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7402

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NSABP Protocol R-04 Missing Data Form for Quality of Life Questionnaire Radiation Therapy and Either Capecitabine or Fluorouracil With or Without Oxaliplatin Before Surgery in Treating Patients With Resectable Rectal Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B7822FF2-369B-24FE-E034-0003BA12F5E7

Länk

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B7822FF2-369B-24FE-E034-0003BA12F5E7

Nyckelord

  1. 2012-08-27 2012-08-27 -
  2. 2015-01-09 2015-01-09 - Martin Dugas
Uppladdad den

9 januari 2015

DOI

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Licens

Creative Commons BY-NC 3.0 Legacy

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    Colorectal Cancer NCT00058474 Quality of Life - NSABP Protocol R-04 Missing Data Form for Quality of Life Questionnaire - 2082577v3.0

    Mark Circle Like This

    1. StudyEvent: NSABP Protocol R-04 Missing Data Form for Quality of Life Questionnaire
      1. Mark Circle Like This
    Ccrr Module For Nsabp Protocol R-04 Missing Data Form For Quality Of Life Questionnaire
    Beskrivning

    Ccrr Module For Nsabp Protocol R-04 Missing Data Form For Quality Of Life Questionnaire

    First Three Letters of Patients Last Name
    Beskrivning

    FirstThreeLettersofPatient'sLastName

    Datatyp

    text

    Patient Study ID 34
    Beskrivning

    Patient ID NSABP

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2348585
    NCI Thesaurus ObjectClass
    C16960
    UMLS CUI-2
    C1513905
    NCI Thesaurus Property
    C25364
    NCI Thesaurus Property-2
    C15818
    Institution Name / Affiliate Name
    Beskrivning

    Affiliate Name

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C21541
    UMLS CUI-1
    C1510825
    NCI Thesaurus ObjectClass-2
    C25413
    NCI Thesaurus Property
    C25364
    NCI Thesaurus ValueDomain
    C25191
    NCI Thesaurus ValueDomain-2
    C21541
    Person Completing Form
    Beskrivning

    Person Completing Form

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C1550483
    NCI Thesaurus ObjectClass
    C25657
    NCI Thesaurus Property
    C25364
    Last Name
    Beskrivning

    Person Completing Form Last Name

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C25190
    UMLS CUI-1
    C1550483
    NCI Thesaurus ObjectClass-2
    C25657
    UMLS CUI-2
    C1301584
    NCI Thesaurus Property
    C25364
    NCI Thesaurus Property-2
    C25551
    NCI Thesaurus ValueDomain
    C25191
    First Name
    Beskrivning

    Person Completing Form First Name

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C25190
    UMLS CUI-1
    C1550483
    NCI Thesaurus ObjectClass-2
    C25657
    UMLS CUI-2
    C1443235
    NCI Thesaurus Property
    C25364
    NCI Thesaurus Property-2
    C25509
    NCI Thesaurus ValueDomain
    C25191
    Are Data Amended?
    Beskrivning

    Data amended

    Datatyp

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS CUI-1
    C0680532
    NCI Thesaurus ObjectClass
    C25474
    NCI Thesaurus Property
    C25416
    Time Point for this Form (mark one)
    Beskrivning

    AbsentQualityofLifeAssessmentPeriodType

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C17047
    UMLS 2011AA ObjectClass
    C0518214
    NCI Thesaurus ObjectClass-2
    C20989
    UMLS 2011AA ObjectClass-2
    C0031809
    NCI Thesaurus ObjectClass-3
    C48190
    UMLS 2011AA ObjectClass-3
    C0332197
    NCI Thesaurus Property
    C25616
    UMLS 2011AA Property
    C1948053
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    Other (specify)
    Beskrivning

    Agent

    Datatyp

    text

    Alias
    NCI Thesaurus Property
    C25364
    UMLS CUI-1
    C1521826
    NCI Thesaurus ObjectClass
    C1708
    NCI Thesaurus ValueDomain
    C1708
    NCI Thesaurus ValueDomain-2
    C42614
    Other (specify)
    Beskrivning

