist been completed
Descripción

Has the eligibility checklist been completed

Tipo de datos

boolean

Alias
NCI Thesaurus ValueDomain
C38147
NCI Thesaurus Property
C25250
NCI Thesaurus ObjectClass
C25171
NCI Thesaurus Property
C49073
UMLS CUI-1
C0807522
In the opinion of the investigator, is the patient eligible?
Descripción

In the opinion of the investigator, is the patient eligible?

Tipo de datos

boolean

Alias
NCI Thesaurus ValueDomain
C38148
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25171
Date Informed Consent Signed (mm/dd/yyyy)
Descripción

Date Informed Consent Signed (mm/dd/yyyy)

Tipo de datos

date

Alias
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ValueDomain
C25367
NCI Thesaurus ObjectClass
C16468
NCI Thesaurus Property
C25679
UMLS CUI-1
C2985782
Verifying physician
Descripción

PhysicianPersonVerificationIdentifierName

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ObjectClass
C25741
UMLS 2011AA ObjectClass
C0031831
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus Property
C45513
UMLS 2011AA Property
C1711411
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
Patient ID
Descripción

PatientCoordinatingIdentifierNumber

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25462
UMLS 2011AA Property
C0700114
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Race
Descripción

RegistrationRaceVerificationCategory

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25372
UMLS 2011AA ValueDomain
C0683312
NCI Thesaurus ObjectClass
C25646
UMLS 2011AA ObjectClass
C1514821
NCI Thesaurus Property
C17049
UMLS 2011AA Property
C0034510
NCI Thesaurus Property
C45513
UMLS 2011AA Property
C1711411
Any care at VA or military hospital
Descripción

Any care at VA or military hospital

Tipo de datos

boolean

Alias
NCI Thesaurus ObjectClass
C49236
NCI Thesaurus Property
C16696
NCI Thesaurus Property
C25639
NCI Thesaurus Property
C68638
NCI Thesaurus Property
C17239
NCI Thesaurus ValueDomain
C38148
Calendar base date
Descripción

TherapeuticProcedureCalendarGenerationDate

Tipo de datos

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C49236
UMLS 2011AA ObjectClass
C0087111
NCI Thesaurus Property
C19459
UMLS 2011AA Property
C1516147
NCI Thesaurus Property
C48151
UMLS 2011AA Property
C0079411
Randomization Date
Descripción

PatientRandomizationDate

Tipo de datos

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25196
UMLS 2011AA Property
C0034656
Medical oncologist's name
Descripción

MedicalOncologistPersonIdentifierName

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ObjectClass
C17838
UMLS 2011AA ObjectClass
C0278631
Have you obtained the patient's consent for his or her tissue to be used for research to learn about, prevent or treat cancer?
Descripción

PersonSpecimenMalignantNeoplasmResearchConsentInd-2

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C15319
NCI Thesaurus Property
C9305
UMLS 2011AA Property
C0006826
NCI Thesaurus Property
C19157
UMLS 2011AA Property
C0370003
NCI Thesaurus Property
C25460
UMLS 2011AA Property
C1511481
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Have you obtained the patient's consent for his or her blood to be kept for use in research to learn about, prevent, treat, or cure cancer?
Descripción

Patient's consent for blood to be kept for use in research to learn about, prevent, treat, or cure cancer?

Tipo de datos

boolean

Alias
NCI Thesaurus ObjectClass
C12434
NCI Thesaurus ObjectClass
C19157
NCI Thesaurus Property
C15319
NCI Thesaurus Property
C25648
NCI Thesaurus Property
C9305
NCI Thesaurus Property
C25460
NCI Thesaurus ValueDomain
C25180
Have you obtained the patient's consent for his or her tissue to be kept for use research about other health problems (for example: causes of diabetes, Alzheimer's disease, and heart disease)?
Descripción

Patient's consent for tissue to be kept for use research about other health problems (for example: causes of diabetes, Alzheimer's disease, and heart disease)?

