ID

6187

Description

ECOG Non-Protocol Therapy Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A134152B-EFC9-660E-E034-080020C9C0E0

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A134152B-EFC9-660E-E034-080020C9C0E0

Keywords

Versions (2)
  1. 9/19/12 9/19/12 -
  2. 12/16/14 12/16/14 - Martin Dugas
Uploaded on

December 16, 2014

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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Lung Cancer null Treatment - ECOG Non-Protocol Therapy Form - 2036091v3.0

English

No Instruction available.

1 forms  
  1. StudyEvent: ECOG Non-Protocol Therapy Form
    1. No Instruction available.
General information
Description

General information

Alias
UMLS CUI-1
C1508263
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

Patient Name
Description

PatientName

Data type

text

Particip. Group Protocol Number
Description

Particip.GroupProtocolNumber

Data type

double

Patient Study ID, Participating Group
Description

PatientStudyID,ParticipatingGroup

Data type

text

Step Number
Description

StepNumber

Data type

text

Institution Name
Description

InstitutionName

Data type

text

Affiliate Name
Description

AffiliateName

Data type

text

Data amended
Description

Data amended

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C25474
NCI Thesaurus Property
C25416
UMLS CUI-1
C0680532
Data amended
Description

Data amended

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C25474
NCI Thesaurus Property
C25416
UMLS CUI-1
C0680532
Non-Protocol Chemotherapy Ind
Description

Non-ProtocolChemotherapyInd

Data type

text

Non-Protocol HDC/ASCT Ind
Description

Non-ProtocolHDC/ASCTInd

Data type

text

Non-Protocol Hormonal Therapy Ind
Description

Non-ProtocolHormonalTherapyInd

Data type

text

Non-Protocol Therapy Date, First
Description

Non-ProtocolTherapyDate,First

Data type

date

Non-Protocol RT Ind
Description

Non-ProtocolRTInd

Data type

text

Other Non-Protocol Therapy Name
Description

OtherNon-ProtocolTherapyName

Data type

text

Non-Protocol Immunotherapy Ind
Description

Non-ProtocolImmunotherapyInd

Data type

text

Other Non-Protocol Therapy Ind
Description

OtherNon-ProtocolTherapyInd

Data type

text

Step No.
Description

StepNo.

Data type

text

Comments
Description

Comments

Data type

text

Comments
Description

Comments

Data type

text

Non-Protocol Surgery performed
Description

Non-protocol Surgery Performed

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38148
NCI Thesaurus Property
C38000
NCI Thesaurus ObjectClass
C15329
NCI Thesaurus ObjectClass
C25590
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Similar models

No Instruction available.

1 forms
  1. StudyEvent: ECOG Non-Protocol Therapy Form
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
General information
C1508263 (UMLS CUI-1)
Dateofdatatransfer
Item
Date of data transfer
text
TransferMethod
Item
Transfer Method
text
Specifyothertransfermethod
Item
Specify other transfer method
text
PatientName
Item
Patient Name
text
Particip.GroupProtocolNumber
Item
Particip. Group Protocol Number
double
PatientStudyID,ParticipatingGroup
Item
Patient Study ID, Participating Group
text
StepNumber
Item
Step Number
text
InstitutionName
Item
Institution Name
text
AffiliateName
Item
Affiliate Name
text
Data amended
Item
Data amended
boolean
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)
C0680532 (UMLS CUI-1)
Data amended
Item
Data amended
boolean
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)
C0680532 (UMLS CUI-1)
Non-ProtocolChemotherapyInd
Item
Non-Protocol Chemotherapy Ind
text
Non-ProtocolHDC/ASCTInd
Item
Non-Protocol HDC/ASCT Ind
text
Non-ProtocolHormonalTherapyInd
Item
Non-Protocol Hormonal Therapy Ind
text
Non-ProtocolTherapyDate,First
Item
Non-Protocol Therapy Date, First
date
Non-ProtocolRTInd
Item
Non-Protocol RT Ind
text
OtherNon-ProtocolTherapyName
Item
Other Non-Protocol Therapy Name
text
Non-ProtocolImmunotherapyInd
Item
Non-Protocol Immunotherapy Ind
text
OtherNon-ProtocolTherapyInd
Item
Other Non-Protocol Therapy Ind
text
StepNo.
Item
Step No.
text
Comments
Item
Comments
text
Comments
Item
Comments
text
Non-protocol Surgery Performed
Item
Non-Protocol Surgery performed
boolean
C38148 (NCI Thesaurus ValueDomain)
C38000 (NCI Thesaurus Property)
C15329 (NCI Thesaurus ObjectClass)
C25590 (NCI Thesaurus ObjectClass)
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