    Agent

    Datatyp

    text

    Alias
    NCI Thesaurus Property
    C25364
    UMLS CUI-1
    C1521826
    NCI Thesaurus ObjectClass
    C1708
    NCI Thesaurus ValueDomain
    C1708
    NCI Thesaurus ValueDomain-2
    C42614
    Reason QOL was Not Assessed During Clinic Visit (Mark the main reason and add comments below.)
    Beskrivning

    AbsentQualityofLifeAssessmentClinicVisitReason

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C17047
    UMLS 2011AA ObjectClass
    C0518214
    NCI Thesaurus ObjectClass-2
    C20989
    UMLS 2011AA ObjectClass-2
    C0031809
    NCI Thesaurus ObjectClass-3
    C48190
    UMLS 2011AA ObjectClass-3
    C0332197
    NCI Thesaurus Property
    C25716
    UMLS 2011AA Property
    C0545082
    NCI Metathesaurus Property
    C0442592
    NCI Thesaurus ValueDomain
    C25638
    UMLS 2011AA ValueDomain
    C0392360
    Reason QOL was Not Obtained by Phone or Mail (Mark all that apply and add comments below.)
    Beskrivning

    AbsentQualityofLifeAssessmentMailContactReason

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25638
    UMLS 2011AA ValueDomain
    C0392360
    NCI Thesaurus ObjectClass
    C17047
    UMLS 2011AA ObjectClass
    C0518214
    NCI Thesaurus Property
    C25217
    UMLS 2011AA Property
    C1516048
    NCI Thesaurus Property-2
    C48190
    UMLS 2011AA Property-2
    C0332197
    Comments
    Beskrivning

    Research Comments

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704
    UMLS CUI-1
    C0947611
    NCI Thesaurus ObjectClass
    C15319
    NCI Thesaurus Property
    C25393

