ID

6875

Beschreibung

Upper Gastrointestinal Cancers - Treatment Form (for Periodic Reporting) Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=99CD59C5-A9B2-3FA4-E034-080020C9C0E0

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=99CD59C5-A9B2-3FA4-E034-080020C9C0E0

Stichworte

Versionen (2)
  1. 19.09.12 19.09.12 -
  2. 08.01.15 08.01.15 - Martin Dugas
Hochgeladen am

8. Januar 2015

DOI

Für eine Beantragung loggen Sie sich ein.

Lizenz

Creative Commons BY-NC 3.0 Legacy
Modell Kommentare :

Hier können Sie das Modell kommentieren. Über die Sprechblasen an den Itemgruppen und Items können Sie diese spezifisch kommentieren.

Zurück zu Modell Kommentaren
Itemgroup Kommentare für :

Item Kommentare für :

Um Formulare herunterzuladen müssen Sie angemeldet sein. Bitte loggen Sie sich ein oder registrieren Sie sich kostenlos.

Treatment - Upper Gastrointestinal Cancers - Treatment Form (for Periodic Reporting) - 2020209v2.31

Englisch

No Instruction available.

1 Formulare  
  1. StudyEvent: Upper Gastrointestinal Cancers - Treatment Form (for Periodic Reporting)
    1. No Instruction available.
Crf Header
Beschreibung

Crf Header

Coordinating Group Protocol Number
Beschreibung

CoordinatingGroupProtocolNumber

Datentyp

text

Coordinating Group Code
Beschreibung

CoordinatingGroupCode

Datentyp

text

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

Protocol Title

Datentyp

text

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

PatientStudyID,CoordinatingGroup

Datentyp

text

Patient Study ID, Participating Group
Beschreibung

PatientStudyID,ParticipatingGroup

Datentyp

text

Participating Group Code
Beschreibung

ParticipatingGroupCode

Datentyp

text

Institution Name
Beschreibung

InstitutionName

Datentyp

text

Affiliate Name
Beschreibung

AffiliateName

Datentyp

text

Patient Name, Last
Beschreibung

PatientName,Last

Datentyp

text

Patient Name, First
Beschreibung

PatientName,First

Datentyp

text

Patient Name, Middle
Beschreibung

PatientName,Middle

Datentyp

text

Gi: Treatment Reporting Interval
Beschreibung

Gi: Treatment Reporting Interval

Interval Report From Date
Beschreibung

IntervalReportFromDate

Datentyp

date

Interval Report To Date
Beschreibung

IntervalReportToDate

Datentyp

date

Gi: Treatment Schedule - Radiation Therapy
Beschreibung

Gi: Treatment Schedule - Radiation Therapy

Protocol Treatment, RT Ind
Beschreibung

ProtocolTreatment,RTInd

Datentyp

text

RT Begin Date
Beschreibung

RTBeginDate

Datentyp

date

RT End Date
Beschreibung

RTEndDate

Datentyp

date

RT Type
Beschreibung

RTType

Datentyp

text

RT Type, Other
Beschreibung

RTType,Other

Datentyp

text

RT Site
Beschreibung

RTSite

Datentyp

text

RT Total Dose
Beschreibung

RTTotalDose

Datentyp

float

RT Interruptions Ind
Beschreibung

RTInterruptionsInd

Datentyp

text

RT Interruptions Reason
Beschreibung

RTInterruptionsReason

Datentyp

text

Gi: Treatment Cycle Information - Systemic Therapy
Beschreibung

Gi: Treatment Cycle Information - Systemic Therapy

Protocol Treatment, Systemic Therapy Ind
Beschreibung

ProtocolTreatment,SystemicTherapyInd

Datentyp

text

Total Course Number
Beschreibung

TotalCourseNumber

Datentyp

float

First Treatment Start Date
Beschreibung

FirstTreatmentStartDate

Datentyp

date

Last Treatment Date
Beschreibung

LastTreatmentDate

Datentyp

date

Systemic Therapy Type
Beschreibung

SystemicTherapyType

Datentyp

text

Systemic Therapy Type, Other
Beschreibung

SystemicTherapyType,Other

Datentyp

text

Agent Name
Beschreibung

AgentName

Datentyp

text

Agent Total Dose (per course)
Beschreibung

AgentTotalDose(percourse)

