ID

7187

Descripción

Primary Brain Cancer - On-Study Form Newly Diagnosed Patients Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=E51E77B9-7E48-3A03-E034-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=E51E77B9-7E48-3A03-E034-0003BA3F9857

Palabras clave

Versiones (3)
  1. 19/9/12 19/9/12 -
  2. 9/1/15 9/1/15 - Martin Dugas
  3. 9/1/15 9/1/15 - Martin Dugas
Subido en

9 de enero de 2015

DOI

Para solicitar uno, por favor iniciar sesión.

Licencia

Creative Commons BY-NC 3.0 Legacy
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On-Study - Primary Brain Cancer - On-Study Form Newly Diagnosed Patients - 2293729v3.0

Inglés

No Instruction available.

1 formularios  
  1. StudyEvent: Primary Brain Cancer - On-Study Form Newly Diagnosed Patients
    1. No Instruction available.
Crf Header
Descripción

Crf Header

Coordinating Group Protocol No.
Descripción

Protocol ID Coordinating Group

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C3274381
NCI Thesaurus ObjectClass
C25320
UMLS CUI-2
C1711341
NCI Thesaurus Property
C25462
NCI Thesaurus Property-2
C25364
Coordinating Group Code
Descripción

Coordinating Group Code

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25162
UMLS CUI-1
C1711341
NCI Thesaurus ObjectClass
C17005
UMLS CUI-2
C0805701
NCI Thesaurus ObjectClass-2
C25462
NCI Thesaurus Property
C25364
Protocol Title
Descripción

Protocol Title

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986303
NCI Thesaurus ObjectClass
C25320
NCI Thesaurus Property
C42774
Patient Study ID
Descripción

Patient Study ID

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25462
NCI Thesaurus Property-2
C25364
Institution/Affiliate
Descripción

Institution Name

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C25454
UMLS CUI-1
C1301943
NCI Thesaurus ObjectClass-2
C21541
NCI Thesaurus Property
C25364
NCI Thesaurus ValueDomain
C25191
NCI Thesaurus ValueDomain-2
C21541
Other Patient ID
Descripción

Trial subject ID Participating Group

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
UMLS CUI-2
C2347449
NCI Thesaurus Property
C25608
NCI Thesaurus Property-2
C25364
Participating Group Code
Descripción

ParticipatingGroupIdentifierCode

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25162
UMLS 2011AA ValueDomain
C0805701
NCI Thesaurus ObjectClass
C25608
UMLS 2011AA ObjectClass
C0679823
NCI Thesaurus ObjectClass-2
C17005
UMLS 2011AA ObjectClass-2
C1257890
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Patient Name (initials acceptable)
Descripción

PatientName

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Brain: Form Administration
Descripción

Brain: Form Administration

Person Completing Form
Descripción

Person Completing Form

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C1550483
NCI Thesaurus ObjectClass
C25657
NCI Thesaurus Property
C25364
Are data amended (If data are amended, please circle in red when using paper form)
Descripción

Data amended

Tipo de datos

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS CUI-1
C0680532
NCI Thesaurus ObjectClass
C25474
NCI Thesaurus Property
C25416
Brain: Disease Description
Descripción

Brain: Disease Description

Date of Initial Diagnosis of Primary Tumor (MM DD YYYY)
Descripción

FirstBiopsyPositiveDate

Tipo de datos

date

Alias
NCI Thesaurus ObjectClass
C15189
UMLS 2011AA ObjectClass
C0005558
NCI Thesaurus ObjectClass-2
C25509
UMLS 2011AA ObjectClass-2
C1279901
NCI Thesaurus Property
C25246
UMLS 2011AA Property
C1446409
NCI Thesaurus Property-2
C25275
UMLS 2011AA Property-2
C2745955
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ValueDomain-2
C25367
Basis of Diagnosis
Descripción

DiagnosisMethodType

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus Property
C16847
UMLS 2011AA Property
C0449851
NCI Thesaurus ObjectClass
C15220
UMLS 2011AA ObjectClass
C0011900
Infratentorial Involvement
Descripción

BrainInfratentorialInvolvementInd-3

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
NCI Thesaurus ObjectClass
C12439
UMLS 2011AA ObjectClass
C0006104
NCI Thesaurus Property
C25548
UMLS 2011AA Property
C1314939
NCI Metathesaurus Property
CL211504
Supratentorial Involvement
Descripción

SupratentorialInvolvementInd-3

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus Property
C25548
UMLS 2011AA Property
C1314939
NCI Thesaurus ObjectClass
C12923
UMLS 2011AA ObjectClass
C0441938
Site of Lesion (check all that apply)
Descripción

BrainLesionSite

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C13717
UMLS 2011AA ValueDomain
C1515974
NCI Thesaurus ObjectClass
C3824
UMLS 2011AA ObjectClass
C0221198
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus ObjectClass-2
C12439
UMLS 2011AA ObjectClass-2
C0006104
Other specify
Descripción

Primary Disease Site

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS CUI-1
C0449695
NCI Thesaurus Property
C25341
NCI Thesaurus ObjectClass
C25251
NCI Thesaurus ObjectClass-2
C2991
Side
Descripción

BrainTumorSideType

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C3262
UMLS 2011AA ObjectClass
C0027651
NCI Thesaurus ObjectClass-2
C12439
UMLS 2011AA ObjectClass-2
C0006104
NCI Thesaurus Property
C25306
UMLS 2011AA Property
C0441987
Histologic Type
Descripción

BrainTumorHistologicCategory

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C3262
UMLS 2011AA ObjectClass
C0027651
NCI Thesaurus ObjectClass-2
C12439
UMLS 2011AA ObjectClass-2
C0006104
NCI Thesaurus Property
C25526
UMLS 2011AA Property
C0205462
NCI Thesaurus Property-2
C25161
UMLS 2011AA Property-2
C0008902
NCI Thesaurus ValueDomain
C25372
UMLS 2011AA ValueDomain
C0683312
Other specify
Descripción

