ID
7351
Beschrijving
CALGB 90802 On-Study Form Everolimus With or Without Bevacizumab in Treating Patients With Advanced Kidney Cancer That Progressed After First-Line Therapy Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=88715713-3A23-2D6C-E040-BB89AD433D3B
Link
Trefwoorden
Versies (2)
- 19-09-12 19-09-12 -
- 09-01-15 09-01-15 - Martin Dugas
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9 januari 2015
DOI
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Licentie
Creative Commons BY-NC 3.0 Legacy
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Kidney Cancer NCT01198158 On-Study - CALGB 90802 On-Study Form - 3107346v1.0
INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy complete the form electronically. After entering all data, click the "Print and/or Submit to CALGB" button located at the bottom of the last page of the form. Retain a copy of the form for your records. Submit supporting documentation by fax (919-416-4990) or mail. If data are amended, circle amended items, check the "Yes" box, and submit by fax or mail
Beschrijving
Patient Description
Beschrijving
Primary Site MedDRA Code
Datatype
float
Alias
- NCI Thesaurus ObjectClass
- C41331
- UMLS CUI-1
- C0449695
- NCI Thesaurus ObjectClass-2
- C71886
- UMLS CUI-2
- C1552878
- NCI Thesaurus Property
- C25162
- NCI Thesaurus Property-2
- C43820
- NCI Thesaurus ValueDomain
- C25162
- NCI Thesaurus ValueDomain-2
- C41331
- NCI Thesaurus ValueDomain-3
- C45255
- NCI Thesaurus ValueDomain-4
- C43820
- NCI Thesaurus ValueDomain-5
- C25714
Beschrijving
NewCancerDiagnosisDate
Datatype
date
Alias
- NCI Thesaurus ObjectClass
- C25586
- UMLS 2011AA ObjectClass
- C0205314
- NCI Thesaurus ObjectClass-2
- C9305
- UMLS 2011AA ObjectClass-2
- C0006826
- NCI Thesaurus Property
- C15220
- UMLS 2011AA Property
- C0011900
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ValueDomain-2
- C25367
Beschrijving
KarnofskyPerformanceStatusScore
Datatype
text
Alias
- NCI Thesaurus Property
- C25367
- NCI Thesaurus ObjectClass
- C20641
- UMLS 2011AA ObjectClass
- C1518965
- NCI Thesaurus ValueDomain
- C25338
- UMLS 2011AA ValueDomain
- C0449820
Beschrijving
PriorCancerDiagnosisInd-3
Datatype
boolean
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
- NCI Thesaurus ObjectClass
- C9305
- UMLS 2011AA ObjectClass
- C0006826
- NCI Thesaurus ObjectClass-2
- C25629
- UMLS 2011AA ObjectClass-2
- C0332152
- NCI Thesaurus Property
- C15220
- UMLS 2011AA Property
- C0011900
Beschrijving
PriorMalignantNeoplasmSpecify
Datatype
text
Alias
- NCI Thesaurus ObjectClass
- C3262
- UMLS 2011AA ObjectClass
- C0027651
- NCI Thesaurus ObjectClass-2
- C25629
- UMLS 2011AA ObjectClass-2
- C0332152
- NCI Thesaurus ObjectClass-3
- C14143
- UMLS 2011AA ObjectClass-3
- C0205282
- NCI Metathesaurus Property
- CL111053
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
Beschrijving
PriorCancerDiagnosisYearDate
Datatype
date
Alias
- NCI Thesaurus ObjectClass
- C9305
- UMLS 2011AA ObjectClass
- C0006826
- NCI Thesaurus ObjectClass-2
- C25629
- UMLS 2011AA ObjectClass-2
- C0332152
- NCI Thesaurus Property
- C15220
- UMLS 2011AA Property
- C0011900
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ValueDomain-2
- C29848
- UMLS 2011AA ValueDomain-2
- C0439234
Beschrijving
RenalNeoplasmHistologicGradeClinicalTrialsEligibilityCriteriaType
Datatype
text
Alias
- NCI Thesaurus ObjectClass
- C3262
- UMLS 2011AA ObjectClass
- C0027651
- NCI Thesaurus ObjectClass-2
- C25225
- UMLS 2011AA ObjectClass-2
- C0022646
- NCI Thesaurus Property
- C18000
- UMLS 2011AA Property
- C0919553
- NCI Metathesaurus Property
- CL008804
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
Beschrijving
RenalCellCarcinomaHistologicSubtypeClassificationSpecify
Datatype
text
Alias
- NCI Thesaurus ObjectClass
- C9385
- UMLS 2011AA ObjectClass
- C0007134
- NCI Thesaurus Property
- C25526
