ID
7042
Beschrijving
E3F05 Neurologic Function Status and KPS Form Radiation Therapy With or Without Temozolomide in Treating Patients With Low-Grade Glioma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=6C76FF0A-A486-4EDB-E040-BB89AD4325FA
Link
Trefwoorden
Versies (3)
- 26-08-12 26-08-12 -
- 03-12-14 03-12-14 - Martin Dugas
- 08-01-15 08-01-15 - Martin Dugas
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8 januari 2015
DOI
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Licentie
Creative Commons BY-NC 3.0 Legacy
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Brain and Central Nervous System Tumors NCT00978458 On-Study - E3F05 Neurologic Function Status and KPS Form - 2901661v1.0
INSTRUCTIONS: Complete this form according to the on-treatment and follow up schedules. Submit original to the ECOG Coordinating Center. Keep a copy for your files. Refer to forms packet for submission schedule
- StudyEvent: E3F05 Neurologic Function Status and KPS Form
Beschrijving
On Treatment
Beschrijving
Cycle number
Datatype
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS CUI-1
- C2045829
- NCI Thesaurus Property
- C25214
- NCI Thesaurus Property-2
- C25616
- NCI Thesaurus ObjectClass
- C15368
Beschrijving
Off Treatment
Beschrijving
PersonOff-TreatmentTimePeriodType
Datatype
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C25616
- UMLS 2011AA Property
- C1948053
- NCI Thesaurus Property-2
- C25601
- UMLS 2011AA Property-2
- C1518544
- NCI Thesaurus Property-3
- C25207
- UMLS 2011AA Property-3
- C0040223
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
Beschrijving
Amendment
Alias
- UMLS CUI-1
- C0680532
Beschrijving
Data amended
Datatype
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS CUI-1
- C0680532
- NCI Thesaurus ObjectClass
- C25474
- NCI Thesaurus Property
- C25416
Beschrijving
Data amended date
Datatype
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C0680532
- NCI Thesaurus ObjectClass
- C25474
- UMLS CUI-2
- C0011008
- NCI Thesaurus Property
- C25416
- NCI Thesaurus ValueDomain-2
- C25367
Beschrijving
Vital Status
Beschrijving
Patient Status
Datatype
text
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS CUI-1
- C3846084
- NCI Thesaurus ValueDomain
- C18003
- NCI Thesaurus ValueDomain-2
- C25688
- NCI Thesaurus Property
- C25717
Beschrijving
Date last contact
Datatype
date
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS CUI-1
- C0805839
- NCI Thesaurus Property
- C25461
- NCI Thesaurus Property-2
- C25551
- NCI Thesaurus ValueDomain
- C25164
- NCI Thesaurus ValueDomain-2
- C25367
Beschrijving
Primary Cause of Death
Datatype
text
Alias
- NCI Thesaurus ValueDomain
- C25638
- UMLS CUI-1
- C0007465
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C28554
- NCI Thesaurus ValueDomain-2
- C25251
Beschrijving
Cause of Death, specify
Datatype
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS CUI-1
- C0007465
- NCI Thesaurus ObjectClass
- C16960
- UMLS CUI-2
- C1521902
- NCI Thesaurus Property
- C28554
Beschrijving
Patient Characteristics
Beschrijving
NeurologicalFunctionStatus
Datatype
text
Alias
- NCI Thesaurus ObjectClass
- C25262
- UMLS 2011AA ObjectClass
- C0205494
- NCI Thesaurus ObjectClass-2
- C25518
- UMLS 2011AA ObjectClass-2
- C0542341
- NCI Thesaurus ValueDomain
- C25688
- UMLS 2011AA ValueDomain
- C0449438
- NCI Thesaurus Property
- C25365
- UMLS 2011AA Property
- C0678257
Beschrijving
KarnofskyPerformanceStatusScore
