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ID

7082

Description

The Division of Cancer Prevention's pharmacokinetics results tissue case report form (CRF) template. Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=5C37C68E-37F3-2ED2-E044-0003BA3F9857

Lien

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=5C37C68E-37F3-2ED2-E044-0003BA3F9857

Mots-clés

Versions (2)
  1. 19/09/2012 19/09/2012 -
  2. 09/01/2015 09/01/2015 - Martin Dugas
Téléchargé le

9 janvier 2015

DOI

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Licence

Creative Commons BY-NC 3.0 Legacy
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    On-Study - Pharmacokinetics Results Tissue - 2804379v1.0

    Anglais

    No Instruction available.

    1 Formulaires  
    1. StudyEvent: Pharmacokinetics Results Tissue
      1. No Instruction available.
    Screening
    Description

    Screening

    DCP Protocol #
    Description

    Protocol ID NCI

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337 (undefined)
    UMLS CUI-1
    C3274381 (Clinical Trial Registry Identifier)
    NCI Thesaurus ObjectClass
    C25320 (undefined)
    UMLS CUI-2
    C1513882 (National Cancer Institute)
    LOINC
    LA4524-0
    NCI Thesaurus Property
    C25364 (undefined)
    NCI Thesaurus Property-2
    C19202 (undefined)
    Institution Code
    Description

    NationalCancerInstituteInstituteCode

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25162 (undefined)
    UMLS 2011AA ValueDomain
    C0805701 (Code)
    NCI Thesaurus ObjectClass
    C21541 (undefined)
    UMLS 2011AA ObjectClass
    C0018704 (Health care facility)
    SNOMED
    257622000
    LOINC
    LA30302-6
    NCI Thesaurus Property
    C25364 (undefined)
    UMLS 2011AA Property
    C0600091 (Identifier)
    SNOMED
    118522005
    LOINC
    LP31795-5
    Participant ID
    Description

    ParticipantIdentifier

    Type de données

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960 (undefined)
    UMLS 2011AA ObjectClass
    C0030705 (Patients)
    SNOMED
    116154003
    NCI Thesaurus Property
    C25364 (undefined)
    UMLS 2011AA Property
    C0600091 (Identifier)
    SNOMED
    118522005
    LOINC
    LP31795-5
    NCI Thesaurus ValueDomain
    C25364 (undefined)
    UMLS 2011AA ValueDomain
    C0600091 (Identifier)
    SNOMED
    118522005
    LOINC
    LP31795-5
    Visit Type
    Description

    VisitTypeText

    Type de données

    text

    Alias
    NCI Thesaurus Property
    C25284 (undefined)
    UMLS 2011AA Property
    C0332307 (Type - attribute)
    SNOMED
    261664005
    NCI Thesaurus ValueDomain
    C25704 (undefined)
    UMLS 2011AA ValueDomain
    C1527021 (Text)
    LOINC
    LP6885-0
    NCI Thesaurus ObjectClass
    C25716 (undefined)
    UMLS 2011AA ObjectClass
    C0545082 (Visit)
    Visit Date
    Description

    VisitDate

    Type de données

    date

    Alias
    NCI Thesaurus Property
    C25164 (undefined)
    UMLS 2011AA Property
    C0011008 (Date in time)
    SNOMED
    410671006
    NCI Thesaurus ValueDomain
    C25164 (undefined)
    UMLS 2011AA ValueDomain
    C0011008 (Date in time)
    SNOMED
    410671006
    NCI Thesaurus ValueDomain-2
    C25367 (undefined)
    NCI Thesaurus ObjectClass
    C25716 (undefined)
    UMLS 2011AA ObjectClass
    C0545082 (Visit)
    Pharmacokinetics Results Blood
    Description