Histologic Type, other

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS CUI-1
C1299220
NCI Thesaurus ObjectClass
C3262
NCI Thesaurus Property
C25526
NCI Thesaurus Property-2
C25161
Histologic Grade (WHO)
Descripción

BrainTumorWHOHistologicGrade

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C3262
UMLS 2011AA ObjectClass
C0027651
NCI Thesaurus ObjectClass-2
C12439
UMLS 2011AA ObjectClass-2
C0006104
NCI Thesaurus Property
C25365
UMLS 2011AA Property
C0678257
NCI Metathesaurus Property
C0043237
NCI Thesaurus ValueDomain
C25526
UMLS 2011AA ValueDomain
C0205462
NCI Thesaurus ValueDomain-2
C18000
UMLS 2011AA ValueDomain-2
C0919553
CSF Cytology
Descripción

CerebrospinalFluidCytologyPerformedInd

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
NCI Thesaurus ObjectClass
C16491
UMLS 2011AA ObjectClass
C0010819
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus ObjectClass-2
C12692
UMLS 2011AA ObjectClass-2
C0007806
CSF Involvement
Descripción

CerebrospinalFluidInvolvementInd

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
NCI Thesaurus ObjectClass
C12692
UMLS 2011AA ObjectClass
C0007806
NCI Thesaurus Property
C25548
UMLS 2011AA Property
C1314939
Brain: Neurologic Function
Descripción

Brain: Neurologic Function

Neurologic Function Status
Descripción

NeurologicalFunctionStatus

Tipo de datos

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
Brain: Prior Health History
Descripción

Brain: Prior Health History

Has the patient experienced an intracranial hemorrhage?
Descripción

IntracranialBrainHemorrhageOccurrenceInd-3

Tipo de datos

boolean

Alias
NCI Thesaurus ObjectClass
C12439
UMLS 2011AA ObjectClass
C0006104
NCI Thesaurus ObjectClass-2
C38236
UMLS 2011AA ObjectClass-2
C1522213
NCI Thesaurus Property
C26791
UMLS 2011AA Property
C0019080
NCI Thesaurus Property-2
C25275
UMLS 2011AA Property-2
C2745955
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
Date of Most Recent (MM DD YYYY)
Descripción

BrainHemorrhageObservedMostRecentDate

Tipo de datos

date

Alias
NCI Thesaurus ObjectClass
C12439
UMLS 2011AA ObjectClass
C0006104
NCI Thesaurus Property
C26791
UMLS 2011AA Property
C0019080
NCI Thesaurus Property-2
C25599
UMLS 2011AA Property-2
C1441672
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ValueDomain-2
C25577
UMLS 2011AA ValueDomain-2
C1513491
Has the patient experienced an intraocular hemorrhage?
Descripción

EyeHemorrhageOccurrenceInd-3

Tipo de datos

boolean

Alias
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
NCI Thesaurus Property
C26791
UMLS 2011AA Property
C0019080
NCI Thesaurus Property-2
C25275
UMLS 2011AA Property-2
C2745955
NCI Metathesaurus ObjectClass
C0015392
Date of Most Recent (MM DD YYYY)
Descripción

EyeHemorrhageObservedMostRecentDate

Tipo de datos

date

Alias
NCI Metathesaurus ObjectClass
C0015392
NCI Thesaurus Property
C26791
UMLS 2011AA Property
C0019080
NCI Thesaurus Property-2
C25599
UMLS 2011AA Property-2
C1441672
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ValueDomain-2
C25577
UMLS 2011AA ValueDomain-2
C1513491
Current Medical Conditions (currently symptomatic or on medications for)
Descripción

PatientMedicalConditionCurrentType

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25261
UMLS 2011AA Property
C0205476
NCI Thesaurus Property-2
C25457
UMLS 2011AA Property-2
C0348080
Other malignancies specify
Descripción

MalignantDiseaseOtherPresentSpecify

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C14143
UMLS 2011AA ObjectClass
C0205282
NCI Thesaurus ObjectClass-2
C2991
UMLS 2011AA ObjectClass-2
C0012634
NCI Thesaurus Property
C17649
UMLS 2011AA Property
C0205394
NCI Thesaurus Property-2
C25626
UMLS 2011AA Property-2
C0150312
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
Other specify
Descripción

PatientMedicalConditionCurrentSpecify

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25261
UMLS 2011AA Property
C0205476
NCI Thesaurus Property-2
C25457
UMLS 2011AA Property-2
C0348080
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus ValueDomain-2
C25471
UMLS 2011AA ValueDomain-2
C0521116
Brain: Concomitant Medications
Descripción

Brain: Concomitant Medications

Is the person receiving anti-convulsant medication?
Descripción

AnticonvulsantMedicationAdministrationInd-3

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass
C459
UMLS 2011AA ObjectClass
C0013227
NCI Thesaurus Property
C25409
UMLS 2011AA Property
C1533734
NCI Thesaurus ObjectClass-2
C264
UMLS 2011AA ObjectClass-2
C0003286
Is this anti-convulsant medication enzyme-inducing?
Descripción

AnticonvulsantMedicationEnzymePresentInd-3

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C459
UMLS 2011AA ObjectClass
C0013227
NCI Thesaurus ObjectClass-2
C264
UMLS 2011AA ObjectClass-2
C0003286
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus Property-2
C16554
UMLS 2011AA Property-2
C0014442
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Is the patient receiving corticosteroids?
Descripción

CorticosteroidAdministrationInd-3

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus Property
C25629
UMLS 2011AA Property
C0332152
NCI Thesaurus ObjectClass
C2322
UMLS 2011AA ObjectClass
C0001617
NCI Thesaurus Property-2
C25382
UMLS 2011AA Property-2
C1521801
Agent Total Dose (per day)
Descripción

