ID

6868

Beschrijving

Upper Gastrointestinal Cancers - Follow Up Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=99CD59C5-A9B0-3FA4-E034-080020C9C0E0

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=99CD59C5-A9B0-3FA4-E034-080020C9C0E0

Trefwoorden

  1. 19-09-12 19-09-12 -
  2. 08-01-15 08-01-15 - Martin Dugas
Geüploaded op

8 januari 2015

DOI

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Licentie

Creative Commons BY-NC 3.0 Legacy

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Follow-Up - Upper Gastrointestinal Cancers - Follow Up Form - 2020208v2.31

No Instruction available.

  1. StudyEvent: Upper Gastrointestinal Cancers - Follow Up Form
    1. No Instruction available.
Crf Header
Beschrijving

Crf Header

Cytogenetics Ind
Beschrijving

CytogeneticsInd

Datatype

text

Coordinating Group Protocol Number
Beschrijving

CoordinatingGroupProtocolNumber

Datatype

text

Coordinating Group Code
Beschrijving

CoordinatingGroupCode

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25162
UMLS 2011AA ValueDomain
C0805701
Protocol Title
Beschrijving

Protocol Title

Datatype

text

Alias
NCI Thesaurus ObjectClass
C25320
UMLS CUI-1
C2986303
NCI Thesaurus Property
C42774
Patient Study ID, Coordinating Group
Beschrijving

PatientStudyID,CoordinatingGroup

Datatype

text

Patient Study ID, Participating Group
Beschrijving

PatientStudyID,ParticipatingGroup

Datatype

text

Participating Group Code
Beschrijving

ParticipatingGroupCode

Datatype

text

Institution Name
Beschrijving

InstitutionName

Datatype

text

Affiliate Name
Beschrijving

AffiliateName

Datatype

text

Patient Name, Last
Beschrijving

PatientName,Last

Datatype

text

Patient Name, First
Beschrijving

PatientName,First

Datatype

text

Patient Name, Middle
Beschrijving

PatientName,Middle

Datatype

text

Gi: Vital Status
Beschrijving

Gi: Vital Status

Patient's Vital Status
Beschrijving

Patient'sVitalStatus

Datatype

text

Death Reason
Beschrijving

DeathReason

Datatype

text

Death Date/Last Contact Date
Beschrijving

DeathDate/LastContactDate

Datatype

date

Gi: Disease Follow-up Status
Beschrijving

Gi: Disease Follow-up Status

Cancer Follow-up Status Ind
Beschrijving

CancerFollow-upStatusInd

Datatype

text

Cancer Follow-up Status Date
Beschrijving

CancerFollow-upStatusDate

Datatype

date

Alias
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus Property
C25365
UMLS 2011AA Property
C0678257
Gi: Notice Of Progression
Beschrijving

Gi: Notice Of Progression

Progression Ind
Beschrijving

ProgressionInd

Datatype

text

Progression Date
Beschrijving

ProgressionDate

Datatype

date

Progression Site
Beschrijving

ProgressionSite

Datatype

text

Progression Site, Other
Beschrijving

ProgressionSite,Other

Datatype

text

Gi: Notice Of New Primary
Beschrijving

Gi: Notice Of New Primary

New Primary Cancer Ind
Beschrijving

NewPrimaryCancerInd

Datatype

text

New Primary Cancer Date
Beschrijving

NewPrimaryCancerDate

Datatype

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
New Primary Site
Beschrijving

NewPrimarySite

Datatype

text

Allows Documentation Of Any Additional Cooments
Beschrijving

Allows Documentation Of Any Additional Cooments

Comments
Beschrijving

Comments

Datatype

text

Similar models

No Instruction available.

  1. StudyEvent: Upper Gastrointestinal Cancers - Follow Up Form
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Crf Header
CytogeneticsInd
Item
Cytogenetics Ind
text
CoordinatingGroupProtocolNumber
Item
Coordinating Group Protocol Number
text
CoordinatingGroupCode
Item
Coordinating Group Code
text
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
Protocol Title
Item
Protocol Title
text
C25320 (NCI Thesaurus ObjectClass)
C2986303 (UMLS CUI-1)
C42774 (NCI Thesaurus Property)
PatientStudyID,CoordinatingGroup
Item
Patient Study ID, Coordinating Group
text
PatientStudyID,ParticipatingGroup
Item
Patient Study ID, Participating Group
text
Item
Participating Group Code
text
Code List
Participating Group Code
CL Item
Http://ctep.info.nih.gov. (http://ctep.info.nih.gov.)
InstitutionName
Item
Institution Name
text
AffiliateName
Item
Affiliate Name
text
PatientName,Last
Item
Patient Name, Last
text
PatientName,First
Item
Patient Name, First
text
PatientName,Middle
Item
Patient Name, Middle
text
Item Group
Gi: Vital Status
Item
Patient's Vital Status
text
Code List
Patient's Vital Status
CL Item
Dead (Dead)
CL Item
Alive (Alive)
Item
Death Reason
text
Code List
Death Reason
CL Item
Due To Other Cause, Specify (Due to other cause, specify)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
CL Item
Due To This Disease (Due to this disease)
CL Item
Due To Protocol Treatment (Due to protocol treatment)
DeathDate/LastContactDate
Item
Death Date/Last Contact Date
date
Item Group
Gi: Disease Follow-up Status
Item
Cancer Follow-up Status Ind
text
Code List
Cancer Follow-up Status Ind
CL Item
Yes (YES)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (UNKNOWN)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
CL Item
No (NO)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CancerFollow-upStatusDate
Item
Cancer Follow-up Status Date
date
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
Item Group
Gi: Notice Of Progression
Item
Progression Ind
text
Code List
Progression Ind
CL Item
Yes (YES)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (NO)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Unknown (UNKNOWN)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
ProgressionDate
Item
Progression Date
date
Item
Progression Site
text
Code List
Progression Site
CL Item
Bone (Bone)
C12366 (NCI Thesaurus)
C0262950 (UMLS 2011AA)
CL Item
Cns/brain (CNS/Brain)
CL Item
Distant Lymph Nodes (Distant lymph nodes)
CL Item
Regional Lymph Nodes (Regional lymph nodes)
CL Item
Lung (Lung)
C12468 (NCI Thesaurus)
C0024109 (UMLS 2011AA)
CL Item
Other, Specify (Other, specify)
CL Item
Liver (Liver)
C12392 (NCI Thesaurus)
C0023884 (UMLS 2011AA)
ProgressionSite,Other
Item
Progression Site, Other
text
Item Group
Gi: Notice Of New Primary
Item
New Primary Cancer Ind
text
Code List
New Primary Cancer Ind
CL Item
Yes (YES)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (UNKNOWN)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
CL Item
No (NO)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
NewPrimaryCancerDate
Item
New Primary Cancer Date
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
NewPrimarySite
Item
New Primary Site
text
Item Group
Allows Documentation Of Any Additional Cooments
Comments
Item
Comments
text

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