- UMLS 2011AA Property
- C0205462
- NCI Thesaurus Property-2
- C25161
- UMLS 2011AA Property-2
- C0008902
- NCI Thesaurus Property-3
- C25696
- UMLS 2011AA Property-3
- C0449560
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
Beschrijving
RenalCellCarcinomaEasternCooperativeOncologyGroupRiskFactorStageGroupingType
Datatype
text
Alias
- NCI Thesaurus ObjectClass
- C9385
- UMLS 2011AA ObjectClass
- C0007134
- NCI Thesaurus Property
- C25491
- UMLS 2011AA Property
- C1512162
- NCI Thesaurus Property-2
- C38027
- UMLS 2011AA Property-2
- C1519504
- NCI Thesaurus Property-3
- C17103
- UMLS 2011AA Property-3
- C0035648
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
Beschrijving
DiseaseAssessmentTNMClassificationText
Datatype
text
Alias
- NCI Thesaurus ObjectClass
- C20989
- UMLS 2011AA ObjectClass
- C0031809
- NCI Thesaurus ObjectClass-2
- C2991
- UMLS 2011AA ObjectClass-2
- C0012634
- NCI Thesaurus Property
- C25161
- UMLS 2011AA Property
- C0008902
- NCI Thesaurus Property-2
- C25384
- UMLS 2011AA Property-2
- C1515169
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
Beschrijving
Sites Of Disease
Beschrijving
DiseaseSite
Datatype
text
Alias
- NCI Thesaurus ValueDomain
- C13717
- UMLS 2011AA ValueDomain
- C1515974
- NCI Thesaurus Property
- C25341
- UMLS 2011AA Property
- C0450429
- NCI Thesaurus ObjectClass
- C2991
- UMLS 2011AA ObjectClass
- C0012634
Beschrijving
DiseaseInvolvementSiteOtherSpecify
Datatype
text
Alias
- NCI Thesaurus ObjectClass
- C2991
- UMLS 2011AA ObjectClass
- C0012634
- NCI Thesaurus Property
- C25341
- UMLS 2011AA Property
- C0450429
- NCI Thesaurus Property-2
- C25547
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
- NCI Thesaurus ValueDomain-2
- C17649
- UMLS 2011AA ValueDomain-2
- C0205394
Beschrijving
RenalCellCarcinomaHistologicSubtypeClassificationCategory
Datatype
text
Alias
- NCI Thesaurus ObjectClass
- C9385
- UMLS 2011AA ObjectClass
- C0007134
- NCI Thesaurus Property
- C25526
- UMLS 2011AA Property
- C0205462
- NCI Thesaurus Property-2
- C25161
- UMLS 2011AA Property-2
- C0008902
- NCI Thesaurus Property-3
- C25696
- UMLS 2011AA Property-3
- C0449560
- NCI Thesaurus ValueDomain
- C25372
- UMLS 2011AA ValueDomain
- C0683312
Beschrijving
Baseline Lab Values (hematologic)
Beschrijving
Leukocytes (WBC)
Datatype
float
Alias
- NCI Thesaurus ObjectClass
- C25294
- UMLS CUI-1
- C0023508
- NCI Thesaurus Property
- C12529
- NCI Thesaurus Property-2
- C20200
- NCI Thesaurus ValueDomain
- C38046
- NCI Thesaurus ValueDomain-2
- C25712
Beschrijving
Neutrophil count
Datatype
float
Alias
- NCI Thesaurus ObjectClass
- C25294
- UMLS CUI-1
- C0200633
- NCI Thesaurus Property
- C12533
- NCI Thesaurus Property-2
- C20200
- NCI Thesaurus ValueDomain
- C25304
- NCI Thesaurus ValueDomain-2
- C25712
Beschrijving
Platelets
Datatype
float
Maateenheden
- 1000/uL
Alias
- NCI Thesaurus Property
- C20200
- UMLS CUI-1
- C0005821
- NCI Thesaurus Property-2
- C12520
- NCI Thesaurus ObjectClass
- C25294
- NCI Thesaurus ValueDomain
- C25712
Beschrijving
LaboratoryProcedureHemoglobinResultSpecifiedValue
Datatype
float
Maateenheden
- g/dL
Alias
- NCI Thesaurus Property
- C16676
- UMLS 2011AA Property
- C0019046
- NCI Thesaurus Property-2
- C20200
- UMLS 2011AA Property-2
- C1274040
- NCI Thesaurus ObjectClass
- C25294
- UMLS 2011AA ObjectClass
- C0022885
- NCI Thesaurus ValueDomain
- C25712
- UMLS 2011AA ValueDomain
- C1522609
Beschrijving
Creatinine, Serum
Datatype
float
Maateenheden
- mg/dL
Alias
- NCI Thesaurus Property
- C20200
- UMLS CUI-1
- C0201976
- NCI Thesaurus Property-2
- C399
- NCI Thesaurus ObjectClass
- C25294
- NCI Thesaurus ValueDomain
- C25712
Beschrijving
LaboratoryProcedureCreatinineClearanceOutcomeEstimateValue
Datatype
float
Alias
- NCI Thesaurus ObjectClass
- C25294
- UMLS 2011AA ObjectClass
- C0022885
- NCI Thesaurus Property
- C20200
- UMLS 2011AA Property
