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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

  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

    No Instruction available.

    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

    Similar models

    No Instruction available.

    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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