    Pharmacokinetics Results Blood

    Specimen Number
    Description

    SpecimenIdentifierNumber

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337 (undefined)
    UMLS 2011AA ValueDomain
    C0237753 (Numbers)
    SNOMED
    260299005
    LOINC
    LP6841-3
    NCI Thesaurus Property
    C25364 (undefined)
    UMLS 2011AA Property
    C0600091 (Identifier)
    SNOMED
    118522005
    LOINC
    LP31795-5
    NCI Thesaurus ObjectClass
    C19157 (undefined)
    UMLS 2011AA ObjectClass
    C0370003 (Specimen)
    SNOMED
    123038009
    LOINC
    LP7593-9
    Not Obtained
    Description

    NotObtainedIndicator

    Type de données

    text

    Alias
    NCI Thesaurus Property
    C25180 (undefined)
    UMLS 2011AA Property
    C1522602 (Indicator)
    NCI Metathesaurus ObjectClass
    CL310460 (undefined)
    NCI Metathesaurus ObjectClass-2
    CL052458 (undefined)
    NCI Metathesaurus ValueDomain
    C0021212 (Indicators)
    Date Sample Collected (MM/DD/YYYY)
    Description

    SpecimenCollectedDate

    Type de données

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164 (undefined)
    UMLS 2011AA ValueDomain
    C0011008 (Date in time)
    SNOMED
    410671006
    NCI Thesaurus ObjectClass
    C19157 (undefined)
    UMLS 2011AA ObjectClass
    C0370003 (Specimen)
    SNOMED
    123038009
    LOINC
    LP7593-9
    NCI Thesaurus Property
    C25452 (undefined)
    NCI Thesaurus Property-2
    C25275 (undefined)
    UMLS 2011AA Property
    C2745955 (Occurrence)
    SNOMED
    246454002
    Time Specimen Collected (hr:mm per 24 hour clock - if unknown report UNK)
    Description

    SpecimenCollectedTime

    Type de données

    time

    Alias
    NCI Thesaurus ValueDomain
    C25207 (undefined)
    UMLS 2011AA ValueDomain
    C0040223 (Time)
    SNOMED
    410670007
    LOINC
    LP73517-2
    NCI Thesaurus ObjectClass
    C19157 (undefined)
    UMLS 2011AA ObjectClass
    C0370003 (Specimen)
    SNOMED
    123038009
    LOINC
    LP7593-9
    NCI Thesaurus Property
    C25452 (undefined)
    NCI Thesaurus Property-2
    C25275 (undefined)
    UMLS 2011AA Property
    C2745955 (Occurrence)
    SNOMED
    246454002
    Result
    Description

    LaboratoryTestResultNumericValue

    Type de données

    float

    Alias
    NCI Thesaurus ObjectClass
    C37984 (undefined)
    UMLS 2011AA ObjectClass
    C0022877 (Laboratory)
    SNOMED
    261904005
    LOINC
    MTHU029808
    NCI Thesaurus Property
    C25294 (undefined)
    UMLS 2011AA Property
    C0022885 (Laboratory Procedures)
    SNOMED
    269814003
    NCI Thesaurus ValueDomain
    C25712 (undefined)
    UMLS 2011AA ValueDomain
    C1522609 (Numerical value)
    Units
    Description

    LabTestResultUnitofMeasureCode

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25162 (undefined)
    UMLS 2011AA ValueDomain
    C0805701 (Code)
    NCI Thesaurus Property
    C37984 (undefined)
    UMLS 2011AA Property
    C0022877 (Laboratory)
    SNOMED
    261904005
    LOINC
    MTHU029808
    NCI Thesaurus ObjectClass
    C25709 (undefined)
    UMLS 2011AA ObjectClass
    C1519795 (Unit of Measure)
    SNOMED
    767524001
    Other Result
    Description

