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ID

7068

Description

The Division of Cancer Prevention's death report case report form (CRF) template. Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=51746AB3-F58D-0C29-E044-0003BA3F9857

Lien

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=51746AB3-F58D-0C29-E044-0003BA3F9857

Mots-clés

  1. 27/08/2012 27/08/2012 -
  2. 09/01/2015 09/01/2015 - Martin Dugas
Téléchargé le

9 janvier 2015

DOI

Pour une demande vous connecter.

Licence

Creative Commons BY-NC 3.0 Legacy

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    Death Report - 2762971v1.0

    No Instruction available.

    1. StudyEvent: Death Report
      1. No Instruction available.
    Screening
    Description

    Screening

    DCP Protocol #
    Description

    Protocol ID NCI

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C3274381
    NCI Thesaurus ObjectClass
    C25320
    UMLS CUI-2
    C1513882
    NCI Thesaurus Property
    C25364
    NCI Thesaurus Property-2
    C19202
    Institution Code
    Description

    NationalCancerInstituteInstituteCode

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25162
    UMLS 2011AA ValueDomain
    C0805701
    NCI Thesaurus ObjectClass
    C21541
    UMLS 2011AA ObjectClass
    C0018704
    NCI Thesaurus Property
    C25364
    UMLS 2011AA Property
    C0600091
    Participant ID
    Description

    ParticipantIdentifier

    Type de données

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25364
    UMLS 2011AA Property
    C0600091
    NCI Thesaurus ValueDomain
    C25364
    UMLS 2011AA ValueDomain
    C0600091
    Form Date
    Description

    FormCompletionDate

    Type de données

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ObjectClass
    C40988
    UMLS 2011AA ObjectClass
    C1516308
    NCI Thesaurus Property
    C25250
    UMLS 2011AA Property
    C0205197
    Death Report
    Description

    Death Report

    Date of Death (MM/DD/YYYY)
    Description

    DeathDate

    Type de données

    date

    Alias
    NCI Thesaurus Property
    C25164
    UMLS 2011AA Property
    C0011008
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ObjectClass
    C28554
    UMLS 2011AA ObjectClass
    C0011065
    Place of Death
    Description

    PlaceofDeathName

    Type de données

    text

    Alias
    NCI Thesaurus ObjectClass
    C28554
    UMLS 2011AA ObjectClass
    C0011065
    NCI Thesaurus ValueDomain
    C42614
    UMLS 2011AA ValueDomain
    C0027365
    NCI Thesaurus Property
    C25319
    UMLS 2011AA Property
    C0442504
    Other, Specify
    Description

    OtherSpecifyText

    Type de données

    text

    Alias
    NCI Thesaurus Property
    C25685
    UMLS 2011AA Property
    C1521902
    NCI Thesaurus ValueDomain
    C25704
    UMLS 2011AA ValueDomain
    C1527021
    NCI Thesaurus ObjectClass
    C17649
    UMLS 2011AA ObjectClass
    C0205394
    NCI Thesaurus Property-2
    C25638
    UMLS 2011AA Property-2
    C0392360
    Cause of Death
    Description

    DeathCauseName

    Type de données

    text

    Alias
    NCI Thesaurus Property
    C25638
    UMLS 2011AA Property
    C0392360
    NCI Thesaurus ObjectClass
    C28554
    UMLS 2011AA ObjectClass
    C0011065
    NCI Thesaurus Property-2
    C25251
    UMLS 2011AA Property-2
    C0205225
    NCI Thesaurus ValueDomain
    C42614
    UMLS 2011AA ValueDomain
    C0027365
    Cause of Death other, specify
    Description

    PatientCauseofDeathText

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704
    UMLS 2011AA ValueDomain
    C1527021
    NCI Thesaurus Property
    C25638
    UMLS 2011AA Property
    C0392360
    NCI Thesaurus ObjectClass
    C28554
    UMLS 2011AA ObjectClass
    C0011065
    NCI Thesaurus Property-2
    C25251
    UMLS 2011AA Property-2
    C0205225
    Autopsy performed?
    Description

    ParticipantAutopsyPerformedIndicator

    Type de données

    text

    Alias
    NCI Thesaurus Property
    C25180
    UMLS 2011AA Property
    C1522602
    NCI Thesaurus ObjectClass
    C25153
    UMLS 2011AA ObjectClass
    C0004398
    NCI Thesaurus Property-2
    C38000
    UMLS 2011AA Property-2
    C0884358
    NCI Metathesaurus ValueDomain
    C0021212
    Dcp Template Footer
    Description