Datentyp

float

Agent Dose Units
Beschreibung

AgentDoseUnits

Datentyp

text

Dose Modification (Change)
Beschreibung

DoseModification(Change)

Datentyp

text

Therapy Modification Name
Beschreibung

TherapyModificationName

Datentyp

text

Therapy Modification Reason
Beschreibung

TherapyModificationReason

Datentyp

text

Allows Documentation Of Any Additional Cooments
Beschreibung

Allows Documentation Of Any Additional Cooments

Comments
Beschreibung

Comments

Datentyp

text

Zum Seitenanfang zurückkehren

Ähnliche Modelle

No Instruction available.

1 Formulare
  1. StudyEvent: Upper Gastrointestinal Cancers - Treatment Form (for Periodic Reporting)
    1. No Instruction available.
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Crf Header
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: Treatment Reporting Interval
IntervalReportFromDate
Item
Interval Report From Date
date
IntervalReportToDate
Item
Interval Report To Date
date
Item Group
Gi: Treatment Schedule - Radiation Therapy
Item
Protocol Treatment, RT Ind
text
CL.2
Code List
Protocol Treatment, RT Ind
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
RTBeginDate
Item
RT Begin Date
date
RTEndDate
Item
RT End Date
date
Item
RT Type
text
CL.3
Code List
RT Type
CL Item
Adjuvant Radiation Therapy (Adjuvant RT)
CL Item
Brachytherapy (Brachytherapy)
CL054378 (NCI Metathesaurus)
CL Item
Palliative Radiation Therapy (Palliative RT)
CL Item
Neoadjuvant Radiation Therapy (Neoadjuvant RT)
CL Item
Other, Specify (Other, specify)
CL Item
External Beam Radiation (External beam radiation)
RTType,Other
Item
RT Type, Other
text
RTSite
Item
RT Site
text
RTTotalDose
Item
RT Total Dose
float
Item
RT Interruptions Ind
text
CL.4
Code List
RT Interruptions Ind
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes, For Other Reasons, Specify (Yes, for other reasons, specify)
CL Item
Yes, Due To Toxicity (Yes, due to toxicity)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
RTInterruptionsReason
Item
RT Interruptions Reason
text
Item Group
Gi: Treatment Cycle Information - Systemic Therapy
Item
Protocol Treatment, Systemic Therapy Ind
text
CL.5
Code List
Protocol Treatment, Systemic Therapy Ind
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
TotalCourseNumber
Item
Total Course Number
float
FirstTreatmentStartDate
Item
First Treatment Start Date
date
LastTreatmentDate
Item
Last Treatment Date
date
Item
Systemic Therapy Type
text
CL.6
Code List
Systemic Therapy Type
CL Item
Chemotherapy (Chemotherapy)
C15632 (NCI Thesaurus)
C0392920 (UMLS 2011AA)
CL Item
Other Specify (Other, specify)
CL Item
Immunotherapy (Immunotherapy)
C15262 (NCI Thesaurus)
C0021083 (UMLS 2011AA)
SystemicTherapyType,Other
Item
Systemic Therapy Type, Other
text
AgentName
Item
Agent Name
text
AgentTotalDose(percourse)
Item
Agent Total Dose (per course)
float
Item
Agent Dose Units
text
