Informations:
Erreur:
ID
6297
Description
S0100 ALLOGENEIC PBSCT TREATMENT FORM Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AEB397EC-8B44-42D5-E034-0003BA12F5E7
Lien
Mots-clés
Versions (1)
- 18/12/2014 18/12/2014 - Martin Dugas
Téléchargé le
18 décembre 2014
DOI
Pour une demande vous connecter.
Licence
Creative Commons BY-NC 3.0 Legacy
Modèle Commentaires :
Ici, vous pouvez faire des commentaires sur le modèle. À partir des bulles de texte, vous pouvez laisser des commentaires spécifiques sur les groupes Item et les Item.
Groupe Item commentaires pour :
Item commentaires pour :
Vous devez être connecté pour pouvoir télécharger des formulaires. Veuillez vous connecter ou s’inscrire gratuitement.
Leukemia null Treatment - S0100 ALLOGENEIC PBSCT TREATMENT FORM - 2071283v3.0
No Instruction available.
- StudyEvent: S0100 ALLOGENEIC PBSCT TREATMENT FORM
Similar models
No Instruction available.
- StudyEvent: S0100 ALLOGENEIC PBSCT TREATMENT FORM
Name
Type
Description | Question | Decode (Coded Value)
Type de données
Alias
PatientWeight
Item
Weight (kg)
double
BodySurfaceArea
Item
BSA (2 m)
double
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25157 (NCI Thesaurus Property)
C0005902 (UMLS 2011AA Property)
C0030705 (UMLS 2011AA ObjectClass)
C25157 (NCI Thesaurus Property)
C0005902 (UMLS 2011AA Property)
CL Item
VP-16 (VP-16)
CL Item
TBI (TBI)
CL Item
Testicular Boost (Testicular Boost)
CL Item
Allopurinol (Allopurinol)
TreatmentStartDate
Item
Start Date
date
TreatmentEndDate
Item
Stop Date
date
AgentTotalDose
Item
Total dose given (mg)
double
RTTotalFractionCount
Item
Number of fractions
double
Item
Were there any dose modifications or additions/omissions to protocol treatment? (check one)
text
Code List
Were there any dose modifications or additions/omissions to protocol treatment? (check one)
CL Item
(i.e., The Treatment Was Changed According To Protocol Guidelines) (Yes, planned (i.e., the treatment was changed according to protocol guidelines))
CL Item
(i.e., The Treatment Change Was Not Part Of Protocol Guidelines) (Yes, unplanned (i.e., the treatment change was not part of protocol guidelines))
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
C1298908 (UMLS 2011AA)
Dateoflastperipheralbloodstemcellinfusion
Item
date of infusion
text
Totalno.ofCD34+cellsinfused
Item
CD34 cells infused (6 X 10 cells/kg)
text
CL Item
A (A)
C14653 (NCI Thesaurus)
CL Item
B (B)
CL Item
Ab (AB)
CL Item
O (O)
Item
Patient ABO type (** Explain modifications to dose and/or course and reasons for modification)
text
Code List
Patient ABO type (** Explain modifications to dose and/or course and reasons for modification)
CL Item
A (A)
C14653 (NCI Thesaurus)
CL Item
B (B)
CL Item
Ab (AB)
CL Item
O (O)
SWOGPatientID
Item
SWOG Patient ID
text
SWOGStudyNo.
Item
SWOG Study No.
text
RegistrationStep
Item
Registration Step
text
PatientInitials
Item
Patient Initials (L, F, M)
text
MainMemberInstitution/Affiliate
Item
Institution/Affiliate
text
TreatingPhysician
Item
Physician
text
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25741 (NCI Thesaurus ObjectClass)
C0031831 (UMLS 2011AA ObjectClass)
C25705 (NCI Thesaurus ObjectClass)
C1522326 (UMLS 2011AA ObjectClass)
C0600091 (UMLS 2011AA Property)
C25741 (NCI Thesaurus ObjectClass)
C0031831 (UMLS 2011AA ObjectClass)
C25705 (NCI Thesaurus ObjectClass)
C1522326 (UMLS 2011AA ObjectClass)