    Dcp Template Footer

    Protocol Title
    Description

    Protocol Title

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2986303
    NCI Thesaurus ObjectClass
    C25320
    NCI Thesaurus Property
    C42774
    Protocol Version
    Description

    Protocol Version

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704
    UMLS CUI-1
    C2985700
    NCI Thesaurus ObjectClass
    C25320
    NCI Thesaurus Property
    C25364
    Protocol Date
    Description

    Protocol Version Date

    Type de données

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS CUI-1
    C2985700
    NCI Thesaurus ObjectClass
    C25320
    UMLS CUI-2
    C0011008
    NCI Thesaurus Property
    C25364
    NCI Thesaurus ValueDomain-2
    C25367
    Page #
    Description

    PageNumber

    Type de données

    float

    Alias
    NCI Thesaurus Property
    C25337
    UMLS 2011AA Property
    C0237753
    NCI Thesaurus ValueDomain
    C25337
    UMLS 2011AA ValueDomain
    C0237753
    NCI Metathesaurus ObjectClass
    C0439643
    Total Page Number
    Description

    CaseReportFormTotalPageNumber

    Type de données

    text

    Alias
    NCI Thesaurus ObjectClass
    C40988
    UMLS 2011AA ObjectClass
    C1516308
    NCI Thesaurus Property
    C25337
    UMLS 2011AA Property
    C0237753
    NCI Thesaurus Property-2
    C25304
    UMLS 2011AA Property-2
    C0439810
    NCI Thesaurus Property-3
    C42783
    UMLS 2011AA Property-3
    C1704732
    NCI Thesaurus ValueDomain
    C25337
    UMLS 2011AA ValueDomain
    C0237753
    DCP Template Version
    Description

    DCPTemplateVersionText

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704
    UMLS 2011AA ValueDomain
    C1527021
    NCI Metathesaurus ObjectClass
    C0728990
    NCI Thesaurus Property
    C25714
    UMLS 2011AA Property
    C0333052

    Similar models

    No Instruction available.

