0 Évaluations
ID

6549

Description

AMC-046 Death Form (F04) Cidofovir in Treating HIV-Infected Patients With High-Grade Squamous Intraepithelial Lesions of the Skin Near the Anus NCT00550589 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=7D8985E5-2EC8-08A5-E040-BB89AD434A3B

Lien

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=7D8985E5-2EC8-08A5-E040-BB89AD434A3B

Mots-clés

Versions (2)
  1. 26/08/2012 26/08/2012 -
  2. 08/01/2015 08/01/2015 - Martin Dugas
Téléchargé le

8 janvier 2015

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.

Retour au modèle Commentaires
Groupe Item commentaires pour :

Item commentaires pour :

  • Plus récent
  • Plus ancien
  • Favori
  • Plus récent
    • Plus récent
    • Plus ancien
    • Favori

    Aucun commentaire

    Vous devez être connecté pour pouvoir télécharger des formulaires. Veuillez vous connecter ou s’inscrire gratuitement.

    Death Form (F04) Anal Cancer (NCT00550589)

    Anglais

    No Instruction available.

    1 Formulaires  
    1. StudyEvent: AMC-046 Death Form (F04)
      1. No Instruction available.
    Date of Death (mm/dd/yyyy)
    Description

    DeathDocumentedDate

    Type de données

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ObjectClass
    C28554
    UMLS 2011AA ObjectClass
    C0011065
    NCI Thesaurus Property
    C25356
    UMLS 2011AA Property
    C1301725
    Treatment Status (at time of death)
    Description

    Treatment Status

    Type de données

    text

    Alias
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus ValueDomain
    C25688
    UMLS CUI-1
    C0749659
    NCI Thesaurus Property
    C25365
    Last Date (any modality of) protocol therapy was given (mm/dd/yyyy)
    Description

    Treatment End Date

    Type de données

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS CUI-1
    C1531784
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus Property
    C25275
    NCI Thesaurus Property-2
    C25496
    Primary cause of death
    Description

    AcquiredImmunodeficiencySyndromePatientPrimaryDeathReason

    Type de données

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus ObjectClass-2
    C2851
    UMLS 2011AA ObjectClass-2
    C0001175
    NCI Thesaurus Property
    C28554
    UMLS 2011AA Property
    C0011065
    NCI Thesaurus Property-2
    C25251
    UMLS 2011AA Property-2
    C0205225
    NCI Thesaurus ValueDomain
    C25638
    UMLS 2011AA ValueDomain
    C0392360
    Contributing cause of death
    Description

    AcquiredImmunodeficiencySyndromePatientSecondaryDeathReason

    Type de données

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus ObjectClass-2
    C2851
    UMLS 2011AA ObjectClass-2
    C0001175
    NCI Thesaurus Property
    C28554
    UMLS 2011AA Property
    C0011065
    NCI Thesaurus Property-2
    C25667
    UMLS 2011AA Property-2
    C0175668
    NCI Thesaurus ValueDomain
    C25638
    UMLS 2011AA ValueDomain
    C0392360
    Specify
    Description

    AcquiredImmunodeficiencySyndromePatientSecondaryDeathSpecify

    Type de données

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus ObjectClass-2
    C2851
    UMLS 2011AA ObjectClass-2
    C0001175
    NCI Thesaurus Property
    C28554
    UMLS 2011AA Property
    C0011065
    NCI Thesaurus Property-2
    C25667
    UMLS 2011AA Property-2
    C0175668
    NCI Thesaurus ValueDomain
    C25685
    UMLS 2011AA ValueDomain
    C1521902
    Describe cause of death
    Description

    Cause of Death, specify

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    UMLS CUI-1
    C0007465
    NCI Thesaurus ObjectClass
    C16960
    UMLS CUI-2
    C1521902
    NCI Thesaurus Property
    C28554
    Source of death information
    Description

    AcquiredImmunodeficiencySyndromePatientDeathSource

    Type de données

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C28554
    UMLS 2011AA Property
    C0011065
    NCI Thesaurus ObjectClass-2
    C2851
    UMLS 2011AA ObjectClass-2
    C0001175
    NCI Thesaurus ValueDomain
    C25683
    UMLS 2011AA ValueDomain
    C0449416
    Other, specify
    Description

    PatientDeathSourceSpecify

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    UMLS 2011AA ValueDomain
    C1521902
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C28554
    UMLS 2011AA Property
    C0011065
    Comments
    Description

    Research Comments

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704
    UMLS CUI-1
    C0947611
    NCI Thesaurus ObjectClass
    C15319
    NCI Thesaurus Property
    C25393
    Retour au début de la page

    Similar models

    No Instruction available.