Agent Total Dose

Tipo de datos

float

Alias
NCI Thesaurus ValueDomain
C25304
UMLS CUI-1
C2986497
NCI Thesaurus Property
C25379
NCI Thesaurus ValueDomain-2
C25488
NCI Thesaurus ObjectClass
C1708
Is the patient receiving other medications?
Descripción

OtherMedicationAdministrationInd-3

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C17649
UMLS 2011AA ObjectClass
C0205394
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass-2
C459
UMLS 2011AA ObjectClass-2
C0013227
NCI Thesaurus Property
C25409
UMLS 2011AA Property
C1533734
Agent Name (If Yes,)
Descripción

Agent

Tipo de datos

text

Alias
NCI Thesaurus Property
C25364
UMLS CUI-1
C1521826
NCI Thesaurus ObjectClass
C1708
NCI Thesaurus ValueDomain
C1708
NCI Thesaurus ValueDomain-2
C42614
Agent Name (If Yes,)
Descripción

Agent

Tipo de datos

text

Alias
NCI Thesaurus Property
C25364
UMLS CUI-1
C1521826
NCI Thesaurus ObjectClass
C1708
NCI Thesaurus ValueDomain
C1708
NCI Thesaurus ValueDomain-2
C42614
Agent Name (If Yes,)
Descripción

Agent

Tipo de datos

text

Alias
NCI Thesaurus Property
C25364
UMLS CUI-1
C1521826
NCI Thesaurus ObjectClass
C1708
NCI Thesaurus ValueDomain
C1708
NCI Thesaurus ValueDomain-2
C42614
Agent Start Date (MM DD YYYY)
Descripción

Medication Start Date

Tipo de datos

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS CUI-1
C1521826
NCI Thesaurus ValueDomain-2
C25431
UMLS CUI-2
C0808070
NCI Thesaurus ObjectClass
C1708
NCI Thesaurus Property
C25275
Agent Start Date (MM DD YYYY)
Descripción

Medication Start Date

Tipo de datos

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS CUI-1
C1521826
NCI Thesaurus ValueDomain-2
C25431
UMLS CUI-2
C0808070
NCI Thesaurus ObjectClass
C1708
NCI Thesaurus Property
C25275
Agent Start Date (MM DD YYYY)
Descripción

Medication Start Date

Tipo de datos

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS CUI-1
C1521826
NCI Thesaurus ValueDomain-2
C25431
UMLS CUI-2
C0808070
NCI Thesaurus ObjectClass
C1708
NCI Thesaurus Property
C25275
Brain: Prior Surgical Treatment For Primary Site
Descripción

Brain: Prior Surgical Treatment For Primary Site

Primary Surgery Date (MM DD YYYY)
Descripción

PrimarySurgeryDate

Tipo de datos

date

Alias
NCI Thesaurus ObjectClass
C25251
UMLS 2011AA ObjectClass
C0205225
NCI Thesaurus ObjectClass-2
C15329
UMLS 2011AA ObjectClass-2
C0543467
NCI Thesaurus Property
C25275
UMLS 2011AA Property
C2745955
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ValueDomain-2
C25367
Extent of Resection (at primary site)
Descripción

BrainMalignantNeoplasmExtentSurgicalResectionType

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C12439
UMLS 2011AA ObjectClass
C0006104
NCI Thesaurus ObjectClass-2
C9305
UMLS 2011AA ObjectClass-2
C0006826
NCI Thesaurus Property
C25698
NCI Thesaurus Property-2
C15232
UMLS 2011AA Property
C0728940
NCI Thesaurus Property-3
C25332
UMLS 2011AA Property-2
C0439792
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Enhancing residual disease?
Descripción

ResidualDiseasePositiveContrastInd

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus ObjectClass-2
C37895
UMLS 2011AA ObjectClass-2
C1609982
NCI Thesaurus Property
C25246
UMLS 2011AA Property
C1446409
NCI Thesaurus Property-2
C390
UMLS 2011AA Property-2
C0009924
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
Non-enhancing residual disease?
Descripción

