ID
736
Beschreibung
CALGB: QOL ASSESSMENT SUMARY FORM Comparison of Combination Chemotherapy Regimens in Treating Older Women Who Have Undergone Surgery for Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A50D1BCF-4910-2EA3-E034-080020C9C0E0
Link
Stichworte
Versionen (3)
- 26.08.12 26.08.12 -
- 08.07.15 08.07.15 -
- 08.07.15 08.07.15 -
Hochgeladen am
26. August 2012
DOI
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Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT00024102 Quality of Life - CALGB: QOL ASSESSMENT SUMARY FORM - 2037828v3.0
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 use black ink. Mark an X in the appropriate box for fields with a choice. Print text in capital letters. Avoid contact with the edges of the boxes. Circle amended items and check "Amended data" box to the right. If submitting by mail, retain a copy for your records and send the original to the CALGB Data Management Center. If faxing, use an original form for maximum clarity in transmission and fax to 919-416-4990. If submitting electronically, click the Send button when you have completed the PDF version of the form.
Beschreibung
Unnamed2
Beschreibung
Patient'sName
Datentyp
text
Beschreibung
ParticipatingGroup
Datentyp
text
Alias
- NCI Thesaurus ObjectClass
- C17005
- UMLS 2011AA ObjectClass
- C1257890
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
Beschreibung
PatientHospitalNumber
Datentyp
text
Beschreibung
ParticipatingGroupProtocolNo.
Datentyp
text
Beschreibung
MainMemberInstitution/Adjunct
Datentyp
text
Beschreibung
ParticipatingGroupPatientNo.
Datentyp
text
Beschreibung
Unnamed3
Beschreibung
Unnamed4
Beschreibung
Methodofassessment
Datentyp
text
Beschreibung
datequestionnairewassenttopatient
Datentyp
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Beschreibung
Numberofattemptsmadetocontactpatientbytelephoneand/ormail
Datentyp
double
Beschreibung
Languageinwhichassessmentwasconducted
Datentyp
text
Beschreibung
Other,specify(languageinwhichassessmentwasconducted)
Datentyp
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
Beschreibung
Qualityoflifeassessment
Datentyp
text
Alias
- NCI Thesaurus ObjectClass
- C17047
- UMLS 2011AA ObjectClass
- C0518214
- NCI Thesaurus Property
- C25217
- UMLS 2011AA Property
- C1516048
Beschreibung
numberofQOLinstrument(s)completed
Datentyp
double
Beschreibung
Iftheassessmentwaspartiallycompletedornotdone,indicatereason(s)below
Datentyp
text
Beschreibung
Other,specify(reasonassessmentwaspartiallycompletedornotdone)
Datentyp
text
Beschreibung
Ccrr Module For Calgb: Qol Assessment Sumary Form
Ähnliche Modelle
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 use black ink. Mark an X in the appropriate box for fields with a choice. Print text in capital letters. Avoid contact with the edges of the boxes. Circle amended items and check "Amended data" box to the right. If submitting by mail, retain a copy for your records and send the original to the CALGB Data Management Center. If faxing, use an original form for maximum clarity in transmission and fax to 919-416-4990. If submitting electronically, click the Send button when you have completed the PDF version of the form.
C1705108 (UMLS 2011AA)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C0011008 (UMLS 2011AA ValueDomain)
C1556083 (UMLS 2011AA)
C1527021 (UMLS 2011AA ValueDomain)
C0518214 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)