    1 Formulaires
    1. StudyEvent: AMC-046 Death Form (F04)
      1. No Instruction available.
    Name
    Type
    Description | Question | Decode (Coded Value)
    Type de données
    Alias
    DeathDocumentedDate
    Item
    Date of Death (mm/dd/yyyy)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C28554 (NCI Thesaurus ObjectClass)
    C0011065 (UMLS 2011AA ObjectClass)
    C25356 (NCI Thesaurus Property)
    C1301725 (UMLS 2011AA Property)
    Item
    Treatment Status (at time of death)
    text
    C15368 (NCI Thesaurus ObjectClass)
    C25688 (NCI Thesaurus ValueDomain)
    C0749659 (UMLS CUI-1)
    C25365 (NCI Thesaurus Property)
    CL.1
    Code List
    Treatment Status (at time of death)
    CL Item
    On Study, On Protocol Treatment (On study, on protocol treatment)
    CL Item
    On Study, Off Protocol Treatment (On study, off protocol treatment)
    CL Item
    Off Study (Off study)
    Treatment End Date
    Item
    Last Date (any modality of) protocol therapy was given (mm/dd/yyyy)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C1531784 (UMLS CUI-1)
    C15368 (NCI Thesaurus ObjectClass)
    C25275 (NCI Thesaurus Property)
    C25496 (NCI Thesaurus Property-2)
    Item
    Primary cause of death
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C2851 (NCI Thesaurus ObjectClass-2)
    C0001175 (UMLS 2011AA ObjectClass-2)
    C28554 (NCI Thesaurus Property)
    C0011065 (UMLS 2011AA Property)
    C25251 (NCI Thesaurus Property-2)
    C0205225 (UMLS 2011AA Property-2)
    C25638 (NCI Thesaurus ValueDomain)
    C0392360 (UMLS 2011AA ValueDomain)
    CL.2
    Code List
    Primary cause of death
    CL Item
    Due To Non-malignancy Complications Of Hiv Disease (Due to Non-malignancy complications of HIV disease)
    CL Item
    Due To Other Cause, Specify (Due to other cause)
    CL Item
    Due To Protocol Treatment (Due to protocol treatment)
    CL Item
    Due To Second Primary Or Other Malignancy (Due to second primary or other malignancy)
    CL Item
    Due To This Disease (Due to this disease)
    Item
    Contributing cause of death
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C2851 (NCI Thesaurus ObjectClass-2)
    C0001175 (UMLS 2011AA ObjectClass-2)
    C28554 (NCI Thesaurus Property)
    C0011065 (UMLS 2011AA Property)
    C25667 (NCI Thesaurus Property-2)
    C0175668 (UMLS 2011AA Property-2)
    C25638 (NCI Thesaurus ValueDomain)
    C0392360 (UMLS 2011AA ValueDomain)
    CL.3
    Code List
    Contributing cause of death
    CL Item
    Due To Protocol Treatment (Due to protocol treatment)
    CL Item
    Due To This Disease (Due to this disease)
    CL Item
    Due To Second Primary Or Other Malignancy (Due to second primary or other malignancy)
    CL Item
    Due To Non-malignancy Complications Of Hiv Disease (Due to Non-malignancy complications of HIV disease)
    CL Item
    Due To Other Cause, Specify (Due to other cause)
    AcquiredImmunodeficiencySyndromePatientSecondaryDeathSpecify
    Item
    Specify
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C2851 (NCI Thesaurus ObjectClass-2)
    C0001175 (UMLS 2011AA ObjectClass-2)
    C28554 (NCI Thesaurus Property)
    C0011065 (UMLS 2011AA Property)
    C25667 (NCI Thesaurus Property-2)
    C0175668 (UMLS 2011AA Property-2)
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    Cause of Death, specify
    Item
    Describe cause of death
    text
    C25685 (NCI Thesaurus ValueDomain)
    C0007465 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C1521902 (UMLS CUI-2)
    C28554 (NCI Thesaurus Property)
    Item
    Source of death information
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C28554 (NCI Thesaurus Property)
    C0011065 (UMLS 2011AA Property)
    C2851 (NCI Thesaurus ObjectClass-2)
    C0001175 (UMLS 2011AA ObjectClass-2)
    C25683 (NCI Thesaurus ValueDomain)
    C0449416 (UMLS 2011AA ValueDomain)
    CL.4
    Code List
    Source of death information
    CL Item
    Autopsy (Autopsy)
    C25153 (NCI Thesaurus)
    C0004398 (UMLS 2011AA)
    CL Item
    Histological Evidence Was The Source Of Information On The Patient's Death (Histological evidence)
    CL Item
    Clinical Evidence Was The Source Of Information On The Patient's Death (Clinical evidence)
    CL Item
    Contact With Physician (Contact with physician)
    CL Item
    Information From Friends And Relatives (Information from friends and relatives)
    CL Item
    Death Certificate Was The Source Of Information On The Patient's Death (Death certificate)
    CL Item
    Other (Other)
    C17649 (NCI Thesaurus)
    C0205394 (UMLS 2011AA)
    PatientDeathSourceSpecify
    Item
    Other, specify
    text
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C28554 (NCI Thesaurus Property)
    C0011065 (UMLS 2011AA Property)
    Research Comments
    Item
    Comments
    text
    C25704 (NCI Thesaurus ValueDomain)
    C0947611 (UMLS CUI-1)
    C15319 (NCI Thesaurus ObjectClass)
    C25393 (NCI Thesaurus Property)
    Retour au début de la page 

    Aide

    Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

    Watch Tutorial