ID
6884
Beskrivning
E2905 Source Document Tracking Coversheet Lenalidomide With or Without Epoetin Alfa in Treating Patients With Myelodysplastic Syndrome and Anemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=0EA9D5AE-D3E2-1B14-E044-0003BA3F9857
Länk
Nyckelord
Versioner (4)
- 2012-09-19 2012-09-19 -
- 2015-01-08 2015-01-08 - Martin Dugas
- 2015-06-08 2015-06-08 -
- 2015-07-28 2015-07-28 - Julian Varghese
Uppladdad den
8 januari 2015
DOI
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Licens
Creative Commons BY-NC 3.0 Legacy
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Leukemia NCT00843882 Flow Sheet - E2905 Source Document Tracking Coversheet - 2454954v1.0
INSTRUCTIONS (Single-step studies): Complete this form either after patient has completed protocol treatment for this study or when patient is stopping early or never started protocol treatment. Complete this form and submit original
Beskrivning
Unnamed2
Beskrivning
Patient Initials
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS CUI-1
- C2986440
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25536
Beskrivning
Protocol Number ECOG
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS CUI-1
- C3274381
- NCI Thesaurus ObjectClass
- C25320
- UMLS CUI-2
- C1512162
- NCI Thesaurus Property
- C25364
- NCI Thesaurus Property-2
- C25491
Beskrivning
Patient ID ECOG
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS CUI-1
- C2348585
- NCI Thesaurus ObjectClass
- C16960
- UMLS CUI-2
- C1512162
- NCI Thesaurus Property
- C25364
- NCI Thesaurus Property-2
- C25491
Beskrivning
Study Number Participating Group
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS CUI-1
- C3274381
- NCI Thesaurus ObjectClass
- C25320
- UMLS CUI-2
- C2347449
- NCI Thesaurus Property
- C25608
- NCI Thesaurus Property-2
- C25364
Beskrivning
Trial subject ID Participating Group
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS CUI-1
- C2348585
- NCI Thesaurus ObjectClass
- C16960
- UMLS CUI-2
- C2347449
- NCI Thesaurus Property
- C25608
- NCI Thesaurus Property-2
- C25364
Beskrivning
Institution Name
Datatyp
text
Alias
- NCI Thesaurus ObjectClass
- C25454
- UMLS CUI-1
- C1301943
- NCI Thesaurus ObjectClass-2
- C21541
- NCI Thesaurus Property
- C25364
- NCI Thesaurus ValueDomain
- C25191
- NCI Thesaurus ValueDomain-2
- C21541
Beskrivning
Section Ii
Beskrivning
ProtocolDocumentSubmittedType
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus ObjectClass
- C42651
- UMLS 2011AA ObjectClass
- C0442711
- NCI Thesaurus ObjectClass-2
- C19498
- UMLS 2011AA ObjectClass-2
- C1547673
- NCI Thesaurus Property
- C25695
- UMLS 2011AA Property
- C1515023
Beskrivning
ProtocolOtherDocumentSubmittedSpecify
Datatyp
text
Alias
- NCI Thesaurus ObjectClass
- C17649
- UMLS 2011AA ObjectClass
- C0205394
- NCI Thesaurus ObjectClass-2
- C42651
- UMLS 2011AA ObjectClass-2
- C0442711
- NCI Thesaurus ObjectClass-3
- C19498
- UMLS 2011AA ObjectClass-3
- C1547673
- NCI Thesaurus Property
- C25695
- UMLS 2011AA Property
- C1515023
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
Beskrivning
ReportCreatedDate
Datatyp
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ObjectClass
- C25375
- UMLS 2011AA ObjectClass
- C0684224
- NCI Thesaurus Property
- C42620
- UMLS 2011AA Property
- C1706214
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INSTRUCTIONS (Single-step studies): Complete this form either after patient has completed protocol treatment for this study or when patient is stopping early or never started protocol treatment. Complete this form and submit original
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1512162 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25491 (NCI Thesaurus Property-2)
C2348585 (UMLS CUI-1)
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C25452 (NCI Thesaurus ObjectClass-2)
C1514821 (UMLS CUI-1)
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C0237753 (UMLS CUI-2)
C16154 (NCI Thesaurus Property)
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C25214 (NCI Thesaurus Property)
C25616 (NCI Thesaurus Property-2)
C15368 (NCI Thesaurus ObjectClass)
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C25214 (NCI Thesaurus Property)
C25616 (NCI Thesaurus Property-2)
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C1302181 (UMLS CUI-1)
C25616 (NCI Thesaurus Property-2)
C25685 (NCI Thesaurus ValueDomain)
C25472 (NCI Thesaurus ValueDomain-2)
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C25214 (NCI Thesaurus Property)
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C25472 (NCI Thesaurus ValueDomain-2)
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C3274381 (UMLS CUI-1)
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C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1512162 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25491 (NCI Thesaurus Property-2)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
C25191 (NCI Thesaurus ValueDomain)
C21541 (NCI Thesaurus ValueDomain-2)
C0332307 (UMLS 2011AA ValueDomain)
C42651 (NCI Thesaurus ObjectClass)
C0442711 (UMLS 2011AA ObjectClass)
C19498 (NCI Thesaurus ObjectClass-2)
C1547673 (UMLS 2011AA ObjectClass-2)
C25695 (NCI Thesaurus Property)
C1515023 (UMLS 2011AA Property)
C0205394 (UMLS 2011AA)
C0205394 (UMLS 2011AA ObjectClass)
C42651 (NCI Thesaurus ObjectClass-2)
C0442711 (UMLS 2011AA ObjectClass-2)
C19498 (NCI Thesaurus ObjectClass-3)
C1547673 (UMLS 2011AA ObjectClass-3)
C25695 (NCI Thesaurus Property)
C1515023 (UMLS 2011AA Property)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25375 (NCI Thesaurus ObjectClass)
C0684224 (UMLS 2011AA ObjectClass)
C42620 (NCI Thesaurus Property)
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