Tipo de datos

boolean

Alias
NCI Thesaurus ObjectClass
C12801
NCI Thesaurus ObjectClass
C12434
NCI Thesaurus ObjectClass
C19157
NCI Thesaurus Property
C17649
NCI Thesaurus Property
C15319
NCI Thesaurus Property
C2991
NCI Thesaurus Property
C25460
NCI Thesaurus ValueDomain
C38148
Have you obtained the patient's consent for his or her blood to be kept for use research about other health problems (for example: causes of diabetes, Alzheimer's disease, and heart disease)?
Descripción

BloodSpecimenOtherDiseasesandDisordersResearchConsentInd-3

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C12434
UMLS 2011AA ObjectClass
C0229664
NCI Thesaurus ObjectClass
C19157
UMLS 2011AA ObjectClass
C0370003
NCI Thesaurus Property
C17649
UMLS 2011AA Property
C0205394
NCI Thesaurus Property
C15319
NCI Thesaurus Property
C2991
UMLS 2011AA Property
C0012634
NCI Thesaurus Property
C25460
UMLS 2011AA Property
C1511481
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Have you obtained the patient's consent for allow someone from this institution to contact him or her in the future to ask him or her to take part in more research
Descripción

PatientContactConsentInd-3

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C67527
UMLS 2011AA Property
C0016884
NCI Thesaurus Property
C25460
UMLS 2011AA Property
C1511481
NCI Thesaurus Property
C16452
UMLS 2011AA Property
C0009452
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Patient has consented to participate in the cosmesis study
Descripción

PatientBreastReconstructionConsentInd-2

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25460
UMLS 2011AA Property
C1511481
NCI Thesaurus Property
C15354
UMLS 2011AA Property
C0085076
If no, provide reason
Descripción

PatientBreastReconstructionRefuseConsentReason

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C49161
UMLS 2011AA Property
C1705116
NCI Thesaurus Property
C25460
UMLS 2011AA Property
C1511481
NCI Thesaurus Property
C15354
UMLS 2011AA Property
C0085076
NCI Thesaurus ValueDomain
C25638
UMLS 2011AA ValueDomain
C0392360
Other, specify
Descripción

PatientBreastReconstructionRefuseConsentSpecify

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C49161
UMLS 2011AA Property
C1705116
NCI Thesaurus Property
C25460
UMLS 2011AA Property
C1511481
NCI Thesaurus Property
C15354
UMLS 2011AA Property
C0085076
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
Other reason, specify
Descripción

PatientBreastReconstructionRefuseConsentOtherSpecify

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C49161
UMLS 2011AA Property
C1705116
NCI Thesaurus Property
C25460
UMLS 2011AA Property
C1511481
NCI Thesaurus Property
C15354
UMLS 2011AA Property
C0085076
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus ValueDomain
C17649
UMLS 2011AA ValueDomain
C0205394
Patient has consented to take part in the circulating tumor cell portion of the trial
Descripción

Patient has consented to take part in the circulating tumor cell portion of the trial

Tipo de datos

boolean

Alias
NCI Thesaurus ValueDomain
C38147
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C63797
NCI Thesaurus Property
C25460
If no, provide reason
Descripción

PatientCirculatingTumorCellRefuseConsentReason

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C49161
UMLS 2011AA Property
C1705116
NCI Thesaurus Property
C63797
UMLS 2011AA Property
C0027625
NCI Thesaurus Property
C25460
UMLS 2011AA Property
C1511481
NCI Thesaurus ValueDomain
C25638
UMLS 2011AA ValueDomain
C0392360
Other, specify
Descripción

PatientCirculatingTumorCellRefuseConsentSpecify

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C49161
UMLS 2011AA Property
C1705116
NCI Thesaurus Property
C63797
UMLS 2011AA Property
C0027625
NCI Thesaurus Property
C25460
UMLS 2011AA Property
C1511481
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
Other reason, specify
Descripción