- C1274040
- NCI Thesaurus Property-2
- C25747
- UMLS 2011AA Property-2
- C0373595
- NCI Thesaurus ValueDomain
- C25498
- UMLS 2011AA ValueDomain
- C0750572
- NCI Thesaurus ValueDomain-2
- C25712
- UMLS 2011AA ValueDomain-2
- C1522609
Beschrijving
SGOT (AST)
Datatype
float
Alias
- NCI Thesaurus ObjectClass
- C25294
- UMLS CUI-1
- C0201899
- NCI Thesaurus Property
- C25202
- NCI Thesaurus Property-2
- C20200
- NCI Thesaurus ValueDomain
- C38046
- NCI Thesaurus ValueDomain-2
- C25712
Beschrijving
LaboratoryProcedureSerumGlutamicOxaloaceticTransferaseResultUnspecifiedUpperLimitofNormalValue
Datatype
float
Alias
- NCI Thesaurus ObjectClass
- C25294
- UMLS 2011AA ObjectClass
- C0022885
- NCI Thesaurus Property
- C25202
- UMLS 2011AA Property
- C0242192
- NCI Thesaurus Property-2
- C20200
- UMLS 2011AA Property-2
- C1274040
- NCI Thesaurus ValueDomain
- C25712
- UMLS 2011AA ValueDomain
- C1522609
- NCI Thesaurus ValueDomain-2
- C25706
- UMLS 2011AA ValueDomain-2
- C1519815
Beschrijving
SGPT (ALT)
Datatype
float
Alias
- NCI Thesaurus ObjectClass
- C25294
- UMLS CUI-1
- C0201836
- NCI Thesaurus Property
- C20200
- NCI Thesaurus Property-2
- C25293
- NCI Thesaurus ValueDomain
- C38046
- NCI Thesaurus ValueDomain-2
- C25712
Beschrijving
LaboratoryProcedureSerumGlutamicPyruvicTransaminaseResultUpperLimitofNormalValue
Datatype
float
Alias
- NCI Thesaurus ObjectClass
- C25294
- UMLS 2011AA ObjectClass
- C0022885
- NCI Thesaurus Property
- C20200
- UMLS 2011AA Property
- C1274040
- NCI Thesaurus Property-2
- C25293
- UMLS 2011AA Property-2
- C0376147
- NCI Thesaurus ValueDomain
- C25712
- UMLS 2011AA ValueDomain
- C1522609
- NCI Thesaurus ValueDomain-2
- C25706
- UMLS 2011AA ValueDomain-2
- C1519815
Beschrijving
Bilirubin, Total
Datatype
float
Alias
- NCI Thesaurus ObjectClass
- C25294
- UMLS CUI-1
- C0201913
- NCI Thesaurus Property
- C20200
- NCI Thesaurus Property-2
- C38037
- NCI Thesaurus ValueDomain
- C38046
- NCI Thesaurus ValueDomain-2
- C25712
Beschrijving
Bilirubin, Total ULN
Datatype
float
Alias
- NCI Thesaurus ObjectClass
- C25294
- UMLS CUI-1
- C0201913
- NCI Thesaurus Property
- C20200
- UMLS CUI-2
- C1519815
- NCI Thesaurus Property-2
- C38037
- NCI Thesaurus ValueDomain
- C25712
- NCI Thesaurus ValueDomain-2
- C25706
Beschrijving
LaboratoryProcedureFastingPlasmaGlucoseMeasurementOutcomeValue
Datatype
float
Maateenheden
- mg/dL
Alias
- NCI Thesaurus ObjectClass
- C25294
- UMLS 2011AA ObjectClass
- C0022885
- NCI Thesaurus Property
- C20200
- UMLS 2011AA Property
- C1274040
- NCI Thesaurus Property-2
- C41376
- UMLS 2011AA Property-2
- C0202042
- NCI Thesaurus Property-3
- C63663
- UMLS 2011AA Property-3
- C0015663
- NCI Thesaurus ValueDomain
- C25712
- UMLS 2011AA ValueDomain
- C1522609
Beschrijving
HematologySerumTotalCholesterolLaboratoryResultValueinmg/dL
Datatype
float
Maateenheden
- mg/dL
Alias
- NCI Thesaurus ObjectClass
- C16673
- UMLS 2011AA ObjectClass
- C0018943
- NCI Thesaurus Property
- C25304
- UMLS 2011AA Property
- C0439810
- NCI Thesaurus Property-2
- C13325
- UMLS 2011AA Property-2
- C0229671
- NCI Thesaurus Property-3
- C25294
- UMLS 2011AA Property-3
- C0022885
- NCI Thesaurus Property-4
- C369
- UMLS 2011AA Property-4
- C0008377
- NCI Thesaurus ValueDomain
- C28253
- UMLS 2011AA ValueDomain
- C0439210
- NCI Thesaurus ValueDomain-2
- C20200
- UMLS 2011AA ValueDomain-2
- C1274040
- NCI Thesaurus ValueDomain-3
- C37984
- UMLS 2011AA ValueDomain-3
- C0022877
- NCI Thesaurus ValueDomain-4
- C25712
- UMLS 2011AA ValueDomain-4
- C1522609
Beschrijving
HematologySerumTriglyceridesLaboratoryResultValueinmg/dL
Datatype
float
Maateenheden
- mg/dL
Alias
- NCI Thesaurus ObjectClass
- C16673
- UMLS 2011AA ObjectClass
- C0018943
- NCI Thesaurus Property
- C13325
- UMLS 2011AA Property
- C0229671
- NCI Thesaurus Property-2
- C25294
- UMLS 2011AA Property-2
- C0022885
- NCI Thesaurus Property-3
