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ID

6919

Beschrijving

Gynecologic Cancer - Toxicity Form- copy 2 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=13996779-2A06-0B29-E044-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=13996779-2A06-0B29-E044-0003BA3F9857

Trefwoorden

Versies (2)
  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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    Toxicity - Gynecologic Cancer - Toxicity Form- copy 2 - 2481262v1.0

    Engels

    No Instruction available.

    1 Formulieren  
    1. StudyEvent: Gynecologic Cancer - Toxicity Form- copy 2
      1. No Instruction available.
    Crf Header
    Beschrijving

    Crf Header

    Coordinating Group Protocol Number
    Beschrijving

    CoordinatingGroupProtocolNumber

    Datatype

    text

    Coordinating Group Code
    Beschrijving

    CoordinatingGroupCode

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25162 (undefined)
    UMLS 2011AA ValueDomain
    C0805701 (Code)
    Protocol Title
    Beschrijving

    Protocol Title

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C25320 (undefined)
    UMLS CUI-1
    C2986303 (Study Protocol Document Version Public Title)
    NCI Thesaurus Property
    C42774 (undefined)
    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

    Alias
    NCI Thesaurus ValueDomain
    C25162 (undefined)
    UMLS 2011AA ValueDomain
    C0805701 (Code)
    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

    Gyn: Form Administration
    Beschrijving

    Gyn: Form Administration

    Person Completing Form, First Name
    Beschrijving

    PersonCompletingForm,FirstName

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C25190 (undefined)
    UMLS 2011AA ObjectClass
    C0027361 (Persons)
    SNOMED
    125676002
    NCI Thesaurus Property
    C25364 (undefined)
    UMLS 2011AA Property
    C0600091 (Identifier)
    SNOMED
    118522005
    LOINC
    LP31795-5
    Amended Data Ind
    Beschrijving

    AmendedDataInd

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C25474 (undefined)
    UMLS 2011AA ObjectClass
    C1511726 (Data)
    NCI Thesaurus Property
    C25416 (undefined)
    UMLS 2011AA Property
    C1691222 (Amended)
    Interval Report From Date
    Beschrijving

    IntervalReportFromDate

    Datatype

    date

    Interval Report To Date
    Beschrijving

    IntervalReportToDate

    Datatype

    date

    Responsible Person Last Name
    Beschrijving

    Person Completing Form Last Name

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C25190 (undefined)
    UMLS CUI-1
    C1550483 (data entry person)
    NCI Thesaurus ObjectClass-2
    C25657 (undefined)
    UMLS CUI-2
    C1301584 (Last Name)
    SNOMED
    397678008
    NCI Thesaurus Property
    C25364 (undefined)
    NCI Thesaurus Property-2
    C25551 (undefined)
    NCI Thesaurus ValueDomain
    C25191 (undefined)
    Responsible Person Last Name
    Beschrijving

    Person Completing Form Last Name

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C25190 (undefined)
    UMLS CUI-1
    C1550483 (data entry person)
    NCI Thesaurus ObjectClass-2
    C25657 (undefined)
    UMLS CUI-2
    C1301584 (Last Name)
    SNOMED
    397678008
    NCI Thesaurus Property
    C25364 (undefined)
    NCI Thesaurus Property-2
    C25551 (undefined)
    NCI Thesaurus ValueDomain
    C25191 (undefined)
    Responsible Person Last Name
    Beschrijving

    ResponsiblePersonLastName

    Datatype

    text

    Gyn: Adverse Events
    Beschrijving

    Gyn: Adverse Events

    CTC Adverse Event Report Begin Date
    Beschrijving

    CTCAdverseEventReportBeginDate

    Datatype

    date

    CTC Adverse Event Report End Date
    Beschrijving

    CTCAdverseEventReportEndDate

    Datatype

    date

    CTC Adverse Event Term
    Beschrijving

    CTCAdverseEventTerm

    Datatype

    text

    CTC Adverse Event Grade
    Beschrijving

    CTCAdverseEventGrade

    Datatype

    text

    CTC Adverse Event Attribution Code
    Beschrijving

    CTCAdverseEventAttributionCode

    Datatype

    text

    CTC Adverse Event Term, Other
    Beschrijving

    CTCAdverseEventTerm,Other

    Datatype

    text

    Allows Documentation Of Any Additional Cooments
    Beschrijving

    Allows Documentation Of Any Additional Cooments

    Comments
    Beschrijving

    Comments

    Datatype

    text

    Terug naar het begin van de pagina

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    No Instruction available.