    Similar models

    Mark Circle Like This

    1. StudyEvent: NSABP Protocol R-04 Missing Data Form for Quality of Life Questionnaire
      1. Mark Circle Like This
    Name
    Typ
    Description | Question | Decode (Coded Value)
    Datatyp
    Alias
    Item Group
    Ccrr Module For Nsabp Protocol R-04 Missing Data Form For Quality Of Life Questionnaire
    FirstThreeLettersofPatient'sLastName
    Item
    First Three Letters of Patients Last Name
    text
    Patient ID NSABP
    Item
    Patient Study ID 34
    text
    C25337 (NCI Thesaurus ValueDomain)
    C2348585 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C1513905 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C15818 (NCI Thesaurus Property-2)
    Affiliate Name
    Item
    Institution Name / Affiliate Name
    text
    C21541 (NCI Thesaurus ObjectClass)
    C1510825 (UMLS CUI-1)
    C25413 (NCI Thesaurus ObjectClass-2)
    C25364 (NCI Thesaurus Property)
    C25191 (NCI Thesaurus ValueDomain)
    C21541 (NCI Thesaurus ValueDomain-2)
    Person Completing Form
    Item
    Person Completing Form
    text
    C25191 (NCI Thesaurus ValueDomain)
    C1550483 (UMLS CUI-1)
    C25657 (NCI Thesaurus ObjectClass)
    C25364 (NCI Thesaurus Property)
    Person Completing Form Last Name
    Item
    Last Name
    text
    C25190 (NCI Thesaurus ObjectClass)
    C1550483 (UMLS CUI-1)
    C25657 (NCI Thesaurus ObjectClass-2)
    C1301584 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25551 (NCI Thesaurus Property-2)
    C25191 (NCI Thesaurus ValueDomain)
    Person Completing Form First Name
    Item
    First Name
    text
    C25190 (NCI Thesaurus ObjectClass)
    C1550483 (UMLS CUI-1)
    C25657 (NCI Thesaurus ObjectClass-2)
    C1443235 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25509 (NCI Thesaurus Property-2)
    C25191 (NCI Thesaurus ValueDomain)
    Data amended
    Item
    Are Data Amended?
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C0680532 (UMLS CUI-1)
    C25474 (NCI Thesaurus ObjectClass)
    C25416 (NCI Thesaurus Property)
    Item
    Time Point for this Form (mark one)
    text
    C17047 (NCI Thesaurus ObjectClass)
    C0518214 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus ObjectClass-2)
    C0031809 (UMLS 2011AA ObjectClass-2)
    C48190 (NCI Thesaurus ObjectClass-3)
    C0332197 (UMLS 2011AA ObjectClass-3)
    C25616 (NCI Thesaurus Property)
    C1948053 (UMLS 2011AA Property)
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    Code List
    Time Point for this Form (mark one)
    CL Item
    Post Chemotherapy/radiation (Post chemotherapy/radiation)
    CL Item
    One Year After Surgery (One year after surgery)
    Agent
    Item
    Other (specify)
    text
    C25364 (NCI Thesaurus Property)
    C1521826 (UMLS CUI-1)
    C1708 (NCI Thesaurus ObjectClass)
    C1708 (NCI Thesaurus ValueDomain)
    C42614 (NCI Thesaurus ValueDomain-2)
    Agent
    Item
    Other (specify)
    text
    C25364 (NCI Thesaurus Property)
    C1521826 (UMLS CUI-1)
    C1708 (NCI Thesaurus ObjectClass)
    C1708 (NCI Thesaurus ValueDomain)
    C42614 (NCI Thesaurus ValueDomain-2)
    Item
    Reason QOL was Not Assessed During Clinic Visit (Mark the main reason and add comments below.)
    text
    C17047 (NCI Thesaurus ObjectClass)
    C0518214 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus ObjectClass-2)
    C0031809 (UMLS 2011AA ObjectClass-2)
    C48190 (NCI Thesaurus ObjectClass-3)
    C0332197 (UMLS 2011AA ObjectClass-3)
    C25716 (NCI Thesaurus Property)
    C0545082 (UMLS 2011AA Property)
    C0442592 (NCI Metathesaurus Property)
    C25638 (NCI Thesaurus ValueDomain)
    C0392360 (UMLS 2011AA ValueDomain)
    Code List
    Reason QOL was Not Assessed During Clinic Visit (Mark the main reason and add comments below.)
    CL Item
    Staff Oversight Or Understaffing (Staff oversight or understaffing)
    CL Item
    Patient Was Unavailable (e.g., Scheduling Or Transportation Difficulties) (Patient was unavailable)
    CL Item
    Patient Refused To Complete Questionnaire (Patient refused to complete qustionnaire)
    CL Item
    Clinical Staff Concerned For Patient's Medical Or Emotional Condition (Clinical staff concerned for patinet's medical or emotional condition)
    CL Item
    Patient Felt Too Ill Or Emotionally Upset (Patient felt too ill or emotionally upset)
    Item
    Reason QOL was Not Obtained by Phone or Mail (Mark all that apply and add comments below.)
    text
    C25638 (NCI Thesaurus ValueDomain)
    C0392360 (UMLS 2011AA ValueDomain)
    C17047 (NCI Thesaurus ObjectClass)
    C0518214 (UMLS 2011AA ObjectClass)
    C25217 (NCI Thesaurus Property)
    C1516048 (UMLS 2011AA Property)
    C48190 (NCI Thesaurus Property-2)
    C0332197 (UMLS 2011AA Property-2)
    Code List
    Reason QOL was Not Obtained by Phone or Mail (Mark all that apply and add comments below.)
    CL Item
    Staff Oversight Or Understaffing (Staff oversight or understaffing)
    CL Item
    Staff Was Unable To Contact Patient By Phone (Staff was unable to contact patient by phone)
    CL Item
    Patient Refused (Patient refused)
    Research Comments
    Item
    Comments
    text
    C25704 (NCI Thesaurus ValueDomain)
    C0947611 (UMLS CUI-1)
    C15319 (NCI Thesaurus ObjectClass)
    C25393 (NCI Thesaurus Property)

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