PatientCirculatingTumorCellRefuseConsentOtherSpecify

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C49161
UMLS 2011AA Property
C1705116
NCI Thesaurus Property
C63797
UMLS 2011AA Property
C0027625
NCI Thesaurus Property
C25460
UMLS 2011AA Property
C1511481
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus ValueDomain
C17649
UMLS 2011AA ValueDomain
C0205394
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1 formularios
  1. StudyEvent: A0 Form - 1014 Ph II 3D-CRT Recurrent Breast Form
    1. No Instruction available.
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
Module 1
RandomizationPersonName
Item
Institutional person randomizing case
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25196 (NCI Thesaurus ObjectClass)
C0034656 (UMLS 2011AA ObjectClass)
Eligibility status
Item
Has the eligibility checklist been completed
boolean
C38147 (NCI Thesaurus ValueDomain)
C25250 (NCI Thesaurus Property)
C25171 (NCI Thesaurus ObjectClass)
C49073 (NCI Thesaurus Property)
C0807522 (UMLS CUI-1)
Patient Eligibility Indicator
Item
In the opinion of the investigator, is the patient eligible?
boolean
C38148 (NCI Thesaurus ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C25171 (NCI Thesaurus Property)
Informed Consent Date
Item
Date Informed Consent Signed (mm/dd/yyyy)
date
C25164 (NCI Thesaurus ValueDomain)
C25367 (NCI Thesaurus ValueDomain)
C16468 (NCI Thesaurus ObjectClass)
C25679 (NCI Thesaurus Property)
C2985782 (UMLS CUI-1)
PhysicianPersonVerificationIdentifierName
Item
Verifying physician
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25741 (NCI Thesaurus ObjectClass)
C0031831 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C45513 (NCI Thesaurus Property)
C1711411 (UMLS 2011AA Property)
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
PatientCoordinatingIdentifierNumber
Item
Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25462 (NCI Thesaurus Property)
C0700114 (UMLS 2011AA Property)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
Item
Race
text
C25372 (NCI Thesaurus ValueDomain)
C0683312 (UMLS 2011AA ValueDomain)
C25646 (NCI Thesaurus ObjectClass)
C1514821 (UMLS 2011AA ObjectClass)
C17049 (NCI Thesaurus Property)
C0034510 (UMLS 2011AA Property)
C45513 (NCI Thesaurus Property)
C1711411 (UMLS 2011AA Property)
CL.3
Code List
Race
CL Item
A Person Having Origins In Any Of The Original Peoples Of North And South America (including Central America), And Who Maintains Tribal Affiliation Or Community Attachment. (American Indian or Alaska Native)
C41259 (NCI Thesaurus)
C1515945 (UMLS 2011AA)
CL Item
A Person Having Origins In Any Of The Original Peoples Of The Far East, Southeast Asia, Or The Indian Subcontinent Including, For Example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, The Philippine Islands, Thailand, And Vietnam. (Asian)
C41260 (NCI Thesaurus)
C0078988 (UMLS 2011AA)
CL Item
A Person Having Origins In Any Of The Black Racial Groups Of Africa. Terms Such As "haitian" Or "negro" Can Be Used In Addition To "black Or African American." (Black or African American)
C16352 (NCI Thesaurus)
C0085756 (UMLS 2011AA)
CL Item
A Person Having Origins In Any Of The Original Peoples Of Hawaii, Guam, Samoa, Or Other Pacific Islands. (Native Hawaiian or other Pacific Islander)
C41219 (NCI Thesaurus)
C1513907 (UMLS 2011AA)
CL Item
A Person Having Origins In Any Of The Original Peoples Of Europe, The Middle East, Or North Africa. (White)
C41261 (NCI Thesaurus)
C0007457 (UMLS 2011AA)
CL Item
More Than One Race (More than one race)
CL Item
Could Not Be Determined Or Unsure (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Care at military hospital
Item
Any care at VA or military hospital
boolean
C49236 (NCI Thesaurus ObjectClass)
C16696 (NCI Thesaurus Property)
