0 Évaluations
ID

6824

Description

Southwest Oncology Group S0518 Hypertension Status Form Octreotide and Interferon Alfa-2b or Bevacizumab in Treating Patients With Metastatic or Locally Advanced, High-Risk Neuroendocrine Tumor Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=38429791-B8E2-1FFB-E044-0003BA3F9857

Lien

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=38429791-B8E2-1FFB-E044-0003BA3F9857

Mots-clés

Versions (4)
  1. 20/09/2012 20/09/2012 -
  2. 08/08/2014 08/08/2014 - Martin Dugas
  3. 08/01/2015 08/01/2015 - Martin Dugas
  4. 08/06/2015 08/06/2015 -
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.

    Neuroendocrine Carcinoma NCT00569127 On-Study - Southwest Oncology Group S0518 Hypertension Status Form - 2674433v1.0

    Anglais

    No Instruction available.

    1 Formulaires  
    1. StudyEvent: Southwest Oncology Group S0518 Hypertension Status Form
      1. No Instruction available.
    Header
    Description

    Header

    SWOG Patient ID
    Description

    Trial subject ID SWOG

    Type de données

    float

    Alias
    NCI Thesaurus ValueDomain
    C25337 (undefined)
    UMLS CUI-1
    C2348585 (Clinical Trial Subject Unique Identifier)
    NCI Thesaurus ObjectClass
    C16960 (undefined)
    UMLS CUI-2
    C1519429 (SWOG)
    LOINC
    LA4458-1
    NCI Thesaurus Property
    C25364 (undefined)
    NCI Thesaurus Property-2
    C25699 (undefined)
    SWOG Study No.
    Description

    Protocol ID SWOG

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337 (undefined)
    UMLS CUI-1
    C3274381 (Clinical Trial Registry Identifier)
    NCI Thesaurus ObjectClass
    C25320 (undefined)
    UMLS CUI-2
    C1519429 (SWOG)
    LOINC
    LA4458-1
    NCI Thesaurus Property
    C25364 (undefined)
    NCI Thesaurus Property-2
    C25699 (undefined)
    Registration Step
    Description

    Registration Number

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337 (undefined)
    UMLS CUI-1
    C1514821 (Registration)
    NCI Thesaurus ObjectClass
    C25646 (undefined)
    UMLS CUI-2
    C0237753 (Numbers)
    SNOMED
    260299005
    LOINC
    LP6841-3
    NCI Thesaurus Property
    C16154 (undefined)
    NCI Thesaurus ValueDomain-2
    C16154 (undefined)
    Reporting Period Start Date
    Description

    Reporting Period Start Date

    Type de données

    date

    Alias
    NCI Thesaurus ObjectClass
    C15368 (undefined)
    NCI Thesaurus Property
    C25616 (undefined)
    UMLS CUI-1
    C2361257 (Survey reporting period start date)
    LOINC
    MTHU028176
    NCI Thesaurus Property-2
    C25651 (undefined)
    NCI Thesaurus ValueDomain
    C25164 (undefined)
    NCI Thesaurus ValueDomain-2
    C25431 (undefined)
    Patient Initials (L, F M)
    Description

    Patient Initials

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191 (undefined)
    UMLS CUI-1
    C2986440 (Person Initials)
    NCI Thesaurus ObjectClass
    C16960 (undefined)
    NCI Thesaurus Property
    C25536 (undefined)
    Institution/Affiliate
    Description

    Institution Name

    Type de données

    text

    Alias
    NCI Thesaurus ObjectClass
    C25454 (undefined)
    UMLS CUI-1
    C1301943 (Institution name)
    SNOMED
    398321007
    NCI Thesaurus ObjectClass-2
    C21541 (undefined)
    NCI Thesaurus Property
    C25364 (undefined)
    NCI Thesaurus ValueDomain
    C25191 (undefined)
    NCI Thesaurus ValueDomain-2
    C21541 (undefined)
    Physician
    Description

    Investigator Name

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191 (undefined)
    UMLS CUI-1
    C2826892 (Investigator Name)
    NCI Thesaurus Property
    C25364 (undefined)
    NCI Thesaurus ObjectClass
    C17089 (undefined)
    NCI Thesaurus ObjectClass-2
    C25644 (undefined)
    Participating Group Name
    Description

    Participating Group

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191 (undefined)
    UMLS CUI-1
    C2347449 (Participating Clinical Study Organization)
    NCI Thesaurus ObjectClass
    C25608 (undefined)
    NCI Thesaurus ObjectClass-2
    C17005 (undefined)
    NCI Thesaurus Property
    C25364 (undefined)
    Participating Study No.
    Description

    Study Number Participating Group

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337 (undefined)
    UMLS CUI-1
    C3274381 (Clinical Trial Registry Identifier)
    NCI Thesaurus ObjectClass
    C25320 (undefined)
    UMLS CUI-2
    C2347449 (Participating Clinical Study Organization)
    NCI Thesaurus Property
    C25608 (undefined)
    NCI Thesaurus Property-2
    C25364 (undefined)
    Participating Patient ID (Instructions: Please complete this form after each cycle 1 cycle = 4 weeks. All dates are MONTH, DAY, YEAR. Explain any blank dates or fields in a Comments section. Place an X in appropriate boxes. Circle AMENDED items in red and write AMENDED across top of form.)
    Description