    OtherResultIndicatorResultIndicator

    Type de données

    text

    Alias
    NCI Thesaurus ObjectClass
    C17649 (undefined)
    UMLS 2011AA ObjectClass
    C0205394 (Other)
    SNOMED
    74964007
    LOINC
    LP21049-9
    NCI Thesaurus Property
    C25180 (undefined)
    UMLS 2011AA Property
    C1522602 (Indicator)
    NCI Metathesaurus ObjectClass
    CL282989 (undefined)
    NCI Metathesaurus ValueDomain
    C0021212 (Indicators)
    Date Specimen Analyzed (MM/DD/YYYY)
    Description

    SpecimenAnalyzedDate

    Type de données

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164 (undefined)
    UMLS 2011AA ValueDomain
    C0011008 (Date in time)
    SNOMED
    410671006
    NCI Metathesaurus ObjectClass
    C0370003 (Specimen)
    SNOMED
    123038009
    LOINC
    LP7593-9
    NCI Thesaurus Property
    C25420 (undefined)
    Dcp Template Footer
    Description

    Dcp Template Footer

    Protocol Title
    Description

    Protocol Title

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191 (undefined)
    UMLS CUI-1
    C2986303 (Study Protocol Document Version Public Title)
    NCI Thesaurus ObjectClass
    C25320 (undefined)
    NCI Thesaurus Property
    C42774 (undefined)
    Protocol Version
    Description

    Protocol Version

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704 (undefined)
    UMLS CUI-1
    C2985700 (Study Protocol Version)
    NCI Thesaurus ObjectClass
    C25320 (undefined)
    NCI Thesaurus Property
    C25364 (undefined)
    Protocol Date
    Description

    Protocol Version Date

    Type de données

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164 (undefined)
    UMLS CUI-1
    C2985700 (Study Protocol Version)
    NCI Thesaurus ObjectClass
    C25320 (undefined)
    UMLS CUI-2
    C0011008 (Date in time)
    SNOMED
    410671006
    NCI Thesaurus Property
    C25364 (undefined)
    NCI Thesaurus ValueDomain-2
    C25367 (undefined)
    Page #
    Description

    PageNumber

    Type de données

    float

    Alias
    NCI Thesaurus Property
    C25337 (undefined)
    UMLS 2011AA Property
    C0237753 (Numbers)
    SNOMED
    260299005
    LOINC
    LP6841-3
    NCI Thesaurus ValueDomain
    C25337 (undefined)
    UMLS 2011AA ValueDomain
    C0237753 (Numbers)
    SNOMED
    260299005
    LOINC
    LP6841-3
    NCI Metathesaurus ObjectClass
    C0439643 (Sheets (formation))
    SNOMED
    255292000
    Total Page Number
    Description

    CaseReportFormTotalPageNumber

    Type de données

    text

    Alias
    NCI Thesaurus ObjectClass
    C40988 (undefined)
    UMLS 2011AA ObjectClass
    C1516308 (Case Report Form)
    NCI Thesaurus Property
    C25337 (undefined)
    UMLS 2011AA Property
    C0237753 (Numbers)
    SNOMED
    260299005
    LOINC
    LP6841-3
    NCI Thesaurus Property-2
    C25304 (undefined)
    UMLS 2011AA Property-2
    C0439810 (Total)
    SNOMED
    255619001
    LOINC
    LP21089-5
    NCI Thesaurus Property-3
    C42783 (undefined)
    UMLS 2011AA Property-3
    C1704732 (Page (document))
    NCI Thesaurus ValueDomain
    C25337 (undefined)
    UMLS 2011AA ValueDomain
    C0237753 (Numbers)
    SNOMED
    260299005
    LOINC
    LP6841-3
    DCP Template Version
    Description

    DCPTemplateVersionText

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704 (undefined)
    UMLS 2011AA ValueDomain
    C1527021 (Text)
    LOINC
    LP6885-0
    NCI Metathesaurus ObjectClass
    C0728990 (Clinical Use Template)
    NCI Thesaurus Property
    C25714 (undefined)
    UMLS 2011AA Property
    C0333052 (Version)
    LOINC
    MTHU010265
    Retour au début de la page