- C906
- UMLS 2011AA Property-3
- C0041004
- NCI Thesaurus ValueDomain
- C28253
- UMLS 2011AA ValueDomain
- C0439210
- NCI Thesaurus ValueDomain-2
- C20200
- UMLS 2011AA ValueDomain-2
- C1274040
- NCI Thesaurus ValueDomain-3
- C37984
- UMLS 2011AA ValueDomain-3
- C0022877
- NCI Thesaurus ValueDomain-4
- C25712
- UMLS 2011AA ValueDomain-4
- C1522609
Beschrijving
LaboratoryProcedureCorrectedSerumCalciumMeasurementOutcomeValue
Datatype
float
Maateenheden
- mg/dL
Alias
- NCI Thesaurus Property
- C20200
- UMLS 2011AA Property
- C1274040
- NCI Thesaurus ObjectClass
- C25294
- UMLS 2011AA ObjectClass
- C0022885
- NCI Thesaurus ValueDomain
- C25712
- UMLS 2011AA ValueDomain
- C1522609
- NCI Thesaurus Property-2
- C74950
- UMLS 2011AA Property-2
- C0455288
Beschrijving
LaboratoryProcedureLactateDehydrogenaseResultUnspecifiedValue
Datatype
float
Alias
- NCI Thesaurus ObjectClass
- C25294
- UMLS 2011AA ObjectClass
- C0022885
- NCI Thesaurus Property
- C20200
- UMLS 2011AA Property
- C1274040
- NCI Thesaurus Property-2
- C25184
- UMLS 2011AA Property-2
- C0022917
- NCI Thesaurus ValueDomain
- C38046
- UMLS 2011AA ValueDomain
- C0205370
- NCI Thesaurus ValueDomain-2
- C25712
- UMLS 2011AA ValueDomain-2
- C1522609
Beschrijving
Urinalysis
Beschrijving
UrinalysisProteinLevelAmount
Datatype
text
Alias
- NCI Thesaurus ObjectClass
- C17241
- UMLS 2011AA ObjectClass
- C0042014
- NCI Thesaurus Property
- C17021
- UMLS 2011AA Property
- C0033684
- NCI Thesaurus ValueDomain
- C25417
- NCI Thesaurus Property-2
- C25554
- UMLS 2011AA Property-2
- C0441889
Beschrijving
UrinaryProteinCollectionValue
Datatype
float
Maateenheden
- g/24 hours
Alias
- NCI Thesaurus Property
- C25453
- UMLS 2011AA Property
- C1516698
- NCI Thesaurus ValueDomain
- C25712
- UMLS 2011AA ValueDomain
- C1522609
- NCI Thesaurus ObjectClass
- C17021
- UMLS 2011AA ObjectClass
- C0033684
Beschrijving
UrinaryCreatinineProteinAssessmentValue
Datatype
float
Alias
- NCI Thesaurus ObjectClass
- C25711
- UMLS 2011AA ObjectClass
- C1524119
- NCI Thesaurus ObjectClass-2
- C17021
- UMLS 2011AA ObjectClass-2
- C0033684
- NCI Metathesaurus ObjectClass
- C0010294
- NCI Thesaurus Property
- C25367
- NCI Thesaurus ValueDomain
- C25712
- UMLS 2011AA ValueDomain
- C1522609
Beschrijving
MagneticResonanceImagingSubmissionPatientAncillaryStudyTwoEligibilityDeterminationType
Datatype
text
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus ObjectClass-2
- C16809
- UMLS 2011AA ObjectClass-2
- C0024485
- NCI Thesaurus ObjectClass-3
- C25695
- UMLS 2011AA ObjectClass-3
- C1515023
- NCI Thesaurus Property
- C66833
- UMLS 2011AA Property
- C0205448
- NCI Thesaurus Property-2
- C25171
- UMLS 2011AA Property-2
- C0013893
- NCI Thesaurus Property-3
- C16041
- UMLS 2011AA Property-3
- C1515980
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
Beschrijving
Prior Treatment
Beschrijving
CancerPriorTreatmentInd-3
Datatype
boolean
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
- NCI Thesaurus ObjectClass
- C9305
- UMLS 2011AA ObjectClass
- C0006826
- NCI Thesaurus Property
- C25629
- UMLS 2011AA Property
- C0332152
- NCI Thesaurus Property-2
- C15368
Beschrijving
Non-ProtocolTherapyAdministeredType
Datatype
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus ObjectClass-2
- C25590
- UMLS 2011AA ObjectClass
- C1518384
- NCI Thesaurus Property
- C25382
- UMLS 2011AA Property
- C1521801
Beschrijving
Non-ProtocolEpidermalGrowthFactorReceptorTyrosineKinaseInhibitorAdministeredSpecify
Datatype
text
Alias
- NCI Thesaurus ObjectClass
- C25590
- UMLS 2011AA ObjectClass
- C1518384
- NCI Thesaurus ObjectClass-2
- C2167
- UMLS 2011AA ObjectClass-2
- C1443775
- NCI Thesaurus Property
- C25382
- UMLS 2011AA Property
- C1521801
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
- NCI Thesaurus ValueDomain-2
- C25382
- UMLS 2011AA ValueDomain-2
- C1521801
Beschrijving