C25639 (NCI Thesaurus Property)
C68638 (NCI Thesaurus Property)
C17239 (NCI Thesaurus Property)
C38148 (NCI Thesaurus ValueDomain)
TherapeuticProcedureCalendarGenerationDate
Item
Calendar base date
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C49236 (NCI Thesaurus ObjectClass)
C0087111 (UMLS 2011AA ObjectClass)
C19459 (NCI Thesaurus Property)
C1516147 (UMLS 2011AA Property)
C48151 (NCI Thesaurus Property)
C0079411 (UMLS 2011AA Property)
PatientRandomizationDate
Item
Randomization Date
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25196 (NCI Thesaurus Property)
C0034656 (UMLS 2011AA Property)
MedicalOncologistPersonIdentifierName
Item
Medical oncologist's name
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C17838 (NCI Thesaurus ObjectClass)
C0278631 (UMLS 2011AA ObjectClass)
Item
Have you obtained the patient's consent for his or her tissue to be used for research to learn about, prevent or treat cancer?
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C15319 (NCI Thesaurus Property)
C9305 (NCI Thesaurus Property)
C0006826 (UMLS 2011AA Property)
C19157 (NCI Thesaurus Property)
C0370003 (UMLS 2011AA Property)
C25460 (NCI Thesaurus Property)
C1511481 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
CL.5
Code List
Have you obtained the patient's consent for his or her tissue to be used for research to learn about, prevent or treat cancer?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Biobank consent
Item
Have you obtained the patient's consent for his or her blood to be kept for use in research to learn about, prevent, treat, or cure cancer?
boolean
C12434 (NCI Thesaurus ObjectClass)
C19157 (NCI Thesaurus ObjectClass)
C15319 (NCI Thesaurus Property)
C25648 (NCI Thesaurus Property)
C9305 (NCI Thesaurus Property)
C25460 (NCI Thesaurus Property)
C25180 (NCI Thesaurus ValueDomain)
Biobank consent
Item
Have you obtained the patient's consent for his or her tissue to be kept for use research about other health problems (for example: causes of diabetes, Alzheimer's disease, and heart disease)?
boolean
C12801 (NCI Thesaurus ObjectClass)
C12434 (NCI Thesaurus ObjectClass)
C19157 (NCI Thesaurus ObjectClass)
C17649 (NCI Thesaurus Property)
C15319 (NCI Thesaurus Property)
C2991 (NCI Thesaurus Property)
C25460 (NCI Thesaurus Property)
C38148 (NCI Thesaurus ValueDomain)
Item
Have you obtained the patient's consent for his or her blood to be kept for use research about other health problems (for example: causes of diabetes, Alzheimer's disease, and heart disease)?
text
C12434 (NCI Thesaurus ObjectClass)
C0229664 (UMLS 2011AA ObjectClass)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C17649 (NCI Thesaurus Property)
C0205394 (UMLS 2011AA Property)
C15319 (NCI Thesaurus Property)
C2991 (NCI Thesaurus Property)
C0012634 (UMLS 2011AA Property)
C25460 (NCI Thesaurus Property)
C1511481 (UMLS 2011AA Property)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
CL.8
Code List
Have you obtained the patient's consent for his or her blood to be kept for use research about other health problems (for example: causes of diabetes, Alzheimer's disease, and heart disease)?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Have you obtained the patient's consent for allow someone from this institution to contact him or her in the future to ask him or her to take part in more research
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C67527 (NCI Thesaurus Property)
C0016884 (UMLS 2011AA Property)
C25460 (NCI Thesaurus Property)
C1511481 (UMLS 2011AA Property)
C16452 (NCI Thesaurus Property)
C0009452 (UMLS 2011AA Property)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
CL.9
Code List