    Trial subject ID Participating Group

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337 (undefined)
    UMLS CUI-1
    C2348585 (Clinical Trial Subject Unique Identifier)
    NCI Thesaurus ObjectClass
    C16960 (undefined)
    UMLS CUI-2
    C2347449 (Participating Clinical Study Organization)
    NCI Thesaurus Property
    C25608 (undefined)
    NCI Thesaurus Property-2
    C25364 (undefined)
    Unnamed2
    Description

    Unnamed2

    Date of most recent blood pressure assessment
    Description

    BloodPressurePhysicalExaminationMostRecentDate

    Type de données

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164 (undefined)
    UMLS 2011AA ValueDomain
    C0011008 (Date in time)
    SNOMED
    410671006
    NCI Thesaurus Property
    C20989 (undefined)
    UMLS 2011AA Property
    C0031809 (Physical Examination)
    SNOMED
    5880005
    LOINC
    MTHU028014
    NCI Thesaurus ObjectClass
    C54706 (undefined)
    UMLS 2011AA ObjectClass
    C0005823 (Blood Pressure)
    SNOMED
    75367002
    NCI Thesaurus ValueDomain-2
    C25577 (undefined)
    UMLS 2011AA ValueDomain-2
    C1513491 (Most Recent)
    Blood Pressure, Systolic
    Description

    Systolic blood pressure

    Type de données

    float

    Alias
    NCI Thesaurus ValueDomain
    C25209 (undefined)
    UMLS CUI-1
    C0871470 (Systolic Pressure)
    SNOMED
    271649006
    NCI Thesaurus Property
    C25214 (undefined)
    NCI Thesaurus ObjectClass
    C25298 (undefined)
    Blood pressure, Diastolic
    Description

    Diastolic blood pressure

    Type de données

    float

    Alias
    NCI Thesaurus ValueDomain
    C25209 (undefined)
    UMLS CUI-1
    C0428883 (Diastolic blood pressure)
    SNOMED
    271650006
    NCI Thesaurus Property
    C25214 (undefined)
    NCI Thesaurus ObjectClass
    C25299 (undefined)
    Does the patient have hypertension requiring medication?
    Description

    AntihypertensiveAgentAdministeredInd-2

    Type de données

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38147 (undefined)
    UMLS 2011AA ValueDomain
    C1512698 (Yes or No Response)
    NCI Thesaurus ObjectClass
    C270 (undefined)
    UMLS 2011AA ObjectClass
    C0003364 (Antihypertensive Agents)
    SNOMED
    1182007
    LOINC
    LP31453-1
    NCI Thesaurus Property
    C25382 (undefined)
    UMLS 2011AA Property
    C1521801 (Having administered)
    Agent Name
    Description

    Agent

    Type de données

    text

    Alias
    NCI Thesaurus Property
    C25364 (undefined)
    UMLS CUI-1
    C1521826 (Protocol Agent)
    NCI Thesaurus ObjectClass
    C1708 (undefined)
    NCI Thesaurus ValueDomain
    C1708 (undefined)
    NCI Thesaurus ValueDomain-2
    C42614 (undefined)
    Total Daily Dose of Agent (or Drug)
    Description

    Concomitant Medication Daily Dose

    Type de données

    float

    Alias
    NCI Thesaurus ObjectClass
    C25473 (undefined)
    UMLS CUI-1
    C2826638 (Concomitant Medication Daily Dose)
    NCI Thesaurus ObjectClass-2
    C1708 (undefined)
    NCI Thesaurus Property
    C25304 (undefined)
    NCI Thesaurus Property-2
    C25256 (undefined)
    NCI Thesaurus ValueDomain
    C25488 (undefined)
    NCI Thesaurus ValueDomain-2
    C1708 (undefined)
    Comments
    Description

    Comments

    Comments
    Description

    Research Comments

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704 (undefined)
    UMLS CUI-1
    C0947611 (Comment)
    LOINC
    LP72293-1
    NCI Thesaurus ObjectClass
    C15319 (undefined)
    NCI Thesaurus Property
    C25393 (undefined)
    Retour au début de la page

    Similar models

    No Instruction available.