PriorEpidermalGrowthFactorReceptorTherapyPerformedSpecify
Datatype
text
Alias
- NCI Thesaurus ObjectClass
- C25629
- UMLS 2011AA ObjectClass
- C0332152
- NCI Thesaurus ObjectClass-2
- C15368
- NCI Thesaurus ObjectClass-3
- C17068
- UMLS 2011AA ObjectClass-2
- C0034802
- NCI Thesaurus Property
- C38000
- UMLS 2011AA Property
- C0884358
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
- NCI Thesaurus ValueDomain-2
- C25382
- UMLS 2011AA ValueDomain-2
- C1521801
Beschrijving
Non-ProtocolTherapyAdministeredSpecify
Datatype
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus ObjectClass-2
- C25590
- UMLS 2011AA ObjectClass
- C1518384
- NCI Thesaurus Property
- C25382
- UMLS 2011AA Property
- C1521801
Beschrijving
Non-ProtocolSurgeryAdministeredSpecify
Datatype
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
- NCI Thesaurus ObjectClass
- C15329
- UMLS 2011AA ObjectClass
- C0543467
- NCI Thesaurus ObjectClass-2
- C25590
- UMLS 2011AA ObjectClass-2
- C1518384
- NCI Thesaurus Property
- C25382
- UMLS 2011AA Property
- C1521801
Beschrijving
Non-ProtocolSystemicChemotherapyAdministeredSpecify
Datatype
text
Alias
- NCI Thesaurus ObjectClass
- C15632
- UMLS 2011AA ObjectClass
- C0392920
- NCI Thesaurus ObjectClass-2
- C13310
- UMLS 2011AA ObjectClass-2
- C0205373
- NCI Thesaurus ObjectClass-3
- C25590
- UMLS 2011AA ObjectClass-3
- C1518384
- NCI Thesaurus Property
- C25382
- UMLS 2011AA Property
- C1521801
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
Beschrijving
Non-ProtocolRadiationTherapyAdministeredSpecify
Datatype
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
- NCI Thesaurus ObjectClass
- C15313
- UMLS 2011AA ObjectClass
- C1522449
- NCI Thesaurus ObjectClass-2
- C25590
- UMLS 2011AA ObjectClass-2
- C1518384
- NCI Thesaurus Property
- C25382
- UMLS 2011AA Property
- C1521801
Beschrijving
Non-ProtocolTherapyOtherAdministeredSpecify
Datatype
text
Alias
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus ObjectClass-2
- C25590
- UMLS 2011AA ObjectClass
- C1518384
- NCI Thesaurus Property
- C17649
- UMLS 2011AA Property
- C0205394
- NCI Thesaurus Property-2
- C25382
- UMLS 2011AA Property-2
- C1521801
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
Beschrijving
PriorTreatmentRegimenBeginDate
Datatype
date
Alias
- NCI Thesaurus ObjectClass
- C25629
- UMLS 2011AA ObjectClass
- C0332152
- NCI Thesaurus ObjectClass-2
- C15368
- NCI Thesaurus Property
- C15697
- UMLS 2011AA Property
- C0040808
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ValueDomain-2
- C25431
- UMLS 2011AA ValueDomain-2
- C0439659
Beschrijving
PriorTreatmentRegimenEndDate
Datatype
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ObjectClass
- C25629
- UMLS 2011AA ObjectClass
- C0332152
- NCI Thesaurus ObjectClass-2
- C15368
- NCI Thesaurus Property
- C15697
- UMLS 2011AA Property
- C0040808
Beschrijving
Footer
Beschrijving
Person Completing Form
Datatype
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS CUI-1
- C1550483
- NCI Thesaurus ObjectClass
- C25657
- NCI Thesaurus Property
- C25364
Beschrijving
Date Form Completed
Datatype
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C1115437
- NCI Thesaurus ObjectClass
- C40988
- NCI Thesaurus Property
- C25250
- NCI Thesaurus ValueDomain-2
- C25367
Similar models
INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy complete the form electronically. After entering all data, click the "Print and/or Submit to CALGB" button located at the bottom of the last page of the form. Retain a copy of the form for your records. Submit supporting documentation by fax (919-416-4990) or mail. If data are amended, circle amended items, check the "Yes" box, and submit by fax or mail
C3262252 (UMLS CUI-1)
C19464 (NCI Thesaurus ObjectClass)