Datatype
text
Alias
- NCI Thesaurus Property
- C25367
- NCI Thesaurus ObjectClass
- C20641
- UMLS 2011AA ObjectClass
- C1518965
- NCI Thesaurus ValueDomain
- C25338
- UMLS 2011AA ValueDomain
- C0449820
Beschrijving
Footer Module
Beschrijving
Investigator Signature
Datatype
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS CUI-1
- C2346576
- NCI Thesaurus Property
- C25678
- NCI Thesaurus ObjectClass
- C17089
Beschrijving
Investigator Signature Date
Datatype
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C2346576
- NCI Thesaurus Property
- C25678
- UMLS CUI-2
- C0011008
- NCI Thesaurus ValueDomain-2
- C25367
- NCI Thesaurus ObjectClass
- C17089
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INSTRUCTIONS: Complete this form according to the on-treatment and follow up schedules. Submit original to the ECOG Coordinating Center. Keep a copy for your files. Refer to forms packet for submission schedule
- StudyEvent: E3F05 Neurologic Function Status and KPS Form
C3242750 (UMLS CUI-1)
C19464 (NCI Thesaurus Property)
C25474 (NCI Thesaurus ObjectClass)
C25452 (NCI Thesaurus ObjectClass-2)
C1514821 (UMLS CUI-1)
C25646 (NCI Thesaurus ObjectClass)
C0237753 (UMLS CUI-2)
C16154 (NCI Thesaurus Property)
C16154 (NCI Thesaurus ValueDomain-2)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1512162 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25491 (NCI Thesaurus Property-2)
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)
C16960 (NCI Thesaurus ObjectClass)
C1512162 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25491 (NCI Thesaurus Property-2)
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)
C2045829 (UMLS CUI-1)
C25214 (NCI Thesaurus Property)
C25616 (NCI Thesaurus Property-2)
C15368 (NCI Thesaurus ObjectClass)
C1442488 (UMLS 2011AA)
C25213 (NCI Thesaurus-3)
C1442488 (UMLS 2011AA-4)
C0027361 (UMLS 2011AA ObjectClass)
C25616 (NCI Thesaurus Property)
C1948053 (UMLS 2011AA Property)
C25601 (NCI Thesaurus Property-2)
C1518544 (UMLS 2011AA Property-2)
C25207 (NCI Thesaurus Property-3)
C0040223 (UMLS 2011AA Property-3)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C0680532 (UMLS CUI-1)
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)
C0680532 (UMLS CUI-1)
C25474 (NCI Thesaurus ObjectClass)
C0011008 (UMLS CUI-2)
C25416 (NCI Thesaurus Property)
C25367 (NCI Thesaurus ValueDomain-2)
C3846084 (UMLS CUI-1)
C18003 (NCI Thesaurus ValueDomain)
C25688 (NCI Thesaurus ValueDomain-2)
C25717 (NCI Thesaurus Property)
C0805839 (UMLS CUI-1)
C25461 (NCI Thesaurus Property)
C25551 (NCI Thesaurus Property-2)
C25164 (NCI Thesaurus ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
C0007465 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C28554 (NCI Thesaurus Property)
C25251 (NCI Thesaurus ValueDomain-2)
C0439673 (UMLS 2011AA)
C0007465 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1521902 (UMLS CUI-2)
C28554 (NCI Thesaurus Property)
C0205494 (UMLS 2011AA ObjectClass)
C25518 (NCI Thesaurus ObjectClass-2)
C0542341 (UMLS 2011AA ObjectClass-2)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
C20641 (NCI Thesaurus ObjectClass)
C1518965 (UMLS 2011AA ObjectClass)
C25338 (NCI Thesaurus ValueDomain)
C0449820 (UMLS 2011AA ValueDomain)
C2346576 (UMLS CUI-1)
C25678 (NCI Thesaurus Property)
C17089 (NCI Thesaurus ObjectClass)
C2346576 (UMLS CUI-1)
C25678 (NCI Thesaurus Property)
C0011008 (UMLS CUI-2)
C25367 (NCI Thesaurus ValueDomain-2)
C17089 (NCI Thesaurus ObjectClass)