    1. StudyEvent: Death Report
      1. No Instruction available.
    Name
    Type
    Description | Question | Decode (Coded Value)
    Type de données
    Alias
    Item Group
    Screening
    Protocol ID NCI
    Item
    DCP Protocol #
    text
    C25337 (NCI Thesaurus ValueDomain)
    C3274381 (UMLS CUI-1)
    C25320 (NCI Thesaurus ObjectClass)
    C1513882 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C19202 (NCI Thesaurus Property-2)
    NationalCancerInstituteInstituteCode
    Item
    Institution Code
    text
    C25162 (NCI Thesaurus ValueDomain)
    C0805701 (UMLS 2011AA ValueDomain)
    C21541 (NCI Thesaurus ObjectClass)
    C0018704 (UMLS 2011AA ObjectClass)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    ParticipantIdentifier
    Item
    Participant ID
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    C25364 (NCI Thesaurus ValueDomain)
    C0600091 (UMLS 2011AA ValueDomain)
    FormCompletionDate
    Item
    Form Date
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C40988 (NCI Thesaurus ObjectClass)
    C1516308 (UMLS 2011AA ObjectClass)
    C25250 (NCI Thesaurus Property)
    C0205197 (UMLS 2011AA Property)
    Item Group
    Death Report
    DeathDate
    Item
    Date of Death (MM/DD/YYYY)
    date
    C25164 (NCI Thesaurus Property)
    C0011008 (UMLS 2011AA Property)
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C28554 (NCI Thesaurus ObjectClass)
    C0011065 (UMLS 2011AA ObjectClass)
    Item
    Place of Death
    text
    C28554 (NCI Thesaurus ObjectClass)
    C0011065 (UMLS 2011AA ObjectClass)
    C42614 (NCI Thesaurus ValueDomain)
    C0027365 (UMLS 2011AA ValueDomain)
    C25319 (NCI Thesaurus Property)
    C0442504 (UMLS 2011AA Property)
    Code List
    Place of Death
    CL Item
    Hospital (Hospital)
    CL Item
    Other, Specify (Other, specify)
    CL Item
    Unknown (Unknown)
    C17998 (NCI Thesaurus)
    C0439673 (UMLS 2011AA)
    OtherSpecifyText
    Item
    Other, Specify
    text
    C25685 (NCI Thesaurus Property)
    C1521902 (UMLS 2011AA Property)
    C25704 (NCI Thesaurus ValueDomain)
    C1527021 (UMLS 2011AA ValueDomain)
    C17649 (NCI Thesaurus ObjectClass)
    C0205394 (UMLS 2011AA ObjectClass)
    C25638 (NCI Thesaurus Property-2)
    C0392360 (UMLS 2011AA Property-2)
    Item
    Cause of Death
    text
    C25638 (NCI Thesaurus Property)
    C0392360 (UMLS 2011AA Property)
    C28554 (NCI Thesaurus ObjectClass)
    C0011065 (UMLS 2011AA ObjectClass)
    C25251 (NCI Thesaurus Property-2)
    C0205225 (UMLS 2011AA Property-2)
    C42614 (NCI Thesaurus ValueDomain)
    C0027365 (UMLS 2011AA ValueDomain)
    Code List
    Cause of Death
    CL Item
    Adverse Event/serious Adverse Event (AE/SAE)
    CL Item
    Other, Specify (Other, specify)
    CL Item
    Unknown (Unknown)
    C17998 (NCI Thesaurus)
    C0439673 (UMLS 2011AA)
    PatientCauseofDeathText
    Item
    Cause of Death other, specify
    text
    C25704 (NCI Thesaurus ValueDomain)
    C1527021 (UMLS 2011AA ValueDomain)
    C25638 (NCI Thesaurus Property)
    C0392360 (UMLS 2011AA Property)
    C28554 (NCI Thesaurus ObjectClass)
    C0011065 (UMLS 2011AA ObjectClass)
    C25251 (NCI Thesaurus Property-2)
    C0205225 (UMLS 2011AA Property-2)
    Item
    Autopsy performed?
    text
    C25180 (NCI Thesaurus Property)
    C1522602 (UMLS 2011AA Property)
    C25153 (NCI Thesaurus ObjectClass)
    C0004398 (UMLS 2011AA ObjectClass)
    C38000 (NCI Thesaurus Property-2)
    C0884358 (UMLS 2011AA Property-2)
    C0021212 (NCI Metathesaurus ValueDomain)
    Code List
    Autopsy performed?
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Unknown (Unknown)
    C17998 (NCI Thesaurus)
    C0439673 (UMLS 2011AA)
    Item Group
    Dcp Template Footer
    Protocol Title
    Item
    Protocol Title
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2986303 (UMLS CUI-1)
    C25320 (NCI Thesaurus ObjectClass)
    C42774 (NCI Thesaurus Property)
    Protocol Version
    Item
    Protocol Version
    text
    C25704 (NCI Thesaurus ValueDomain)
    C2985700 (UMLS CUI-1)
    C25320 (NCI Thesaurus ObjectClass)
    C25364 (NCI Thesaurus Property)
    Protocol Version Date
    Item
    Protocol Date
    date
    C25164 (NCI Thesaurus ValueDomain)
    C2985700 (UMLS CUI-1)
    C25320 (NCI Thesaurus ObjectClass)
    C0011008 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25367 (NCI Thesaurus ValueDomain-2)
    PageNumber
    Item
    Page #
    float
    C25337 (NCI Thesaurus Property)
    C0237753 (UMLS 2011AA Property)
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    C0439643 (NCI Metathesaurus ObjectClass)
    CaseReportFormTotalPageNumber
    Item
    Total Page Number
    text
    C40988 (NCI Thesaurus ObjectClass)
    C1516308 (UMLS 2011AA ObjectClass)
    C25337 (NCI Thesaurus Property)
    C0237753 (UMLS 2011AA Property)
    C25304 (NCI Thesaurus Property-2)
    C0439810 (UMLS 2011AA Property-2)
    C42783 (NCI Thesaurus Property-3)
    C1704732 (UMLS 2011AA Property-3)
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    DCPTemplateVersionText
    Item
    DCP Template Version
    text
    C25704 (NCI Thesaurus ValueDomain)
    C1527021 (UMLS 2011AA ValueDomain)
    C0728990 (NCI Metathesaurus ObjectClass)
    C25714 (NCI Thesaurus Property)
    C0333052 (UMLS 2011AA Property)

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