ID
7089
Description
The Division of Cancer Prevention's agent interruption/modification case report form (CRF) template. Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=5C33C988-5236-20C3-E044-0003BA3F9857
Link
Keywords
Versions (2)
- 9/19/12 9/19/12 -
- 1/9/15 1/9/15 - Martin Dugas
Uploaded on
January 9, 2015
DOI
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License
Creative Commons BY-NC 3.0 Legacy
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On-Study - Agent Interruption/Modification - 2803972v1.0
No Instruction available.
- StudyEvent: Agent Interruption/Modification
Description
Agent Interruption/modification Form
Description
AdditionalAgentInterruptionNumber
Data type
float
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
- NCI Thesaurus ObjectClass
- C1708
- UMLS 2011AA ObjectClass
- C0450442
- NCI Thesaurus ObjectClass-2
- C25406
- UMLS 2011AA ObjectClass-2
- C1524062
- NCI Thesaurus Property
- C25542
- UMLS 2011AA Property
- C1512900
Description
AgentInterruptedDate
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ObjectClass
- C1708
- UMLS 2011AA ObjectClass
- C0450442
- NCI Metathesaurus Property
- C0723457
Description
AgentDiscontinuedReasonType
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus ValueDomain-2
- C25638
- UMLS 2011AA ValueDomain-2
- C0392360
- NCI Thesaurus ObjectClass
- C1708
- UMLS 2011AA ObjectClass
- C0450442
- NCI Metathesaurus Property
- CL212531
Description
AgentStoppedReasonText
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus Property
- C25484
- UMLS 2011AA Property
- C1444662
Description
AgentContinuedIndicator
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C1708
- UMLS 2011AA ObjectClass
- C0450442
- NCI Thesaurus ObjectClass-2
- C63536
- UMLS 2011AA ObjectClass-2
- C2603343
- NCI Thesaurus Property
- C25180
- UMLS 2011AA Property
- C1522602
- NCI Thesaurus Property-2
- C53279
- UMLS 2011AA Property-2
- C0549178
- NCI Thesaurus ValueDomain
- C25180
- UMLS 2011AA ValueDomain
- C1522602
Description
AgentContinuedDate
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ObjectClass
- C1708
- UMLS 2011AA ObjectClass
- C0450442
- NCI Thesaurus Property
- C25658
- UMLS 2011AA Property
- C1514902
Description
AgentRestartedReasonType
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus ValueDomain-2
- C25638
- UMLS 2011AA ValueDomain-2
- C0392360
- NCI Thesaurus ObjectClass
- C1708
- UMLS 2011AA ObjectClass
- C0450442
- NCI Thesaurus Property
- C25658
- UMLS 2011AA Property
- C1514902
Description
Agent Modifications
Description
AgentInterruptedModificationorAdjustmentNumber
Data type
float
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
- NCI Thesaurus ObjectClass
- C1708
- UMLS 2011AA ObjectClass
- C0450442
- NCI Metathesaurus Property
- CL212531
- NCI Thesaurus ValueDomain-2
- C53606
- UMLS 2011AA ValueDomain-2
- C1709057
Description
AgentModifiedDate
Data type
date
Alias
- NCI Thesaurus ObjectClass
- C25446
- UMLS 2011AA ObjectClass
- C0392747
- NCI Metathesaurus ObjectClass
- CL076374
- NCI Thesaurus Property
- C25164
- UMLS 2011AA Property
- C0011008
- NCI Metathesaurus Property
- CL219258
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Description
ModifiedDoseAmount
Data type
float
Alias
- NCI Thesaurus ObjectClass
- C25446
- UMLS 2011AA ObjectClass
- C0392747
- NCI Thesaurus ObjectClass-2
- C25488
- UMLS 2011AA ObjectClass-2
- C0178602
- NCI Thesaurus Property
- C25417
- NCI Thesaurus ValueDomain
- C25417
Description
AgentModifiedUnits
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25162
- UMLS 2011AA ValueDomain
- C0805701
- NCI Thesaurus ObjectClass
- C25488
- UMLS 2011AA ObjectClass
- C0178602
- NCI Thesaurus Property
- C25709
- UMLS 2011AA Property
- C1519795
Description
AgentModifiedFrequency
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25162
- UMLS 2011AA ValueDomain
- C0805701
- NCI Thesaurus Property
- C25488
- UMLS 2011AA Property
- C0178602
- NCI Thesaurus ObjectClass
- C1708
- UMLS 2011AA ObjectClass
- C0450442
Description
Dcp Template Footer
Description
Protocol Title
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS CUI-1
- C2986303
- NCI Thesaurus ObjectClass
- C25320
- NCI Thesaurus Property
- C42774
Description
Protocol Version
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS CUI-1
- C2985700
- NCI Thesaurus ObjectClass
- C25320
- NCI Thesaurus Property
- C25364
Description
Protocol Version Date
Data type
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
Description
PageNumber
Data type
float
Alias
- NCI Thesaurus Property
- C25337
- UMLS 2011AA Property
- C0237753
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
- NCI Metathesaurus ObjectClass
- C0439643
Description
CaseReportFormTotalPageNumber
Data type
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
Description
DCPTemplateVersionText
Data type
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.