ResidualDiseaseNegativeContrastInd

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus ObjectClass-2
C37895
UMLS 2011AA ObjectClass-2
C1609982
NCI Thesaurus Property
C25247
UMLS 2011AA Property
C0205160
NCI Thesaurus Property-2
C390
UMLS 2011AA Property-2
C0009924
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
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1 formularios
  1. StudyEvent: Primary Brain Cancer - On-Study Form Newly Diagnosed Patients
    1. No Instruction available.
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
Crf Header
Protocol ID Coordinating Group
Item
Coordinating Group Protocol No.
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1711341 (UMLS CUI-2)
C25462 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Coordinating Group Code
Item
Coordinating Group Code
text
C25162 (NCI Thesaurus ValueDomain)
C1711341 (UMLS CUI-1)
C17005 (NCI Thesaurus ObjectClass)
C0805701 (UMLS CUI-2)
C25462 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
Protocol Title
Item
Protocol Title
text
C25191 (NCI Thesaurus ValueDomain)
C2986303 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C42774 (NCI Thesaurus Property)
Patient Study ID
Item
Patient Study ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25462 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Institution Name
Item
Institution/Affiliate
text
C25454 (NCI Thesaurus ObjectClass)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
C25191 (NCI Thesaurus ValueDomain)
C21541 (NCI Thesaurus ValueDomain-2)
Trial subject ID Participating Group
Item
Other Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
ParticipatingGroupIdentifierCode
Item
Participating Group Code
text
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
C25608 (NCI Thesaurus ObjectClass)
C0679823 (UMLS 2011AA ObjectClass)
C17005 (NCI Thesaurus ObjectClass-2)
C1257890 (UMLS 2011AA ObjectClass-2)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
PatientName
Item
Patient Name (initials acceptable)
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
Item Group
Brain: Form Administration
Person Completing Form
Item
Person Completing Form
text
C25191 (NCI Thesaurus ValueDomain)
C1550483 (UMLS CUI-1)
C25657 (NCI Thesaurus ObjectClass)
C25364 (NCI Thesaurus Property)
Data amended
Item
Are data amended (If data are amended, please circle in red when using paper form)
boolean
C38148 (NCI Thesaurus ValueDomain)
C0680532 (UMLS CUI-1)
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)
Item Group
Brain: Disease Description
FirstBiopsyPositiveDate
Item
Date of Initial Diagnosis of Primary Tumor (MM DD YYYY)
date
C15189 (NCI Thesaurus ObjectClass)
C0005558 (UMLS 2011AA ObjectClass)
C25509 (NCI Thesaurus ObjectClass-2)
C1279901 (UMLS 2011AA ObjectClass-2)
C25246 (NCI Thesaurus Property)
C1446409 (UMLS 2011AA Property)
C25275 (NCI Thesaurus Property-2)
C2745955 (UMLS 2011AA Property-2)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
Item
Basis of Diagnosis
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C16847 (NCI Thesaurus Property)
C0449851 (UMLS 2011AA Property)
C15220 (NCI Thesaurus ObjectClass)
C0011900 (UMLS 2011AA ObjectClass)
CL.2
Code List
Basis of Diagnosis
CL Item
Histology (Histology)
C16681 (NCI Thesaurus)
C0019638 (UMLS 2011AA)
C16681 (NCI Thesaurus-3)
C0019638 (UMLS 2011AA-4)
CL Item
Imaging Only (Imaging only)
Item
Infratentorial Involvement
text
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C12439 (NCI Thesaurus ObjectClass)
C0006104 (UMLS 2011AA ObjectClass)
C25548 (NCI Thesaurus Property)
C1314939 (UMLS 2011AA Property)
CL211504 (NCI Metathesaurus Property)
CL.3
Code List
Infratentorial Involvement
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
Supratentorial Involvement
text
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C25548 (NCI Thesaurus Property)
C1314939 (UMLS 2011AA Property)
C12923 (NCI Thesaurus ObjectClass)
C0441938 (UMLS 2011AA ObjectClass)
CL.4
Code List
Supratentorial Involvement
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
Site of Lesion (check all that apply)
text
C13717 (NCI Thesaurus ValueDomain)
C1515974 (UMLS 2011AA ValueDomain)
C3824 (NCI Thesaurus ObjectClass)
C0221198 (UMLS 2011AA ObjectClass)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C12439 (NCI Thesaurus ObjectClass-2)
C0006104 (UMLS 2011AA ObjectClass-2)
CL.5
Code List
Site of Lesion (check all that apply)
CL Item
Frontal Lobe (Frontal)
C12352 (NCI Thesaurus)
C0016733 (UMLS 2011AA)
CL Item
Temporal Lobe (Temporal)
C12353 (NCI Thesaurus)
C0039485 (UMLS 2011AA)
CL Item
Parietal Lobe (Parietal)
C12354 (NCI Thesaurus)
C0030560 (UMLS 2011AA)
CL Item
Occipital Lobe (Occipital)
C12355 (NCI Thesaurus)
C0028785 (UMLS 2011AA)
CL Item
Cerebellum (Cerebellum)
C12445 (NCI Thesaurus)
C0007765 (UMLS 2011AA)
CL Item
Cerebellar Peduncle (Cerebellar peduncle)
C0228515 (NCI Metathesaurus)
CL Item
Cerebellar Hemisphere (Cerebellar hemisphere)
C0228465 (NCI Metathesaurus)
CL Item