C1516238 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25442 (NCI Thesaurus ObjectClass-2)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1516238 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25442 (NCI Thesaurus Property-2)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1516238 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25442 (NCI Thesaurus Property-2)
C0680532 (UMLS CUI-1)
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
C1301894 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25261 (NCI Thesaurus Property)
C25198 (NCI Thesaurus Property-2)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
C25191 (NCI Thesaurus ValueDomain)
C21541 (NCI Thesaurus ValueDomain-2)
C2347449 (UMLS CUI-1)
C25608 (NCI Thesaurus ObjectClass)
C17005 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
C0449695 (UMLS CUI-1)
C71886 (NCI Thesaurus ObjectClass-2)
C1552878 (UMLS CUI-2)
C25162 (NCI Thesaurus Property)
C43820 (NCI Thesaurus Property-2)
C25162 (NCI Thesaurus ValueDomain)
C41331 (NCI Thesaurus ValueDomain-2)
C45255 (NCI Thesaurus ValueDomain-3)
C43820 (NCI Thesaurus ValueDomain-4)
C25714 (NCI Thesaurus ValueDomain-5)
C0205314 (UMLS 2011AA ObjectClass)
C9305 (NCI Thesaurus ObjectClass-2)
C0006826 (UMLS 2011AA ObjectClass-2)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
C20641 (NCI Thesaurus ObjectClass)
C1518965 (UMLS 2011AA ObjectClass)
C25338 (NCI Thesaurus ValueDomain)
C0449820 (UMLS 2011AA ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus ObjectClass-2)
C0332152 (UMLS 2011AA ObjectClass-2)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
C0027651 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus ObjectClass-2)
C0332152 (UMLS 2011AA ObjectClass-2)
C14143 (NCI Thesaurus ObjectClass-3)
C0205282 (UMLS 2011AA ObjectClass-3)
CL111053 (NCI Metathesaurus Property)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C0006826 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus ObjectClass-2)
C0332152 (UMLS 2011AA ObjectClass-2)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C29848 (NCI Thesaurus ValueDomain-2)
C0439234 (UMLS 2011AA ValueDomain-2)
C0027651 (UMLS 2011AA ObjectClass)
C25225 (NCI Thesaurus ObjectClass-2)
C0022646 (UMLS 2011AA ObjectClass-2)
C18000 (NCI Thesaurus Property)
C0919553 (UMLS 2011AA Property)
CL008804 (NCI Metathesaurus Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C0205394 (UMLS 2011AA)
C0007134 (UMLS 2011AA ObjectClass)
C25526 (NCI Thesaurus Property)
C0205462 (UMLS 2011AA Property)
C25161 (NCI Thesaurus Property-2)
C0008902 (UMLS 2011AA Property-2)
C25696 (NCI Thesaurus Property-3)
C0449560 (UMLS 2011AA Property-3)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C0007134 (UMLS 2011AA ObjectClass)
C25491 (NCI Thesaurus Property)
C1512162 (UMLS 2011AA Property)
C38027 (NCI Thesaurus Property-2)
C1519504 (UMLS 2011AA Property-2)
C17103 (NCI Thesaurus Property-3)
C0035648 (UMLS 2011AA Property-3)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C0205394 (UMLS 2011AA)
C0031809 (UMLS 2011AA ObjectClass)
C2991 (NCI Thesaurus ObjectClass-2)
C0012634 (UMLS 2011AA ObjectClass-2)
C25161 (NCI Thesaurus Property)
C0008902 (UMLS 2011AA Property)
C25384 (NCI Thesaurus Property-2)
C1515169 (UMLS 2011AA Property-2)
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C1515974 (UMLS 2011AA ValueDomain)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C0001625 (UMLS 2011AA)
C0023884 (UMLS 2011AA)
C0024109 (UMLS 2011AA)
C0006104 (UMLS 2011AA)
C0262950 (UMLS 2011AA)
C0205394 (UMLS 2011AA)
C0012634 (UMLS 2011AA ObjectClass)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C25547 (NCI Thesaurus Property-2)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C17649 (NCI Thesaurus ValueDomain-2)
C0205394 (UMLS 2011AA ValueDomain-2)
C0007134 (UMLS 2011AA ObjectClass)
C25526 (NCI Thesaurus Property)
C0205462 (UMLS 2011AA Property)
C25161 (NCI Thesaurus Property-2)
C0008902 (UMLS 2011AA Property-2)
C25696 (NCI Thesaurus Property-3)
C0449560 (UMLS 2011AA Property-3)