    1 Formulieren
    1. StudyEvent: Gynecologic Cancer - Toxicity Form- copy 2
      1. No Instruction available.
    Name
    Type
    Description | Question | Decode (Coded Value)
    Datatype
    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
    ParticipatingGroupCode
    Item
    Participating Group Code
    text
    C25162 (NCI Thesaurus ValueDomain)
    C0805701 (UMLS 2011AA ValueDomain)
    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
    Gyn: Form Administration
    PersonCompletingForm,FirstName
    Item
    Person Completing Form, First Name
    text
    C25190 (NCI Thesaurus ObjectClass)
    C0027361 (UMLS 2011AA ObjectClass)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    Item
    Amended Data Ind
    text
    C25474 (NCI Thesaurus ObjectClass)
    C1511726 (UMLS 2011AA ObjectClass)
    C25416 (NCI Thesaurus Property)
    C1691222 (UMLS 2011AA Property)
    CL.1
    Code List
    Amended Data 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)
    IntervalReportFromDate
    Item
    Interval Report From Date
    date
    IntervalReportToDate
    Item
    Interval Report To Date
    date
    Person Completing Form Last Name
    Item
    Responsible Person Last Name
    text
    C25190 (NCI Thesaurus ObjectClass)
    C1550483 (UMLS CUI-1)
    C25657 (NCI Thesaurus ObjectClass-2)
    C1301584 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25551 (NCI Thesaurus Property-2)
    C25191 (NCI Thesaurus ValueDomain)
    Person Completing Form Last Name
    Item
    Responsible Person Last Name
    text
    C25190 (NCI Thesaurus ObjectClass)
    C1550483 (UMLS CUI-1)
    C25657 (NCI Thesaurus ObjectClass-2)
    C1301584 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25551 (NCI Thesaurus Property-2)
    C25191 (NCI Thesaurus ValueDomain)
    ResponsiblePersonLastName
    Item
    Responsible Person Last Name
    text
    Item Group
    Gyn: Adverse Events
    CTCAdverseEventReportBeginDate
    Item
    CTC Adverse Event Report Begin Date
    date
    CTCAdverseEventReportEndDate
    Item
    CTC Adverse Event Report End Date
    date
    Item
    CTC Adverse Event Term
    text
    CL.2
    Code List
    CTC Adverse Event Term
    CL Item
    Ctep.info.nih.gov/ctc3/ctc.htm (http://ctep.info.nih.gov/CTC3/ctc.htm)
    Item
    CTC Adverse Event Grade
    text
    CL.3
    Code List
    CTC Adverse Event Grade
    CL Item
    Ctep.info.nih.gov/ctc3/ctc.htm (http://ctep.info.nih.gov/CTC3/ctc.htm)
    Item
    CTC Adverse Event Attribution Code
    text
    CL.4
    Code List
    CTC Adverse Event Attribution Code
    CL Item
    Definitely (Definitely)
    CL Item
    Possibly (Possibly)
    CL Item
    Unrelated (Unrelated)
    C25328 (NCI Thesaurus)
    C0445356 (UMLS 2011AA)
    CL Item
    Unlikely (Unlikely)
    CL Item
    Probably (Probably)
    CTCAdverseEventTerm,Other
    Item
    CTC Adverse Event Term, Other
    text
    Item Group
    Allows Documentation Of Any Additional Cooments
    Comments
    Item
    Comments
    text
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