- StudyEvent: Agent Interruption/Modification
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1513882 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C19202 (NCI Thesaurus Property-2)
C0805701 (UMLS 2011AA ValueDomain)
C21541 (NCI Thesaurus ObjectClass)
C0018704 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C0030705 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25364 (NCI Thesaurus ValueDomain)
C0600091 (UMLS 2011AA ValueDomain)
C0332307 (UMLS 2011AA Property)
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25716 (NCI Thesaurus ObjectClass)
C0545082 (UMLS 2011AA ObjectClass)
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)
C0237753 (UMLS 2011AA ValueDomain)
C1708 (NCI Thesaurus ObjectClass)
C0450442 (UMLS 2011AA ObjectClass)
C25406 (NCI Thesaurus ObjectClass-2)
C1524062 (UMLS 2011AA ObjectClass-2)
C25542 (NCI Thesaurus Property)
C1512900 (UMLS 2011AA Property)
C0011008 (UMLS 2011AA ValueDomain)
C1708 (NCI Thesaurus ObjectClass)
C0450442 (UMLS 2011AA ObjectClass)
C0723457 (NCI Metathesaurus Property)
C0332307 (UMLS 2011AA ValueDomain)
C25638 (NCI Thesaurus ValueDomain-2)
C0392360 (UMLS 2011AA ValueDomain-2)
C1708 (NCI Thesaurus ObjectClass)
C0450442 (UMLS 2011AA ObjectClass)
CL212531 (NCI Metathesaurus Property)
C1527021 (UMLS 2011AA ValueDomain)
C15368 (NCI Thesaurus ObjectClass)
C25484 (NCI Thesaurus Property)
C1444662 (UMLS 2011AA Property)
C0450442 (UMLS 2011AA ObjectClass)
C63536 (NCI Thesaurus ObjectClass-2)
C2603343 (UMLS 2011AA ObjectClass-2)
C25180 (NCI Thesaurus Property)
C1522602 (UMLS 2011AA Property)
C53279 (NCI Thesaurus Property-2)
C0549178 (UMLS 2011AA Property-2)
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C1705108 (UMLS 2011AA)
C1298908 (UMLS 2011AA)
C1272460 (UMLS 2011AA)
C0011008 (UMLS 2011AA ValueDomain)
C1708 (NCI Thesaurus ObjectClass)
C0450442 (UMLS 2011AA ObjectClass)
C25658 (NCI Thesaurus Property)
C1514902 (UMLS 2011AA Property)
C0332307 (UMLS 2011AA ValueDomain)
C25638 (NCI Thesaurus ValueDomain-2)
C0392360 (UMLS 2011AA ValueDomain-2)
C1708 (NCI Thesaurus ObjectClass)
C0450442 (UMLS 2011AA ObjectClass)
C25658 (NCI Thesaurus Property)
C1514902 (UMLS 2011AA Property)
C0237753 (UMLS 2011AA ValueDomain)
C1708 (NCI Thesaurus ObjectClass)
C0450442 (UMLS 2011AA ObjectClass)
CL212531 (NCI Metathesaurus Property)
C53606 (NCI Thesaurus ValueDomain-2)
C1709057 (UMLS 2011AA ValueDomain-2)
C0392747 (UMLS 2011AA ObjectClass)
CL076374 (NCI Metathesaurus ObjectClass)
C25164 (NCI Thesaurus Property)
C0011008 (UMLS 2011AA Property)
CL219258 (NCI Metathesaurus Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C0392747 (UMLS 2011AA ObjectClass)
C25488 (NCI Thesaurus ObjectClass-2)
C0178602 (UMLS 2011AA ObjectClass-2)
C25417 (NCI Thesaurus Property)
C25417 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
C25488 (NCI Thesaurus ObjectClass)
C0178602 (UMLS 2011AA ObjectClass)
C25709 (NCI Thesaurus Property)
C1519795 (UMLS 2011AA Property)
C0805701 (UMLS 2011AA ValueDomain)
C25488 (NCI Thesaurus Property)
C0178602 (UMLS 2011AA Property)
C1708 (NCI Thesaurus ObjectClass)
C0450442 (UMLS 2011AA ObjectClass)
C2986303 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C42774 (NCI Thesaurus Property)
C2985700 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C25364 (NCI Thesaurus Property)
C2985700 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C0011008 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25367 (NCI Thesaurus ValueDomain-2)
C0237753 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C0439643 (NCI Metathesaurus 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)
C1527021 (UMLS 2011AA ValueDomain)
C0728990 (NCI Metathesaurus ObjectClass)
C25714 (NCI Thesaurus Property)
C0333052 (UMLS 2011AA Property)