0 Avaliações
ID

730

Descrição

AMC-061 Off Protocol Treatment Summary Form (F05) Sunitinib Malate in Treating HIV-Positive Patients With Cancer Undergoing Highly Active Antiretroviral Therapy Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=71988CF7-F855-68F0-E040-BB89AD4358A1

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=71988CF7-F855-68F0-E040-BB89AD4358A1

Palavras-chave

Versões (2)
  1. 26/08/2012 26/08/2012 -
  2. 08/01/2015 08/01/2015 - Martin Dugas
Transferido a

26 de agosto de 2012

DOI

Para um pedido faça login.

Licença

Creative Commons BY-NC 3.0 Legacy
Comentários do modelo :

Aqui pode comentar o modelo. Pode comentá-lo especificamente através dos balões de texto nos grupos de itens e itens.

Voltar para os comentários do modelo
Comentários do grupo de itens para :

Comentários do item para :

  • Os mais recentes
  • Os mais antigos
  • Preferidos
  • Os mais recentes
    • Os mais recentes
    • Os mais antigos
    • Preferidos

    Sem comentários

    Para descarregar formulários, precisa de ter uma sessão iniciada. Por favor faça login ou registe-se gratuitamente.

    Brain and Central Nervous System Tumors NCT00890747 Off Treatment - AMC-061 Off Protocol Treatment Summary Form (F05) - 2934968v1.0

    Inglês

    Please submit this form if the subject has completed study treatment or discontinued study treatment prematurely. Note: Submission of this form DOES NOT mean the subject is necessarily off study. Please check the protocol for any post treatment follow-up requirements

    1 Formulários  
    Ccrr Module For Off Protocol Treatment Summary - Rf05b
    Descrição

    Ccrr Module For Off Protocol Treatment Summary - Rf05b

    Last Date (any modality of) protocol therapy was given (mm/dd/yyyy)
    Descrição

    TreatmentEndDate

    Tipo de dados

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164 (undefined)
    UMLS 2011AA ValueDomain
    C0011008 (Date in time)
    SNOMED
    410671006
    NCI Thesaurus ObjectClass
    C15368 (undefined)
    NCI Thesaurus Property
    C25275 (undefined)
    UMLS 2011AA Property
    C2745955 (Occurrence)
    SNOMED
    246454002
    NCI Thesaurus Property
    C25496 (undefined)
    UMLS 2011AA Property
    C2746065 (Stop (qualifier value))
    SNOMED
    422117008
    Reason Treatment Ended (select the primary reason)
    Descrição

    Off-treatmentReason

    Tipo de dados

    text

    Alias
    NCI Thesaurus ValueDomain
    C25638 (undefined)
    UMLS 2011AA ValueDomain
    C0392360 (Indication of (contextual qualifier))
    SNOMED
    230165009
    LOINC
    MTHU008319
    NCI Thesaurus ObjectClass
    C25601 (undefined)
    UMLS 2011AA ObjectClass
    C1518544 (Off Treatment)
    NCI Thesaurus Property
    C25365 (undefined)
    UMLS 2011AA Property
    C0678257 (Description)
    LOINC
    LP6800-9
    Other, specify
    Descrição

    Off-treatmentReasonSpecify

    Tipo de dados

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685 (undefined)
    UMLS 2011AA ValueDomain
    C1521902 (To specify)
    NCI Thesaurus ObjectClass
    C25601 (undefined)
    UMLS 2011AA ObjectClass
    C1518544 (Off Treatment)
    NCI Thesaurus Property
    C25365 (undefined)
    UMLS 2011AA Property
    C0678257 (Description)
    LOINC
    LP6800-9
    Comments
    Descrição

    ResearchCommentsText

    Tipo de dados

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704 (undefined)
    UMLS 2011AA ValueDomain
    C1527021 (Text)
    LOINC
    LP6885-0
    NCI Thesaurus ObjectClass
    C15319 (undefined)
    NCI Thesaurus Property
    C25393 (undefined)
    UMLS 2011AA Property
    C0282411 (Published Comment)
    LOINC
    MTHU018874
    Voltar ao início da página

    Similar models

    Please submit this form if the subject has completed study treatment or discontinued study treatment prematurely. Note: Submission of this form DOES NOT mean the subject is necessarily off study. Please check the protocol for any post treatment follow-up requirements

    1 Formulários
    Name
    Tipo
    Description | Question | Decode (Coded Value)
    Tipo de dados
    Alias
    Item Group
    Ccrr Module For Off Protocol Treatment Summary - Rf05b
    TreatmentEndDate
    Item
    Last Date (any modality of) protocol therapy was given (mm/dd/yyyy)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C15368 (NCI Thesaurus ObjectClass)
    C25275 (NCI Thesaurus Property)
    C2745955 (UMLS 2011AA Property)
    C25496 (NCI Thesaurus Property)
    C2746065 (UMLS 2011AA Property)
    Item
    Reason Treatment Ended (select the primary reason)
    text
    C25638 (NCI Thesaurus ValueDomain)
    C0392360 (UMLS 2011AA ValueDomain)
    C25601 (NCI Thesaurus ObjectClass)
    C1518544 (UMLS 2011AA ObjectClass)
    C25365 (NCI Thesaurus Property)
    C0678257 (UMLS 2011AA Property)
    CL.1
    Code List
    Reason Treatment Ended (select the primary reason)
    CL Item
    Treatment Completed Per Protocol Criteria (Treatment completed per protocol criteria)
    CL Item
    Disease Progression, Relapse During Active Treatment (Disease progression, relapse during active treatment)
    CL Item
    Adverse Event/side Effects/complications (Adverse Event/Side Effects/Complications)
    CL Item
    Death On Study (Death on study)
    CL Item
    Patient Withdrawal Or Refusal After Beginning Protocol Therapy (Patient withdrawal/refusal after beginning protocol therapy)
    CL Item
    Patient Withdrawal Or Refusal Before Beginning Protocol Therapy (Patient withdrawal/refusal prior to beginning protocol therapy)
    CL Item
    Alternative Therapy (Alternative therapy)
    CL Item
    Patient Off-treatment For Other Complicating Disease (Patient off-treatment for other complicating disease)
    CL Item
    Lost To Follow-up (Lost to follow-up)
    CL310949 (NCI Metathesaurus)
    CL Item
    Cytogenetic Resistance (Cytogenetic Resistance)
    CL Item
    Disease Progression Before Active Treatment (Disease Progression before active treatment)
    CL Item
    No Treatment, Per Protocol Criteria (No treatment, per protocol criteria)
    CL Item
    Other (Other)
    C17649 (NCI Thesaurus)
    C0205394 (UMLS 2011AA)
    Off-treatmentReasonSpecify
    Item
    Other, specify
    text
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    C25601 (NCI Thesaurus ObjectClass)
    C1518544 (UMLS 2011AA ObjectClass)
    C25365 (NCI Thesaurus Property)
    C0678257 (UMLS 2011AA Property)
    ResearchCommentsText
    Item
    Comments
    text
    C25704 (NCI Thesaurus ValueDomain)
    C1527021 (UMLS 2011AA ValueDomain)
    C15319 (NCI Thesaurus ObjectClass)
    C25393 (NCI Thesaurus Property)
    C0282411 (UMLS 2011AA Property)
    Voltar ao início da página 

    Ajuda

    Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

    Watch Tutorial