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ID

43104

Beschrijving

E4599 On-Study Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A1346A5B-91C6-6A0E-E034-080020C9C0E0

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A1346A5B-91C6-6A0E-E034-080020C9C0E0

Trefwoorden

Versies (2)
  1. 16-12-14 16-12-14 - Martin Dugas
  2. 20-09-21 20-09-21 -
Geüploaded op

20 september 2021

DOI

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Licentie

Creative Commons BY-NC 3.0 Legacy
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    Lung Cancer null On-Study - E4599 On-Study Form - 2036140v3.0

    Engels

    No Instruction available.

    1 Formulieren  
    1. StudyEvent: E4599 On-Study Form
      1. No Instruction available.
    On-study form
    Beschrijving

    On-study form

    Date of data transfer
    Beschrijving

    Dateofdatatransfer

    Datatype

    text

    Transfer Method
    Beschrijving

    TransferMethod

    Datatype

    text

    Specify other transfer method
    Beschrijving

    Specifyothertransfermethod

    Datatype

    text

    Patient Name
    Beschrijving

    PatientName

    Datatype

    text

    Particip. Group Protocol Number
    Beschrijving

    Particip.GroupProtocolNumber

    Datatype

    double

    Patient Study ID, Participating Group
    Beschrijving

    PatientStudyID,ParticipatingGroup

    Datatype

    text

    Institution Name
    Beschrijving

    InstitutionName

    Datatype

    text

    Affiliate Name
    Beschrijving

    AffiliateName

    Datatype

    text

    Patient Height
    Beschrijving

    Patient Height

    Datatype

    integer

    Maateenheden
    • cm
    Alias
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25347
    UMLS CUI-1
    C0489786
    cm
    Body Surface Area
    Beschrijving

    Body Surface Area

    Datatype

    float

    Maateenheden
    • m2
    Alias
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25157
    UMLS CUI-1
    C0005902
    m2
    Patient Weight
    Beschrijving

    Patient Weight

    Datatype

    float

    Maateenheden
    • kg
    Alias
    UMLS CUI-1
    C1305866
    kg
    Performance Status
    Beschrijving

    PerformanceStatus

    Datatype

    text

    Urine dipstick result
    Beschrijving

    Urinedipstickresult

    Datatype

    text

    Date of urine dipstick
    Beschrijving

    Dateofurinedipstick

    Datatype

    text

    Date of 24 hour urine for protein
    Beschrijving

    Dateof24hoururineforprotein

    Datatype

    text

    Weight Loss Prior Six Months
    Beschrijving

    Weight Loss past 6 months

    Datatype

    float

    Alias
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C3445
    UMLS CUI-1
    C1262477
    UMLS CUI-2
    C3828652
    Protein in urine (mg/24hr)
    Beschrijving

    Proteininurine(mg/24hr)

    Datatype

    text

    Stage Grouping
    Beschrijving

    StageGrouping

    Datatype

    text

    Histologic Type
    Beschrijving

    HistologicType

    Datatype

    text

    Histologic Type, Other Name
    Beschrijving

    HistologicType,OtherName

    Datatype

    text

    Disease Assessment, Measurable Ind
    Beschrijving

    DiseaseAssessment,MeasurableInd

    Datatype

    text

    Disease Assessment, Non-measurable Ind
    Beschrijving

    DiseaseAssessment,Non-measurableInd

    Datatype

    text

    Metastatic Site
    Beschrijving

    MetastaticSite

    Datatype

    text

    Metastatic Site Indicator
    Beschrijving

    MetastaticSiteIndicator

    Datatype

    text

    Pleural Effusion Ind
    Beschrijving

    PleuralEffusionInd

    Datatype

    text

    Pleural Effusion, Malignant Ind
    Beschrijving

    PleuralEffusion,MalignantInd

    Datatype

    text

    Lab Unit Type
    Beschrijving

    LabUnitType

    Datatype

    text

    Assessment Type, Target
    Beschrijving

    AssessmentType

    Datatype

    text

    Lab, Chemistry, Albumin
    Beschrijving

    Lab,Chemistry,Albumin

    Datatype

    double

    Date Albumin Obtained
    Beschrijving

    DateAlbuminObtained

    Datatype

    text

    LDH LLN
    Beschrijving

    LDHLLN

    Datatype

    text

    Lab, Chemistry, Lactate Dehydrogenase
    Beschrijving

    Lab,Chemistry,LactateDehydrogenase

    Datatype

    double

    Date LDH Obtained
    Beschrijving

    DateLDHObtained

    Datatype

    text

    Prior Surgery Ind
    Beschrijving

    PriorSurgeryInd

    Datatype

    text

    Prior Chemotherapy Ind
    Beschrijving

    PriorChemotherapyInd

    Datatype

    text

    Prior RT Ind
    Beschrijving

    PriorRTInd

    Datatype

    text

    Prior other systemic therapy
    Beschrijving

    Prior Other Systemic Therapy

    Datatype

    boolean

    Alias
    NCI Thesaurus ObjectClass
    C17649
    NCI Thesaurus ObjectClass
    C15698
    NCI Thesaurus ObjectClass
    C25629
    NCI Thesaurus Property
    C25382
    NCI Thesaurus ValueDomain
    C38147
    Prior RT End Date
    Beschrijving

    PriorRTEndDate

    Datatype

    date

    Other systemic therapy, specify
    Beschrijving

    Othersystemictherapy,specify

    Datatype

    text

    Date of last dose
    Beschrijving

    Last Dose Date

    Datatype

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    NCI Thesaurus ObjectClass
    C25488
    NCI Thesaurus ObjectClass
    C25551
    NCI Thesaurus Property
    C25275
    Comments
    Beschrijving