C25372 (NCI Thesaurus ValueDomain)
C0683312 (UMLS 2011AA ValueDomain)
C0205312 (UMLS 2011AA)
C0205426 (UMLS 2011AA)
C0023508 (UMLS CUI-1)
C12529 (NCI Thesaurus Property)
C20200 (NCI Thesaurus Property-2)
C38046 (NCI Thesaurus ValueDomain)
C25712 (NCI Thesaurus ValueDomain-2)
C0200633 (UMLS CUI-1)
C12533 (NCI Thesaurus Property)
C20200 (NCI Thesaurus Property-2)
C25304 (NCI Thesaurus ValueDomain)
C25712 (NCI Thesaurus ValueDomain-2)
C0005821 (UMLS CUI-1)
C12520 (NCI Thesaurus Property-2)
C25294 (NCI Thesaurus ObjectClass)
C25712 (NCI Thesaurus ValueDomain)
C0019046 (UMLS 2011AA Property)
C20200 (NCI Thesaurus Property-2)
C1274040 (UMLS 2011AA Property-2)
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C0201976 (UMLS CUI-1)
C399 (NCI Thesaurus Property-2)
C25294 (NCI Thesaurus ObjectClass)
C25712 (NCI Thesaurus ValueDomain)
C0022885 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C25747 (NCI Thesaurus Property-2)
C0373595 (UMLS 2011AA Property-2)
C25498 (NCI Thesaurus ValueDomain)
C0750572 (UMLS 2011AA ValueDomain)
C25712 (NCI Thesaurus ValueDomain-2)
C1522609 (UMLS 2011AA ValueDomain-2)
C0201899 (UMLS CUI-1)
C25202 (NCI Thesaurus Property)
C20200 (NCI Thesaurus Property-2)
C38046 (NCI Thesaurus ValueDomain)
C25712 (NCI Thesaurus ValueDomain-2)
C0022885 (UMLS 2011AA ObjectClass)
C25202 (NCI Thesaurus Property)
C0242192 (UMLS 2011AA Property)
C20200 (NCI Thesaurus Property-2)
C1274040 (UMLS 2011AA Property-2)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C25706 (NCI Thesaurus ValueDomain-2)
C1519815 (UMLS 2011AA ValueDomain-2)
C0201836 (UMLS CUI-1)
C20200 (NCI Thesaurus Property)
C25293 (NCI Thesaurus Property-2)
C38046 (NCI Thesaurus ValueDomain)
C25712 (NCI Thesaurus ValueDomain-2)
C0022885 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C25293 (NCI Thesaurus Property-2)
C0376147 (UMLS 2011AA Property-2)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C25706 (NCI Thesaurus ValueDomain-2)
C1519815 (UMLS 2011AA ValueDomain-2)
C0201913 (UMLS CUI-1)
C20200 (NCI Thesaurus Property)
C38037 (NCI Thesaurus Property-2)
C38046 (NCI Thesaurus ValueDomain)
C25712 (NCI Thesaurus ValueDomain-2)
C0201913 (UMLS CUI-1)
C20200 (NCI Thesaurus Property)
C1519815 (UMLS CUI-2)
C38037 (NCI Thesaurus Property-2)
C25712 (NCI Thesaurus ValueDomain)
C25706 (NCI Thesaurus ValueDomain-2)
C0022885 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C41376 (NCI Thesaurus Property-2)
C0202042 (UMLS 2011AA Property-2)
C63663 (NCI Thesaurus Property-3)
C0015663 (UMLS 2011AA Property-3)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C0018943 (UMLS 2011AA ObjectClass)
C25304 (NCI Thesaurus Property)
C0439810 (UMLS 2011AA Property)
C13325 (NCI Thesaurus Property-2)
C0229671 (UMLS 2011AA Property-2)
C25294 (NCI Thesaurus Property-3)
C0022885 (UMLS 2011AA Property-3)
C369 (NCI Thesaurus Property-4)
C0008377 (UMLS 2011AA Property-4)
C28253 (NCI Thesaurus ValueDomain)
C0439210 (UMLS 2011AA ValueDomain)
C20200 (NCI Thesaurus ValueDomain-2)
C1274040 (UMLS 2011AA ValueDomain-2)
C37984 (NCI Thesaurus ValueDomain-3)
C0022877 (UMLS 2011AA ValueDomain-3)
C25712 (NCI Thesaurus ValueDomain-4)
C1522609 (UMLS 2011AA ValueDomain-4)
C0018943 (UMLS 2011AA ObjectClass)
C13325 (NCI Thesaurus Property)
C0229671 (UMLS 2011AA Property)
C25294 (NCI Thesaurus Property-2)
C0022885 (UMLS 2011AA Property-2)
C906 (NCI Thesaurus Property-3)
C0041004 (UMLS 2011AA Property-3)
C28253 (NCI Thesaurus ValueDomain)
C0439210 (UMLS 2011AA ValueDomain)
C20200 (NCI Thesaurus ValueDomain-2)
C1274040 (UMLS 2011AA ValueDomain-2)
C37984 (NCI Thesaurus ValueDomain-3)
C0022877 (UMLS 2011AA ValueDomain-3)
C25712 (NCI Thesaurus ValueDomain-4)
C1522609 (UMLS 2011AA ValueDomain-4)
C1274040 (UMLS 2011AA Property)
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C74950 (NCI Thesaurus Property-2)
C0455288 (UMLS 2011AA Property-2)