Cerebellar Vermis (Cerebellar vermis)
CL Item
Brainstem (Brainstem)
CL Item
Midbrain (Midbrain)
C0025462 (NCI Metathesaurus)
CL Item
Pons (Pons)
C0032639 (NCI Metathesaurus)
CL Item
Medulla (Medulla)
CL Item
Dorsal Exophytic Brainstem (Dorsal exophytic brainstem)
CL Item
Spinal Cord (c1 And Below) (Spinal cord)
CL Item
Corpus Callosum (Corpus callosum)
C12446 (NCI Thesaurus)
C0010090 (UMLS 2011AA)
CL Item
Optic Chiasm (Optic chiasm)
C0029126 (NCI Metathesaurus)
CL Item
Hypothalamus (Hypothalamus)
C12458 (NCI Thesaurus)
C0020663 (UMLS 2011AA)
CL Item
Cavernous Sinus (Cavernous sinus)
C12690 (NCI Thesaurus)
C0007473 (UMLS 2011AA)
CL Item
Lateral Ventricle (Lateral ventricle)
C12834 (NCI Thesaurus)
C0152279 (UMLS 2011AA)
CL Item
Third Ventricle (Third ventricle)
C12827 (NCI Thesaurus)
C0149555 (UMLS 2011AA)
CL Item
Fourth Ventricle (Fourth ventricle)
C12828 (NCI Thesaurus)
C0149556 (UMLS 2011AA)
CL Item
Cisterna Magna (Cisterna magna)
C32324 (NCI Thesaurus)
C0008841 (UMLS 2011AA)
CL Item
Basal Ganglia (Basal ganglia)
C12447 (NCI Thesaurus)
C0004781 (UMLS 2011AA)
CL Item
Thalamus (Thalamus)
C12459 (NCI Thesaurus)
C0039729 (UMLS 2011AA)
CL Item
Optic Nerve (Optic nerve)
C12761 (NCI Thesaurus)
C0029130 (UMLS 2011AA)
CL Item
Pineal (Pineal)
CL Item
Aqueduct Of Sylvius (Aqueduct of sylvius)
C32135 (NCI Thesaurus)
C0007769 (UMLS 2011AA)
CL Item
Leptomeningeal (Leptomeningeal)
CL Item
Cervical (Cervical)
C12844 (NCI Thesaurus)
C0205064 (UMLS 2011AA)
CL Item
Thoracic (Thoracic)
C13360 (NCI Thesaurus)
C0817096 (UMLS 2011AA)
CL Item
Lumbar (Lumbar)
CL Item
Conus (Conus)
C0598489 (NCI Metathesaurus)
CL Item
Cauda Equina (Cauda equina)
C12689 (NCI Thesaurus)
C0007458 (UMLS 2011AA)
CL Item
Other, Specify (Other specify)
Primary Disease Site
Item
Other specify
text
C25685 (NCI Thesaurus ValueDomain)
C0449695 (UMLS CUI-1)
C25341 (NCI Thesaurus Property)
C25251 (NCI Thesaurus ObjectClass)
C2991 (NCI Thesaurus ObjectClass-2)
Item
Side
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C12439 (NCI Thesaurus ObjectClass-2)
C0006104 (UMLS 2011AA ObjectClass-2)
C25306 (NCI Thesaurus Property)
C0441987 (UMLS 2011AA Property)
CL.6
Code List
Side
CL Item
Left (Left)
C25229 (NCI Thesaurus)
C0205091 (UMLS 2011AA)
CL Item
Right (Right)
C25228 (NCI Thesaurus)
C0205090 (UMLS 2011AA)
CL Item
Both (Both)
C49636 (NCI Thesaurus)
C1706086 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Histologic Type
text
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C12439 (NCI Thesaurus ObjectClass-2)
C0006104 (UMLS 2011AA ObjectClass-2)
C25526 (NCI Thesaurus Property)
C0205462 (UMLS 2011AA Property)
C25161 (NCI Thesaurus Property-2)
C0008902 (UMLS 2011AA Property-2)
C25372 (NCI Thesaurus ValueDomain)
C0683312 (UMLS 2011AA ValueDomain)
CL.7
Code List
Histologic Type
CL Item
Diffuse Astrocytoma (Diffuse astrocytoma)
C7173 (NCI Thesaurus)
C0280785 (UMLS 2011AA)
CL Item
9420-3 Fibrillary Astrocytoma (c71._) (Fibrillary astrocytoma)
CL Item
9410-3 Protoplasmic Astrocytoma (c71._) (Protoplasmic astrocytoma)
CL Item
9411-3 Gemistocytic Astrocytoma (c71._) (Gemistocytic astrocytoma)
CL Item
9401-3 Astrocytoma, Anaplastic (c71._) (Anaplastic astrocytoma)
CL Item
9440-3 Glioblastoma, Nos (c71._) (Glioblastoma)
CL Item
9441-3 Giant Cell Glioblastoma (c71._) (Giant cell glioblastoma)
CL Item
9442-3 Gliosarcoma (c71._) (Gliosarcoma)
CL Item
9421-1 Pilocytic Astrocytoma (c71._) (Pilocytic astrocytoma)
CL Item
9424-3 Pleomorphic Xanthoastrocytoma (c71._) (Pleomorphic xanthoastrocytoma)
CL Item
9384-1 Subependymal Giant Cell Astrocytoma (c71._) (Subependymal giant cell astrocytoma)
CL Item
9450-3 Oligodendroglioma, Nos (c71._) (Oligodendroglioma)
CL Item
9451-3 Oligodendroglioma, Anaplastic (c71._) (Anaplastic oligodendroglioma)
CL Item
Oligoastrocytoma (Oligoastrocytoma)
CL Item
Anaplastic Oligoastrocytoma (Anaplastic oligoastrocytoma)
C6959 (NCI Thesaurus)
C0431108 (UMLS 2011AA)
CL Item
9391-3 Ependymoma, Nos (c71._) (Ependymoma)
CL Item
9392-3 Ependymoma, Anaplastic (c71._) (Anaplastic ependymoma)
CL Item
9394-1 Myxopapillary Ependymoma (c72.0) (Myxopapillary ependymoma)
CL Item
9383-1 Subependymoma (c71._) (Subependymoma)
CL Item
9390-0 Choroid Plexus Papilloma, Nos (c71.5) (Choroid plexus papilloma)
CL Item
9390-3 Choroid Plexus Carcinoma (c71.5) (Choroid plexus carcinoma)
CL Item
9430-3 Astroblastoma (c71._) (Astroblastoma)
CL Item
9381-3 Gliomatosis Cerebri (c71._) (Gliomatosis cerebri)
CL Item
Chordoid Glioma Of The Third Ventricle (Chordoid glioma of the third ventricle)
C6961 (NCI Thesaurus)
C1322252 (UMLS 2011AA)
CL Item
9492-0 Gangliocytoma (Gangliocytoma)
CL Item
9493-0 Dysplastic Gangliocytoma Of Cerebellum (lhermitte-duclos) (c71.6) (Dysplastic gangliocytoma of cerebellum)
CL Item
Desmoplastic Infantile Astrocytoma/ganglioma (Desmoplastic infantile astrocytoma/ganglioma)
CL Item
Low Grade Astrocytoma, Nos (Low grade astrocytoma NOS)
CL Item
9413-0 Dysembryoplastic Neuroepithelial Tumor (Dysembryoplastic neuroepithelial tumor)