CL.7
Code List
Agent Dose Units
CL Item
Curie (Ci)
C0700085 (NCI Metathesaurus)
CL Item
Unit (unit)
C44278 (NCI Thesaurus)
C0439148 (UMLS 2011AA)
CL Item
Hertz (Hz)
CL Item
International Unit (IU)
C28255 (NCI Thesaurus)
CL Item
Joules Per Centimeter Square (JCM2)
CL Item
Liter (L)
CL Item
Megahertz (MHz)
CL Item
Milligrams Per Milliliter Per Minute (MMM)
CL Item
Million Electron Volts (MeV)
CL Item
Megarad (Mrad)
CL Item
Not Applicable (N/A)
C48660 (NCI Thesaurus)
C1272460 (UMLS 2011AA)
CL Item
Osmole (Osmol)
CL Item
Pascal (Pa)
C42547 (NCI Thesaurus)
C0439473 (UMLS 2011AA)
CL Item
Viral Particles (VP)
CL Item
Centimeter (cm)
C49668 (NCI Thesaurus)
C0475210 (UMLS 2011AA)
CL Item
Deciliter (dL)
CL Item
Decimeter (dm)
CL Item
Gram (g)
C0439208 (NCI Metathesaurus)
CL Item
Gravity (in Centrifugation) (gravity)
CL Item
Kilohertz (kHz)
CL Item
Kilopascal (kPa)
CL Item
Kilo-electron Volt (keV)
CL Item
Kilogram (kg)
C28252 (NCI Thesaurus)
C0439209 (UMLS 2011AA)
CL Item
Meter (m)
C0475209 (NCI Metathesaurus)
CL Item
Millicurie (mCi)
CL Item
Milliequivalent (mEq)
CL Item
Milliliter (mL)
C28254 (NCI Thesaurus)
C0439242 (UMLS 2011AA)
CL Item
Milliosmole (mOsmol)
CL Item
Million Unit (mU)
CL Item
Millivolt (mV)
C0456691 (NCI Metathesaurus)
CL Item
Microcurie (mcCi)
CL Item
Microliter (mcL)
CL Item
Microgram (mcg)
CL Item
Micrometer (mcm)
CL Item
Milligram (mg)
C28253 (NCI Thesaurus)
C0439210 (UMLS 2011AA)
CL Item
Milliunit (milliunit)
CL Item
Millimeter (mm)
C28251 (NCI Thesaurus)
C0439200 (UMLS 2011AA)
CL Item
Millimole (mmol)
CL Item
Gram-molecular Weight (mole) (mol)
CL Item
Nanocurie (nCi)
C0560007 (NCI Metathesaurus)
CL Item
Nanogram (ng)
CL Item
Nanometer (nm)
C0439202 (NCI Metathesaurus)
CL Item
Nanometers Of Light (nm light)
CL Item
Plaque Forming Unit (pfu)
CL Item
Picogram (pg)
C0439213 (NCI Metathesaurus)
CL Item
Pounds Per Square Inch (psi)
C0439472 (NCI Metathesaurus)
CL Item
Gram-equivalent Weight (Eq)
Item
Dose Modification (Change)
text
CL.8
Code List
Dose Modification (Change)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
(i.e., The Treatment Change Was Not Part Of Protocol Guidelines) (Yes, unplanned)
CL Item
(i.e., The Treatment Was Changed According To Protocol Guidelines) (Yes, planned)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
TherapyModificationName
Item
Therapy Modification Name
text
TherapyModificationReason
Item
Therapy Modification Reason
text
Item Group
Allows Documentation Of Any Additional Cooments
Comments
Item
Comments
text
Zum Seitenanfang zurückkehren 

Kontakt

Benutzen Sie dieses Formular für Rückmeldungen, Fragen und Verbesserungsvorschläge.

Mit * gekennzeichnete Felder sind notwendig.

Hilfe

Benötigen Sie Hilfe bei der Suche? Um mehr Details zu erfahren und die Suche effektiver nutzen zu können schauen Sie sich doch das entsprechende Video auf unserer Tutorial Seite an.

Zum Video