ID

7022

Descrição

North Central Cancer Treatment Group N0577 Preregistration Screening Failure Form Radiation Therapy or Radiation Therapy and Temozolomide or Temozolomide Alone in Treating Patients With Newly Diagnosed Anaplastic Glioma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=4C096CEC-6180-47DB-E044-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=4C096CEC-6180-47DB-E044-0003BA3F9857

Palavras-chave

  1. 26/08/2012 26/08/2012 -
  2. 08/01/2015 08/01/2015 - Martin Dugas
Transferido a

8 de janeiro de 2015

DOI

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Licença

Creative Commons BY-NC 3.0 Legacy

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Brain and Central Nervous System Tumors NCT00887146 Registration - North Central Cancer Treatment Group N0577 Preregistration Screening Failure Form - 2745776v1.0

No Instruction available.

  1. StudyEvent: North Central Cancer Treatment Group N0577 Preregistration Screening Failure Form
    1. No Instruction available.
Header
Descrição

Header

Protocol Number
Descrição

Protocol ID NCCTG

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C3274381
NCI Thesaurus ObjectClass
C25320
UMLS CUI-2
C1518419
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C25581
Patient ID
Descrição

PatientNorthCentralCancerTreatmentGroupIdentifierNumber

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus Property-2
C25581
UMLS 2011AA Property-2
C1518419
Patient Initials (L F M)
Descrição

Patient Initials

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986440
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25536
Institution Number
Descrição

Institution Number

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C1301943
NCI Thesaurus ObjectClass
C21541
UMLS CUI-2
C0805701
NCI Thesaurus Property
C25364
Institution
Descrição

Institution Name

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C1301943
NCI Thesaurus ObjectClass
C21541
NCI Thesaurus ValueDomain-2
C21541
NCI Thesaurus Property
C25364
Are data amended (If yes, highlight amended areas)
Descrição

Data amended

Tipo de dados

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS CUI-1
C0680532
NCI Thesaurus ObjectClass
C25474
NCI Thesaurus Property
C25416
Preregistration Screening Failure
Descrição

Preregistration Screening Failure

Date aware of preregistration screening failure (mm/dd/yyyy)
Descrição

PriorRegistrationScreeningPatientClinicalTrialIneligibilityDate

Tipo de dados

date

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass-2
C48261
UMLS 2011AA ObjectClass-2
C1710032
NCI Thesaurus ObjectClass-3
C25646
UMLS 2011AA ObjectClass-3
C1514821
NCI Thesaurus ObjectClass-4
C25629
UMLS 2011AA ObjectClass-4
C0332152
NCI Thesaurus Property
C15207
NCI Thesaurus Property-2
C40412
UMLS 2011AA Property
C1512714
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
Primary reason screening failed (check one)
Descrição

PriorRegistrationScreeningPatientClinicalTrialIneligibilityReason

Tipo de dados

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass-2
C48261
UMLS 2011AA ObjectClass-2
C1710032
NCI Thesaurus ObjectClass-3
C25646
UMLS 2011AA ObjectClass-3
C1514821
NCI Thesaurus ObjectClass-4
C25629
UMLS 2011AA ObjectClass-4
C0332152
NCI Thesaurus Property
C15207
NCI Thesaurus Property-2
C40412
UMLS 2011AA Property
C1512714
NCI Thesaurus ValueDomain
C25638
UMLS 2011AA ValueDomain
C0392360
Other, specify
Descrição

PriorRegistrationScreeningPatientClinicalTrialIneligibilitySpecify

Tipo de dados

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass-2
C48261
UMLS 2011AA ObjectClass-2
C1710032
NCI Thesaurus ObjectClass-3
C25646
UMLS 2011AA ObjectClass-3
C1514821
NCI Thesaurus ObjectClass-4
C25629
UMLS 2011AA ObjectClass-4
C0332152
NCI Thesaurus Property
C15207
NCI Thesaurus Property-2
C40412
UMLS 2011AA Property
C1512714
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902

Similar models

No Instruction available.

  1. StudyEvent: North Central Cancer Treatment Group N0577 Preregistration Screening Failure Form
    1. No Instruction available.
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de dados
Alias
Item Group
Header
Protocol ID NCCTG
Item
Protocol Number
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1518419 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25581 (NCI Thesaurus Property-2)
PatientNorthCentralCancerTreatmentGroupIdentifierNumber
Item
Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25581 (NCI Thesaurus Property-2)
C1518419 (UMLS 2011AA Property-2)
Patient Initials
Item
Patient Initials (L F M)
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
Institution Number
Item
Institution Number
text
C25337 (NCI Thesaurus ValueDomain)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass)
C0805701 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
Institution Name
Item
Institution
text
C25191 (NCI Thesaurus ValueDomain)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass)
C21541 (NCI Thesaurus ValueDomain-2)
C25364 (NCI Thesaurus Property)
Data amended
Item
Are data amended (If yes, highlight amended areas)
boolean
C38148 (NCI Thesaurus ValueDomain)
C0680532 (UMLS CUI-1)
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)
Item Group
Preregistration Screening Failure
PriorRegistrationScreeningPatientClinicalTrialIneligibilityDate
Item
Date aware of preregistration screening failure (mm/dd/yyyy)
date
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C48261 (NCI Thesaurus ObjectClass-2)
C1710032 (UMLS 2011AA ObjectClass-2)
C25646 (NCI Thesaurus ObjectClass-3)
C1514821 (UMLS 2011AA ObjectClass-3)
C25629 (NCI Thesaurus ObjectClass-4)
C0332152 (UMLS 2011AA ObjectClass-4)
C15207 (NCI Thesaurus Property)
C40412 (NCI Thesaurus Property-2)
C1512714 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
Item
Primary reason screening failed (check one)
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C48261 (NCI Thesaurus ObjectClass-2)
C1710032 (UMLS 2011AA ObjectClass-2)
C25646 (NCI Thesaurus ObjectClass-3)
C1514821 (UMLS 2011AA ObjectClass-3)
C25629 (NCI Thesaurus ObjectClass-4)
C0332152 (UMLS 2011AA ObjectClass-4)
C15207 (NCI Thesaurus Property)
C40412 (NCI Thesaurus Property-2)
C1512714 (UMLS 2011AA Property)
C25638 (NCI Thesaurus ValueDomain)
C0392360 (UMLS 2011AA ValueDomain)
Code List
Primary reason screening failed (check one)
CL Item
Investigator Decision (Investigator decision)
CL Item
Patient Decision (Patient decision)
CL Item
Did Not Meet Eligibility Criteria (Did not meet eligibility criteria)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
PriorRegistrationScreeningPatientClinicalTrialIneligibilitySpecify
Item
Other, specify
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C48261 (NCI Thesaurus ObjectClass-2)
C1710032 (UMLS 2011AA ObjectClass-2)
C25646 (NCI Thesaurus ObjectClass-3)
C1514821 (UMLS 2011AA ObjectClass-3)
C25629 (NCI Thesaurus ObjectClass-4)
C0332152 (UMLS 2011AA ObjectClass-4)
C15207 (NCI Thesaurus Property)
C40412 (NCI Thesaurus Property-2)
C1512714 (UMLS 2011AA Property)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)

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