CL Item
9505-1 Ganglioglioma, Nos (Ganglioglioma)
CL Item
9505-3 Ganglioglioma, Anaplastic (Anaplastic ganglioglioma)
CL Item
9506-1 Central Neurocytoma (Central neurocytoma)
CL Item
Cerebellar Liponeurocytoma (Cerebellar liponeurocytoma)
C6905 (NCI Thesaurus)
C1370507 (UMLS 2011AA)
CL Item
Paraganglioma Of The Filum Terminale (Paraganglioma of the filum terminale)
CL Item
9522-3 Olfactory Neuroblastoma (c30.0) (Olfactory neuroblastoma)
CL Item
9523-3 Olfactory Neuroepithelioma (c30.0) (Olfactory neuroepithelioma)
CL Item
Neuroblastomas Of The Adrenal Gland And Sympathetic Nervous System (Neuroblastomas of the adrenal gland and sympathetic nervous system)
CL Item
9361-1 Pineocytoma (c75.3) (Pineocytoma)
CL Item
9362-3 Pineoblastoma (c75.3) (Pineoblastoma)
CL Item
Pineal Parenchymal Tumor Of Indeterminate Differentiation (Pineal parenchymal tumor of indeterminate differentiation)
CL Item
9501-3 Medulloepithelioma, Nos (Medulloepithelioma)
CL Item
Ependymoblastoma (Ependymoblastoma)
C4915 (NCI Thesaurus)
C0700367 (UMLS 2011AA)
CL Item
9470-3 Medulloblastoma, Nos (c71.6) (Medulloblastoma)
CL Item
Desmoplastic Medulloblastoma (Desmoplastic medulloblastoma)
C4956 (NCI Thesaurus)
C0751291 (UMLS 2011AA)
CL Item
9474-3 Large Cell Medulloblastoma (c71.6) (Large cell medulloblastoma)
CL Item
9472-3 Medullomyoblastoma (c71.6) (Medullomyoblastoma)
CL Item
Melanotic Medulloblastoma (Melanotic medulloblastoma)
C9497 (NCI Thesaurus)
C1275668 (UMLS 2011AA)
CL Item
Supratentorial Primitive Neuroectodermal Tumor (pnet) (Supratentorial primitive neuroectodermal tumor)
CL Item
9500-3 Neuroblastoma, Nos (Neuroblastoma)
CL Item
9490-3 Ganglioneuroblastoma (Ganglioneuroblastoma)
CL Item
9508-3 Atypical Teratoid-rhabdoid Tumor (c71._) (Atypical teratoid/rhabdoid tumor)
CL Item
Schwannoma (neurilemmoma, Neurinoma) (Schwannoma)
CL Item
High Grade Astrocytoma, Nos (High grade astrocytoma NOS)
CL Item
9064-3 Germinoma (Germinoma)
CL Item
Embryonal Carcinoma (Embryonal carcinoma)
C3752 (NCI Thesaurus)
C0026705 (UMLS 2011AA)
CL Item
Yolk Sac Tumor (Yolk sac tumor)
C3011 (NCI Thesaurus)
C0014145 (UMLS 2011AA)
CL Item
Choriocarcinoma (Choriocarcinoma)
C2948 (NCI Thesaurus)
C0008497 (UMLS 2011AA)
CL Item
Teratoma (Teratoma)
C3403 (NCI Thesaurus)
C0039538 (UMLS 2011AA)
CL Item
Mixed Germ Cell Tumor (Mixed germ cell tumors)
C4285 (NCI Thesaurus)
CL Item
9350-1 Craniopharyngioma (c75.2) (Craniopharyngioma)
CL Item
9351-1 Craniopharyngioma, Adamantinomatous (c75.2) (Adamantinomatous)
CL Item
9352-1 Craniopharyngioma, Papillary (c75.2) (Papillary)
CL Item
9580-0 Granular Cell Tumor, Nos (Granular cell tumor)
CL Item
9531-0 Meningothelial Meningioma (Meningothelial meningioma)
CL Item
9532-0 Fibrous Meningioma (Fibrous meningioma)
CL Item
9537-0 Transitional Meningioma (Transitional meningioma)
CL Item
9533-0 Psammomatous Meningioma (Psammomatous meningioma)
CL Item
9534-0 Angiomatous Meningioma (Angiomatous meningioma)
CL Item
Microcystic Meningioma (Microcystic meningioma)
CL Item
Secretory Meningioma (Secretory meningioma)
CL Item
Lymphoplasmacyte-rich Meningioma (Lymphoplasmacyte-rich meningioma)
CL Item
Metaplastic Meningioma (Metaplastic meningioma)
CL Item
9539-1 Atypical Meningioma (Atypical meningioma)
CL Item
9538-1 Clear Cell Meningioma (Clear cell meningioma)
CL Item
Chordoid Meningioma (Chordoid meningioma)
CL Item
Rhabdoid Meningioma (Rhabdoid meningioma)
CL Item
9538-3 Papillary Meningioma (Papillary meningioma)
CL Item
Anaplastic Meningioma (Anaplastic meningioma)
CL Item
Other, Specify (Other specify)
Histologic Type, other
Item
Other specify
text
C25685 (NCI Thesaurus ValueDomain)
C1299220 (UMLS CUI-1)
C3262 (NCI Thesaurus ObjectClass)
C25526 (NCI Thesaurus Property)
C25161 (NCI Thesaurus Property-2)
Item
Histologic Grade (WHO)
text
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C12439 (NCI Thesaurus ObjectClass-2)
C0006104 (UMLS 2011AA ObjectClass-2)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
C0043237 (NCI Metathesaurus Property)
C25526 (NCI Thesaurus ValueDomain)
C0205462 (UMLS 2011AA ValueDomain)
C18000 (NCI Thesaurus ValueDomain-2)
C0919553 (UMLS 2011AA ValueDomain-2)
CL.8
Code List
Histologic Grade (WHO)
CL Item
Well Differentiated (grade I) (Well differentiated (Grade I))
CL Item
Moderately Differentiated (grade Ii) (Moderately Differentiated (Grade II))
CL Item
Poorly Differentiated (grade Iii) (Poorly Differentiated (Grade III))
CL Item
Undifferentiated (grade Iv) (Undifferentiated (Grade IV))
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
CSF Cytology
text
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C16491 (NCI Thesaurus ObjectClass)
C0010819 (UMLS 2011AA ObjectClass)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C12692 (NCI Thesaurus ObjectClass-2)
C0007806 (UMLS 2011AA ObjectClass-2)
CL.9
Code List
CSF Cytology
CL Item
Positive (Positive)
C25246 (NCI Thesaurus)
C1446409 (UMLS 2011AA)
CL Item
Negative (Negative)
C25247 (NCI Thesaurus)