    Comments

    Datatype

    text

    Comments2
    Beschrijving

    Comments2

    Datatype

    text

    Patient Race/Ethnicity
    Beschrijving

    Patient Race

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C17049
    UMLS CUI-1
    C0034510
    Payment Method
    Beschrijving

    PaymentMethod

    Datatype

    text

    Amended Data Ind
    Beschrijving

    AmendedDataInd

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C25474
    UMLS 2011AA ObjectClass
    C1511726
    NCI Thesaurus Property
    C25416
    UMLS 2011AA Property
    C1691222
    Step Number
    Beschrijving

    StepNumber

    Datatype

    text

    Terug naar het begin van de pagina

    Similar models

    No Instruction available.

    1 Formulieren
    1. StudyEvent: E4599 On-Study Form
      1. No Instruction available.
    Name
    Type
    Description | Question | Decode (Coded Value)
    Datatype
    Alias
    Item Group
    On-study form
    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
    InstitutionName
    Item
    Institution Name
    text
    AffiliateName
    Item
    Affiliate Name
    text
    Patient Height
    Item
    Patient Height
    integer
    C16960 (NCI Thesaurus ObjectClass)
    C25347 (NCI Thesaurus Property)
    C0489786 (UMLS CUI-1)
    Body Surface Area
    Item
    Body Surface Area
    float
    C16960 (NCI Thesaurus ObjectClass)
    C25157 (NCI Thesaurus Property)
    C0005902 (UMLS CUI-1)
    Patient Weight
    Item
    Patient Weight
    float
    C1305866 (UMLS CUI-1)
    PerformanceStatus
    Item
    Performance Status
    text
    Urinedipstickresult
    Item
    Urine dipstick result
    text
    Dateofurinedipstick
    Item
    Date of urine dipstick
    text
    Dateof24hoururineforprotein
    Item
    Date of 24 hour urine for protein
    text
    Weight Loss past 6 months
    Item
    Weight Loss Prior Six Months
    float
    C16960 (NCI Thesaurus ObjectClass)
    C3445 (NCI Thesaurus Property)
    C1262477 (UMLS CUI-1)
    C3828652 (UMLS CUI-2)
    Proteininurine(mg/24hr)
    Item
    Protein in urine (mg/24hr)
    text
    StageGrouping
    Item
    Stage Grouping
    text
    HistologicType
    Item
    Histologic Type
    text
    HistologicType,OtherName
    Item
    Histologic Type, Other Name
    text
    DiseaseAssessment,MeasurableInd
    Item
    Disease Assessment, Measurable Ind
    text
    DiseaseAssessment,Non-measurableInd
    Item
    Disease Assessment, Non-measurable Ind
    text
    MetastaticSite
    Item
    Metastatic Site
    text
    MetastaticSiteIndicator
    Item
    Metastatic Site Indicator
    text
    PleuralEffusionInd
    Item
    Pleural Effusion Ind
    text
    PleuralEffusion,MalignantInd
    Item
    Pleural Effusion, Malignant Ind
    text
    LabUnitType
    Item
    Lab Unit Type
    text
    AssessmentType
    Item
    Assessment Type, Target
    text
    Lab,Chemistry,Albumin
    Item
    Lab, Chemistry, Albumin
    double
    DateAlbuminObtained
    Item
    Date Albumin Obtained
    text
    LDHLLN
    Item
    LDH LLN
    text
    Lab,Chemistry,LactateDehydrogenase
    Item
    Lab, Chemistry, Lactate Dehydrogenase
    double
    DateLDHObtained
    Item
    Date LDH Obtained
    text
    PriorSurgeryInd
    Item
    Prior Surgery Ind
    text
    PriorChemotherapyInd
    Item
    Prior Chemotherapy Ind
    text
    PriorRTInd
    Item
    Prior RT Ind
    text
    Prior Other Systemic Therapy
    Item
    Prior other systemic therapy
    boolean
    C17649 (NCI Thesaurus ObjectClass)
    C15698 (NCI Thesaurus ObjectClass)
    C25629 (NCI Thesaurus ObjectClass)
    C25382 (NCI Thesaurus Property)
    C38147 (NCI Thesaurus ValueDomain)
    PriorRTEndDate
    Item
    Prior RT End Date
    date
    Othersystemictherapy,specify
    Item
    Other systemic therapy, specify
    text
    Last Dose Date
    Item
    Date of last dose
    date
    C25164 (NCI Thesaurus ValueDomain)
    C25488 (NCI Thesaurus ObjectClass)
    C25551 (NCI Thesaurus ObjectClass)
    C25275 (NCI Thesaurus Property)
    Comments
    Item
    Comments
    text
    Comments2
    Item
    Comments2
    text
    Patient Race
    Item
    Patient Race/Ethnicity
    text
    C16960 (NCI Thesaurus ObjectClass)
    C17049 (NCI Thesaurus Property)
    C0034510 (UMLS CUI-1)
    PaymentMethod
    Item
    Payment Method
    text
    AmendedDataInd
    Item
    Amended Data Ind
    text
    C25474 (NCI Thesaurus ObjectClass)
    C1511726 (UMLS 2011AA ObjectClass)
    C25416 (NCI Thesaurus Property)
    C1691222 (UMLS 2011AA Property)
    StepNumber
    Item
    Step Number
    text
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