    1 Formulaires
    1. StudyEvent: Southwest Oncology Group S0518 Hypertension Status Form
      1. No Instruction available.
    Name
    Type
    Description | Question | Decode (Coded Value)
    Type de données
    Alias
    Item Group
    Header
    Trial subject ID SWOG
    Item
    SWOG Patient ID
    float
    C25337 (NCI Thesaurus ValueDomain)
    C2348585 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C1519429 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25699 (NCI Thesaurus Property-2)
    Protocol ID SWOG
    Item
    SWOG Study No.
    text
    C25337 (NCI Thesaurus ValueDomain)
    C3274381 (UMLS CUI-1)
    C25320 (NCI Thesaurus ObjectClass)
    C1519429 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25699 (NCI Thesaurus Property-2)
    Registration Number
    Item
    Registration Step
    text
    C25337 (NCI Thesaurus ValueDomain)
    C1514821 (UMLS CUI-1)
    C25646 (NCI Thesaurus ObjectClass)
    C0237753 (UMLS CUI-2)
    C16154 (NCI Thesaurus Property)
    C16154 (NCI Thesaurus ValueDomain-2)
    Reporting Period Start Date
    Item
    Reporting Period Start Date
    date
    C15368 (NCI Thesaurus ObjectClass)
    C25616 (NCI Thesaurus Property)
    C2361257 (UMLS CUI-1)
    C25651 (NCI Thesaurus Property-2)
    C25164 (NCI Thesaurus ValueDomain)
    C25431 (NCI Thesaurus ValueDomain-2)
    Patient Initials
    Item
    Patient Initials (L, F M)
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2986440 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25536 (NCI Thesaurus Property)
    Institution Name
    Item
    Institution/Affiliate
    text
    C25454 (NCI Thesaurus ObjectClass)
    C1301943 (UMLS CUI-1)
    C21541 (NCI Thesaurus ObjectClass-2)
    C25364 (NCI Thesaurus Property)
    C25191 (NCI Thesaurus ValueDomain)
    C21541 (NCI Thesaurus ValueDomain-2)
    Investigator Name
    Item
    Physician
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2826892 (UMLS CUI-1)
    C25364 (NCI Thesaurus Property)
    C17089 (NCI Thesaurus ObjectClass)
    C25644 (NCI Thesaurus ObjectClass-2)
    Participating Group
    Item
    Participating Group Name
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2347449 (UMLS CUI-1)
    C25608 (NCI Thesaurus ObjectClass)
    C17005 (NCI Thesaurus ObjectClass-2)
    C25364 (NCI Thesaurus Property)
    Study Number Participating Group
    Item
    Participating Study No.
    text
    C25337 (NCI Thesaurus ValueDomain)
    C3274381 (UMLS CUI-1)
    C25320 (NCI Thesaurus ObjectClass)
    C2347449 (UMLS CUI-2)
    C25608 (NCI Thesaurus Property)
    C25364 (NCI Thesaurus Property-2)
    Trial subject ID Participating Group
    Item
    Participating Patient ID (Instructions: Please complete this form after each cycle 1 cycle = 4 weeks. All dates are MONTH, DAY, YEAR. Explain any blank dates or fields in a Comments section. Place an X in appropriate boxes. Circle AMENDED items in red and write AMENDED across top of form.)
    text
    C25337 (NCI Thesaurus ValueDomain)
    C2348585 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C2347449 (UMLS CUI-2)
    C25608 (NCI Thesaurus Property)
    C25364 (NCI Thesaurus Property-2)
    Item Group
    Unnamed2
    BloodPressurePhysicalExaminationMostRecentDate
    Item
    Date of most recent blood pressure assessment
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C54706 (NCI Thesaurus ObjectClass)
    C0005823 (UMLS 2011AA ObjectClass)
    C25577 (NCI Thesaurus ValueDomain-2)
    C1513491 (UMLS 2011AA ValueDomain-2)
    Systolic blood pressure
    Item
    Blood Pressure, Systolic
    float
    C25209 (NCI Thesaurus ValueDomain)
    C0871470 (UMLS CUI-1)
    C25214 (NCI Thesaurus Property)
    C25298 (NCI Thesaurus ObjectClass)
    Diastolic blood pressure
    Item
    Blood pressure, Diastolic
    float
    C25209 (NCI Thesaurus ValueDomain)
    C0428883 (UMLS CUI-1)
    C25214 (NCI Thesaurus Property)
    C25299 (NCI Thesaurus ObjectClass)
    AntihypertensiveAgentAdministeredInd-2
    Item
    Does the patient have hypertension requiring medication?
    boolean
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    C270 (NCI Thesaurus ObjectClass)
    C0003364 (UMLS 2011AA ObjectClass)
    C25382 (NCI Thesaurus Property)
    C1521801 (UMLS 2011AA Property)
    Agent
    Item
    Agent Name
    text
    C25364 (NCI Thesaurus Property)
    C1521826 (UMLS CUI-1)
    C1708 (NCI Thesaurus ObjectClass)
    C1708 (NCI Thesaurus ValueDomain)
    C42614 (NCI Thesaurus ValueDomain-2)
    Concomitant Medication Daily Dose
    Item
    Total Daily Dose of Agent (or Drug)
    float
    C25473 (NCI Thesaurus ObjectClass)
    C2826638 (UMLS CUI-1)
    C1708 (NCI Thesaurus ObjectClass-2)
    C25304 (NCI Thesaurus Property)
    C25256 (NCI Thesaurus Property-2)
    C25488 (NCI Thesaurus ValueDomain)
    C1708 (NCI Thesaurus ValueDomain-2)
    Item Group
    Comments
    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