    Similar models

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    1 Formulaires
    1. StudyEvent: Pharmacokinetics Results Tissue
      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)
    VisitTypeText
    Item
    Visit Type
    text
    C25284 (NCI Thesaurus Property)
    C0332307 (UMLS 2011AA Property)
    C25704 (NCI Thesaurus ValueDomain)
    C1527021 (UMLS 2011AA ValueDomain)
    C25716 (NCI Thesaurus ObjectClass)
    C0545082 (UMLS 2011AA ObjectClass)
    VisitDate
    Item
    Visit Date
    date
    C25164 (NCI Thesaurus Property)
    C0011008 (UMLS 2011AA Property)
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C25367 (NCI Thesaurus ValueDomain-2)
    C25716 (NCI Thesaurus ObjectClass)
    C0545082 (UMLS 2011AA ObjectClass)
    Item Group
    Pharmacokinetics Results Blood
    SpecimenIdentifierNumber
    Item
    Specimen Number
    text
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    C19157 (NCI Thesaurus ObjectClass)
    C0370003 (UMLS 2011AA ObjectClass)
    NotObtainedIndicator
    Item
    Not Obtained
    text
    C25180 (NCI Thesaurus Property)
    C1522602 (UMLS 2011AA Property)
    CL310460 (NCI Metathesaurus ObjectClass)
    CL052458 (NCI Metathesaurus ObjectClass-2)
    C0021212 (NCI Metathesaurus ValueDomain)
    SpecimenCollectedDate
    Item
    Date Sample Collected (MM/DD/YYYY)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C19157 (NCI Thesaurus ObjectClass)
    C0370003 (UMLS 2011AA ObjectClass)
    C25452 (NCI Thesaurus Property)
    C25275 (NCI Thesaurus Property-2)
    C2745955 (UMLS 2011AA Property)
    SpecimenCollectedTime
    Item
    Time Specimen Collected (hr:mm per 24 hour clock - if unknown report UNK)
    time
    C25207 (NCI Thesaurus ValueDomain)
    C0040223 (UMLS 2011AA ValueDomain)
    C19157 (NCI Thesaurus ObjectClass)
    C0370003 (UMLS 2011AA ObjectClass)
    C25452 (NCI Thesaurus Property)
    C25275 (NCI Thesaurus Property-2)
    C2745955 (UMLS 2011AA Property)
    LaboratoryTestResultNumericValue
    Item
    Result
    float
    C37984 (NCI Thesaurus ObjectClass)
    C0022877 (UMLS 2011AA ObjectClass)
    C25294 (NCI Thesaurus Property)
    C0022885 (UMLS 2011AA Property)
    C25712 (NCI Thesaurus ValueDomain)
    C1522609 (UMLS 2011AA ValueDomain)
    LabTestResultUnitofMeasureCode
    Item
    Units
    text
    C25162 (NCI Thesaurus ValueDomain)
    C0805701 (UMLS 2011AA ValueDomain)
    C37984 (NCI Thesaurus Property)
    C0022877 (UMLS 2011AA Property)
    C25709 (NCI Thesaurus ObjectClass)
    C1519795 (UMLS 2011AA ObjectClass)
    Item
    Other Result
    text
    C17649 (NCI Thesaurus ObjectClass)
    C0205394 (UMLS 2011AA ObjectClass)
    C25180 (NCI Thesaurus Property)
    C1522602 (UMLS 2011AA Property)
    CL282989 (NCI Metathesaurus ObjectClass)
    C0021212 (NCI Metathesaurus ValueDomain)
    CL.1
    Code List
    Other Result
    CL Item
    Not Assayed (Not assayed)
    CL Item
    Below Limit Of Detection (Below limit of detection)
    SpecimenAnalyzedDate
    Item
    Date Specimen Analyzed (MM/DD/YYYY)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C0370003 (NCI Metathesaurus ObjectClass)
    C25420 (NCI Thesaurus Property)
    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)
    Retour au début de la page 

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