ID

6868

Beskrivning

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

Länk

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

Nyckelord

Versioner (2)
  1. 2012-09-19 2012-09-19 -
  2. 2015-01-08 2015-01-08 - Martin Dugas
Uppladdad den

8 januari 2015

DOI

För en begäran logga in.

Licens

Creative Commons BY-NC 3.0 Legacy
Modellkommentarer :

Här kan du kommentera modellen. Med hjälp av pratbubblor i Item-grupperna och Item kan du lägga in specifika kommentarer.

Tillbaka till modellkommentarer
Itemgroup-kommentar för :

Item-kommentar för :

Du måste vara inloggad för att kunna ladda ner formulär. Var vänlig logga in eller registrera dig utan kostnad.

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

Engelsk

No Instruction available.

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

Crf Header

Cytogenetics Ind
Beskrivning

CytogeneticsInd

Datatyp

text

Coordinating Group Protocol Number
Beskrivning

CoordinatingGroupProtocolNumber

Datatyp

text

Coordinating Group Code
Beskrivning

CoordinatingGroupCode

Datatyp

text

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

Protocol Title

Datatyp

text

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

PatientStudyID,CoordinatingGroup

Datatyp

text

Patient Study ID, Participating Group
Beskrivning

PatientStudyID,ParticipatingGroup

Datatyp

text

Participating Group Code
Beskrivning

ParticipatingGroupCode

Datatyp

text

Institution Name
Beskrivning

InstitutionName

Datatyp

text

Affiliate Name
Beskrivning

AffiliateName

Datatyp

text

Patient Name, Last
Beskrivning

PatientName,Last

Datatyp

text

Patient Name, First
Beskrivning

PatientName,First

Datatyp

text

Patient Name, Middle
Beskrivning

PatientName,Middle

Datatyp

text

Gi: Vital Status
Beskrivning

Gi: Vital Status

Patient's Vital Status
Beskrivning

Patient'sVitalStatus

Datatyp

text

Death Reason
Beskrivning

DeathReason

Datatyp

text

Death Date/Last Contact Date
Beskrivning

DeathDate/LastContactDate

Datatyp

date

Gi: Disease Follow-up Status
Beskrivning

Gi: Disease Follow-up Status

Cancer Follow-up Status Ind
Beskrivning

CancerFollow-upStatusInd

Datatyp

text

Cancer Follow-up Status Date
Beskrivning

CancerFollow-upStatusDate

Datatyp

date

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

Gi: Notice Of Progression

Progression Ind
Beskrivning

ProgressionInd

Datatyp

text

Progression Date
Beskrivning

ProgressionDate

Datatyp

date

Progression Site
Beskrivning

ProgressionSite

Datatyp

text

Progression Site, Other
Beskrivning

ProgressionSite,Other

Datatyp

text

Gi: Notice Of New Primary
Beskrivning

Gi: Notice Of New Primary

New Primary Cancer Ind
Beskrivning

NewPrimaryCancerInd

Datatyp

text

New Primary Cancer Date
Beskrivning

NewPrimaryCancerDate

Datatyp

date

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

NewPrimarySite

Datatyp

text

Allows Documentation Of Any Additional Cooments
Beskrivning

Allows Documentation Of Any Additional Cooments

Comments
Beskrivning

Comments

Datatyp

text

Tillbaka till toppen

Similar models

No Instruction available.

1 Formulär
  1. StudyEvent: Upper Gastrointestinal Cancers - Follow Up Form
    1. No Instruction available.
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
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
CL.1
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
CL.2
Code List
Patient's Vital Status
CL Item
Dead (Dead)
CL Item
Alive (Alive)
Item
Death Reason
text
CL.3
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
CL.4
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
CL.5
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
CL.6
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
CL.7
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
Tillbaka till toppen 

Kontakt

Använd detta formulär för feedback, frågor och förslag på förbättringar.

Fält markerade med * är obligatoriska.

Hjälp

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