C0205160 (UMLS 2011AA)
CL Item
Undetermined (Undetermined)
CL Item
Not Done (Not Done)
CL281691 (NCI Metathesaurus)
Item
CSF Involvement
text
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C12692 (NCI Thesaurus ObjectClass)
C0007806 (UMLS 2011AA ObjectClass)
C25548 (NCI Thesaurus Property)
C1314939 (UMLS 2011AA Property)
CL.10
Code List
CSF Involvement
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
Brain: Neurologic Function
Item
Neurologic Function Status
text
C25262 (NCI Thesaurus ObjectClass)
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)
CL.11
Code List
Neurologic Function Status
CL Item
No Neurologic Symptoms, Fully Active At Home/work Without Assistance (No neurologic symptoms, fully active at home/work without assistance)
CL Item
Minor Neurologic Symptoms, Fully Active At Home/work Without Assistance (Minor neurologic symptoms, fully active at home/work without assistance)
CL Item
Moderate Neurologic Symptoms, Fully Active At Home/work But Requires Assistance (Moderate neurologic symptoms, fully active at home/work but requires assistance)
CL Item
Moderate Neurologic Symptoms, Less Than Fully Active At Home/work And Requires Assitance (Moderate neurologic symptoms, less than fully active at home/work and requires assistance)
CL Item
Severe Neurologic Symptoms, Totally Inactive Requiring Complete Assistance At Home Or Institution, Unable To Work (Severe neurologic symptoms, totally inactive requiring complete assistance at home or institution, unable to work)
Item Group
Brain: Prior Health History
IntracranialBrainHemorrhageOccurrenceInd-3
Item
Has the patient experienced an intracranial hemorrhage?
boolean
C12439 (NCI Thesaurus ObjectClass)
C0006104 (UMLS 2011AA ObjectClass)
C38236 (NCI Thesaurus ObjectClass-2)
C1522213 (UMLS 2011AA ObjectClass-2)
C26791 (NCI Thesaurus Property)
C0019080 (UMLS 2011AA Property)
C25275 (NCI Thesaurus Property-2)
C2745955 (UMLS 2011AA Property-2)
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
BrainHemorrhageObservedMostRecentDate
Item
Date of Most Recent (MM DD YYYY)
date
C12439 (NCI Thesaurus ObjectClass)
C0006104 (UMLS 2011AA ObjectClass)
C26791 (NCI Thesaurus Property)
C0019080 (UMLS 2011AA Property)
C25599 (NCI Thesaurus Property-2)
C1441672 (UMLS 2011AA Property-2)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25577 (NCI Thesaurus ValueDomain-2)
C1513491 (UMLS 2011AA ValueDomain-2)
EyeHemorrhageOccurrenceInd-3
Item
Has the patient experienced an intraocular hemorrhage?
boolean
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C26791 (NCI Thesaurus Property)
C0019080 (UMLS 2011AA Property)
C25275 (NCI Thesaurus Property-2)
C2745955 (UMLS 2011AA Property-2)
C0015392 (NCI Metathesaurus ObjectClass)
EyeHemorrhageObservedMostRecentDate
Item
Date of Most Recent (MM DD YYYY)
date
C0015392 (NCI Metathesaurus ObjectClass)
C26791 (NCI Thesaurus Property)
C0019080 (UMLS 2011AA Property)
C25599 (NCI Thesaurus Property-2)
C1441672 (UMLS 2011AA Property-2)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25577 (NCI Thesaurus ValueDomain-2)
C1513491 (UMLS 2011AA ValueDomain-2)
Item
Current Medical Conditions (currently symptomatic or on medications for)
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25261 (NCI Thesaurus Property)
C0205476 (UMLS 2011AA Property)
C25457 (NCI Thesaurus Property-2)
C0348080 (UMLS 2011AA Property-2)
CL.14
Code List
Current Medical Conditions (currently symptomatic or on medications for)
CL Item
Cerebrovascular Disease (Cerebrovascular disease)
CL Item
Cardiac Disease (Cardiac disease)
CL Item
Deep Vein Thrombosis (Deep vein thrombosis)
CL Item
Hypertension (Hypertension)
C3117 (NCI Thesaurus)
C0020538 (UMLS 2011AA)
CL Item
Diabetes (Diabetes)
CL Item
Other Malignancies, Specify (Other malignancies specify)
CL Item
Other, Specify (Other specify)
MalignantDiseaseOtherPresentSpecify
Item
Other malignancies specify
text
C14143 (NCI Thesaurus ObjectClass)
C0205282 (UMLS 2011AA ObjectClass)
C2991 (NCI Thesaurus ObjectClass-2)
C0012634 (UMLS 2011AA ObjectClass-2)
C17649 (NCI Thesaurus Property)
C0205394 (UMLS 2011AA Property)
C25626 (NCI Thesaurus Property-2)
C0150312 (UMLS 2011AA Property-2)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
PatientMedicalConditionCurrentSpecify
Item
Other specify
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25261 (NCI Thesaurus Property)
C0205476 (UMLS 2011AA Property)
C25457 (NCI Thesaurus Property-2)
C0348080 (UMLS 2011AA Property-2)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C25471 (NCI Thesaurus ValueDomain-2)
C0521116 (UMLS 2011AA ValueDomain-2)
Item Group
Brain: Concomitant Medications
Item
Is the person receiving anti-convulsant medication?
text
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C459 (NCI Thesaurus ObjectClass)
C0013227 (UMLS 2011AA ObjectClass)
C25409 (NCI Thesaurus Property)
C1533734 (UMLS 2011AA Property)
C264 (NCI Thesaurus ObjectClass-2)
C0003286 (UMLS 2011AA ObjectClass-2)
CL.15
Code List
