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Information:
Fel:
ID
6188
Beskrivning
E4599 On-Study Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A1346A5B-91C6-6A0E-E034-080020C9C0E0
Länk
Nyckelord
Versioner (2)
- 2014-12-16 2014-12-16 - Martin Dugas
- 2021-09-20 2021-09-20 -
Uppladdad den
16 december 2014
DOI
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Licens
Creative Commons BY-NC 3.0 Legacy
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Lung Cancer null On-Study - E4599 On-Study Form - 2036140v3.0
No Instruction available.
- StudyEvent: E4599 On-Study Form
Similar models
No Instruction available.
- StudyEvent: E4599 On-Study Form
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
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)
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)
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)
C0043096 (UMLS CUI-1)
C3828652 (UMLS CUI-2)
C3445 (NCI Thesaurus Property)
C0043096 (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)
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)
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)
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)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
StepNumber
Item
Step Number
text
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