C0022885 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C25184 (NCI Thesaurus Property-2)
C0022917 (UMLS 2011AA Property-2)
C38046 (NCI Thesaurus ValueDomain)
C0205370 (UMLS 2011AA ValueDomain)
C25712 (NCI Thesaurus ValueDomain-2)
C1522609 (UMLS 2011AA ValueDomain-2)
C0042014 (UMLS 2011AA ObjectClass)
C17021 (NCI Thesaurus Property)
C0033684 (UMLS 2011AA Property)
C25417 (NCI Thesaurus ValueDomain)
C25554 (NCI Thesaurus Property-2)
C0441889 (UMLS 2011AA Property-2)
C1516698 (UMLS 2011AA Property)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C17021 (NCI Thesaurus ObjectClass)
C0033684 (UMLS 2011AA ObjectClass)
C1524119 (UMLS 2011AA ObjectClass)
C17021 (NCI Thesaurus ObjectClass-2)
C0033684 (UMLS 2011AA ObjectClass-2)
C0010294 (NCI Metathesaurus ObjectClass)
C25367 (NCI Thesaurus Property)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C0030705 (UMLS 2011AA ObjectClass)
C16809 (NCI Thesaurus ObjectClass-2)
C0024485 (UMLS 2011AA ObjectClass-2)
C25695 (NCI Thesaurus ObjectClass-3)
C1515023 (UMLS 2011AA ObjectClass-3)
C66833 (NCI Thesaurus Property)
C0205448 (UMLS 2011AA Property)
C25171 (NCI Thesaurus Property-2)
C0013893 (UMLS 2011AA Property-2)
C16041 (NCI Thesaurus Property-3)
C1515980 (UMLS 2011AA Property-3)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus Property)
C0332152 (UMLS 2011AA Property)
C15368 (NCI Thesaurus Property-2)
C0332307 (UMLS 2011AA ValueDomain)
C15368 (NCI Thesaurus ObjectClass)
C25590 (NCI Thesaurus ObjectClass-2)
C1518384 (UMLS 2011AA ObjectClass)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C0733470 (UMLS 2011AA)
C0038894 (UMLS 2011AA)
C0392920 (UMLS 2011AA)
C1522449 (UMLS 2011AA)
C1518384 (UMLS 2011AA ObjectClass)
C2167 (NCI Thesaurus ObjectClass-2)
C1443775 (UMLS 2011AA ObjectClass-2)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C25382 (NCI Thesaurus ValueDomain-2)
C1521801 (UMLS 2011AA ValueDomain-2)
C0332152 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass-2)
C17068 (NCI Thesaurus ObjectClass-3)
C0034802 (UMLS 2011AA ObjectClass-2)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C25382 (NCI Thesaurus ValueDomain-2)
C1521801 (UMLS 2011AA ValueDomain-2)
C1521902 (UMLS 2011AA ValueDomain)
C15368 (NCI Thesaurus ObjectClass)
C25590 (NCI Thesaurus ObjectClass-2)
C1518384 (UMLS 2011AA ObjectClass)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C1521902 (UMLS 2011AA ValueDomain)
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C25590 (NCI Thesaurus ObjectClass-2)
C1518384 (UMLS 2011AA ObjectClass-2)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C0392920 (UMLS 2011AA ObjectClass)
C13310 (NCI Thesaurus ObjectClass-2)
C0205373 (UMLS 2011AA ObjectClass-2)
C25590 (NCI Thesaurus ObjectClass-3)
C1518384 (UMLS 2011AA ObjectClass-3)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C15313 (NCI Thesaurus ObjectClass)
C1522449 (UMLS 2011AA ObjectClass)
C25590 (NCI Thesaurus ObjectClass-2)
C1518384 (UMLS 2011AA ObjectClass-2)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C25590 (NCI Thesaurus ObjectClass-2)
C1518384 (UMLS 2011AA ObjectClass)
C17649 (NCI Thesaurus Property)
C0205394 (UMLS 2011AA Property)
C25382 (NCI Thesaurus Property-2)
C1521801 (UMLS 2011AA Property-2)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C0332152 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass-2)
C15697 (NCI Thesaurus Property)
C0040808 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25431 (NCI Thesaurus ValueDomain-2)
C0439659 (UMLS 2011AA ValueDomain-2)
C0011008 (UMLS 2011AA ValueDomain)
C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass-2)
C15697 (NCI Thesaurus Property)
C0040808 (UMLS 2011AA Property)
C1550483 (UMLS CUI-1)
C25657 (NCI Thesaurus ObjectClass)
C25364 (NCI Thesaurus Property)
C1115437 (UMLS CUI-1)
C40988 (NCI Thesaurus ObjectClass)
C25250 (NCI Thesaurus Property)
C25367 (NCI Thesaurus ValueDomain-2)