Is the person receiving anti-convulsant medication?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Is this anti-convulsant medication enzyme-inducing?
text
C459 (NCI Thesaurus ObjectClass)
C0013227 (UMLS 2011AA ObjectClass)
C264 (NCI Thesaurus ObjectClass-2)
C0003286 (UMLS 2011AA ObjectClass-2)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C16554 (NCI Thesaurus Property-2)
C0014442 (UMLS 2011AA Property-2)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
CL.16
Code List
Is this anti-convulsant medication enzyme-inducing?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Is the patient receiving corticosteroids?
text
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C25629 (NCI Thesaurus Property)
C0332152 (UMLS 2011AA Property)
C2322 (NCI Thesaurus ObjectClass)
C0001617 (UMLS 2011AA ObjectClass)
C25382 (NCI Thesaurus Property-2)
C1521801 (UMLS 2011AA Property-2)
CL.17
Code List
Is the patient receiving corticosteroids?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Agent Total Dose
Item
Agent Total Dose (per day)
float
C25304 (NCI Thesaurus ValueDomain)
C2986497 (UMLS CUI-1)
C25379 (NCI Thesaurus Property)
C25488 (NCI Thesaurus ValueDomain-2)
C1708 (NCI Thesaurus ObjectClass)
Item
Is the patient receiving other medications?
text
C17649 (NCI Thesaurus ObjectClass)
C0205394 (UMLS 2011AA ObjectClass)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C459 (NCI Thesaurus ObjectClass-2)
C0013227 (UMLS 2011AA ObjectClass-2)
C25409 (NCI Thesaurus Property)
C1533734 (UMLS 2011AA Property)
CL.18
Code List
Is the patient receiving other medications?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Agent
Item
Agent Name (If Yes,)
text
C25364 (NCI Thesaurus Property)
C1521826 (UMLS CUI-1)
C1708 (NCI Thesaurus ObjectClass)
C1708 (NCI Thesaurus ValueDomain)
C42614 (NCI Thesaurus ValueDomain-2)
Agent
Item
Agent Name (If Yes,)
text
C25364 (NCI Thesaurus Property)
C1521826 (UMLS CUI-1)
C1708 (NCI Thesaurus ObjectClass)
C1708 (NCI Thesaurus ValueDomain)
C42614 (NCI Thesaurus ValueDomain-2)
Agent
Item
Agent Name (If Yes,)
text
C25364 (NCI Thesaurus Property)
C1521826 (UMLS CUI-1)
C1708 (NCI Thesaurus ObjectClass)
C1708 (NCI Thesaurus ValueDomain)
C42614 (NCI Thesaurus ValueDomain-2)
Medication Start Date
Item
Agent Start Date (MM DD YYYY)
date
C25164 (NCI Thesaurus ValueDomain)
C1521826 (UMLS CUI-1)
C25431 (NCI Thesaurus ValueDomain-2)
C0808070 (UMLS CUI-2)
C1708 (NCI Thesaurus ObjectClass)
C25275 (NCI Thesaurus Property)
Medication Start Date
Item
Agent Start Date (MM DD YYYY)
date
C25164 (NCI Thesaurus ValueDomain)
C1521826 (UMLS CUI-1)
C25431 (NCI Thesaurus ValueDomain-2)
C0808070 (UMLS CUI-2)
C1708 (NCI Thesaurus ObjectClass)
C25275 (NCI Thesaurus Property)
Medication Start Date
Item
Agent Start Date (MM DD YYYY)
date
C25164 (NCI Thesaurus ValueDomain)
C1521826 (UMLS CUI-1)
C25431 (NCI Thesaurus ValueDomain-2)
C0808070 (UMLS CUI-2)
C1708 (NCI Thesaurus ObjectClass)
C25275 (NCI Thesaurus Property)
Item Group
Brain: Prior Surgical Treatment For Primary Site
PrimarySurgeryDate
Item
Primary Surgery Date (MM DD YYYY)
date
C25251 (NCI Thesaurus ObjectClass)
C0205225 (UMLS 2011AA ObjectClass)
C15329 (NCI Thesaurus ObjectClass-2)
C0543467 (UMLS 2011AA ObjectClass-2)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
Item
Extent of Resection (at primary site)
text
C12439 (NCI Thesaurus ObjectClass)
C0006104 (UMLS 2011AA ObjectClass)
C9305 (NCI Thesaurus ObjectClass-2)
C0006826 (UMLS 2011AA ObjectClass-2)
C25698 (NCI Thesaurus Property)
C15232 (NCI Thesaurus Property-2)
C0728940 (UMLS 2011AA Property)
C25332 (NCI Thesaurus Property-3)
C0439792 (UMLS 2011AA Property-2)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.19
Code List
Extent of Resection (at primary site)
CL Item
Biopsy (Biopsy)
C15189 (NCI Thesaurus)
C0005558 (UMLS 2011AA)
CL Item
Subtotal (Subtotal)
CL Item
Total (gross) (Total (gross))
Item
Enhancing residual disease?
text
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C37895 (NCI Thesaurus ObjectClass-2)
C1609982 (UMLS 2011AA ObjectClass-2)
C25246 (NCI Thesaurus Property)
C1446409 (UMLS 2011AA Property)
C390 (NCI Thesaurus Property-2)
C0009924 (UMLS 2011AA Property-2)
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
CL.20
Code List
Enhancing residual disease?
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Indeterminate (Indeterminate)
C48658 (NCI Thesaurus)
C0205258 (UMLS 2011AA)
Item
Non-enhancing residual disease?
text
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C37895 (NCI Thesaurus ObjectClass-2)
C1609982 (UMLS 2011AA ObjectClass-2)
C25247 (NCI Thesaurus Property)
C0205160 (UMLS 2011AA Property)
C390 (NCI Thesaurus Property-2)
C0009924 (UMLS 2011AA Property-2)
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
CL.21
Code List
Non-enhancing residual disease?
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Indeterminate (Indeterminate)
C48658 (NCI Thesaurus)
C0205258 (UMLS 2011AA)
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