ID
7048
Description
E5103 Hypertension Status Form Doxorubicin, Cyclophosphamide, and Paclitaxel With or Without Bevacizumab in Treating Patients With Lymph Node-Positive or High-Risk, Lymph Node-Negative Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=3AE22206-73CD-059C-E044-0003BA3F9857
Link
Keywords
Versions (4)
- 8/26/12 8/26/12 -
- 8/8/14 8/8/14 - Martin Dugas
- 12/16/14 12/16/14 - Martin Dugas
- 1/8/15 1/8/15 - Martin Dugas
Uploaded on
January 8, 2015
DOI
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License
Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT00433511 Follow-Up - E5103 Hypertension Status Form - 2683669v1.0
INSTRUCTIONS: After patient is off treatment, complete this form for each required follow-up report period (see forms submission schedule).
- StudyEvent: E5103 Hypertension Status Form
Description
Unnamed Module 4
Description
Cycle number
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS CUI-1
- C2045829
- NCI Thesaurus Property
- C25214
- NCI Thesaurus Property-2
- C25616
- NCI Thesaurus ObjectClass
- C15368
Description
PersonOff-TreatmentTimePeriodType
Data type
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
Description
Systolic blood pressure
Data type
integer
Alias
- NCI Thesaurus ValueDomain
- C25209
- NCI Thesaurus Property
- C25214
- NCI Thesaurus ObjectClass
- C25298
- UMLS CUI-1
- C0871470
Description
Diastolic blood pressure
Data type
integer
Alias
- NCI Thesaurus ValueDomain
- C25209
- NCI Thesaurus Property
- C25214
- NCI Thesaurus ObjectClass
- C25299
- UMLS CUI-1
- C0428883
Description
LaboratoryProcedureNotPerformedText
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus Property
- C25594
- UMLS 2011AA Property
- C1518422
- NCI Thesaurus Property-2
- C38000
- UMLS 2011AA Property-2
- C0884358
- NCI Thesaurus ObjectClass
- C25294
- UMLS 2011AA ObjectClass
- C0022885
Description
Assessment Date
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C2985720
- NCI Thesaurus ObjectClass
- C25367
- NCI Thesaurus ValueDomain-2
- C25367
- NCI Thesaurus Property
- C38000
Description
Concomitant Antihypertensive Agent Administered
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- NCI Thesaurus ObjectClass
- C270
- NCI Thesaurus ObjectClass-2
- C25730
- NCI Thesaurus Property
- C25382
Description
ConcomitantAntihypertensiveAgentAdministeredSpecify
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
- NCI Thesaurus ObjectClass
- C270
- UMLS 2011AA ObjectClass
- C0003364
- NCI Thesaurus ObjectClass-2
- C25730
- UMLS 2011AA ObjectClass-2
- C0521115
- NCI Thesaurus Property
- C25382
- UMLS 2011AA Property
- C1521801
Description
Comments
Description
Investigator Signature
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS CUI-1
- C2346576
- NCI Thesaurus Property
- C25678
- NCI Thesaurus ObjectClass
- C17089
Description
Investigator Signature Date
Data type
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: After patient is off treatment, complete this form for each required follow-up report period (see forms submission schedule).
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