Have you obtained the patient's consent for allow someone from this institution to contact him or her in the future to ask him or her to take part in more research
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Patient has consented to participate in the cosmesis study
text
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25460 (NCI Thesaurus Property)
C1511481 (UMLS 2011AA Property)
C15354 (NCI Thesaurus Property)
C0085076 (UMLS 2011AA Property)
CL.10
Code List
Patient has consented to participate in the cosmesis study
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
If no, provide reason
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C49161 (NCI Thesaurus Property)
C1705116 (UMLS 2011AA Property)
C25460 (NCI Thesaurus Property)
C1511481 (UMLS 2011AA Property)
C15354 (NCI Thesaurus Property)
C0085076 (UMLS 2011AA Property)
C25638 (NCI Thesaurus ValueDomain)
C0392360 (UMLS 2011AA ValueDomain)
CL.11
Code List
If no, provide reason
CL Item
Patient Refused Due To Illness (Patient refused due to illness)
CL Item
Patient Refused For Other Reason (Patient refused for other reason)
CL Item
Not Approved By Institutional Irb (Not approved by institutional IRB)
CL Item
Other, Specify (Other, specify)
PatientBreastReconstructionRefuseConsentSpecify
Item
Other, specify
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C49161 (NCI Thesaurus Property)
C1705116 (UMLS 2011AA Property)
C25460 (NCI Thesaurus Property)
C1511481 (UMLS 2011AA Property)
C15354 (NCI Thesaurus Property)
C0085076 (UMLS 2011AA Property)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
PatientBreastReconstructionRefuseConsentOtherSpecify
Item
Other reason, specify
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C49161 (NCI Thesaurus Property)
C1705116 (UMLS 2011AA Property)
C25460 (NCI Thesaurus Property)
C1511481 (UMLS 2011AA Property)
C15354 (NCI Thesaurus Property)
C0085076 (UMLS 2011AA Property)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C17649 (NCI Thesaurus ValueDomain)
C0205394 (UMLS 2011AA ValueDomain)
Patient Circulating Tumor Cel lConsent
Item
Patient has consented to take part in the circulating tumor cell portion of the trial
boolean
C38147 (NCI Thesaurus ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C63797 (NCI Thesaurus Property)
C25460 (NCI Thesaurus Property)
Item
If no, provide reason
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C49161 (NCI Thesaurus Property)
C1705116 (UMLS 2011AA Property)
C63797 (NCI Thesaurus Property)
C0027625 (UMLS 2011AA Property)
C25460 (NCI Thesaurus Property)
C1511481 (UMLS 2011AA Property)
C25638 (NCI Thesaurus ValueDomain)
C0392360 (UMLS 2011AA ValueDomain)
CL.13
Code List
If no, provide reason
CL Item
Patient Refused Due To Illness (Patient refused due to illness)
CL Item
Patient Refused For Other Reason (Patient refused for other reason)
CL Item
Not Approved By Institutional Irb (Not approved by institutional IRB)
CL Item
Other, Specify (Other, specify)
PatientCirculatingTumorCellRefuseConsentSpecify
Item
Other, specify
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C49161 (NCI Thesaurus Property)
C1705116 (UMLS 2011AA Property)
C63797 (NCI Thesaurus Property)
C0027625 (UMLS 2011AA Property)
C25460 (NCI Thesaurus Property)
C1511481 (UMLS 2011AA Property)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
PatientCirculatingTumorCellRefuseConsentOtherSpecify
Item
Other reason, specify
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C49161 (NCI Thesaurus Property)
C1705116 (UMLS 2011AA Property)
C63797 (NCI Thesaurus Property)
C0027625 (UMLS 2011AA Property)
C25460 (NCI Thesaurus Property)
C1511481 (UMLS 2011AA Property)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C17649 (NCI Thesaurus ValueDomain)
C0205394 (UMLS 2011AA ValueDomain)
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