ID

7559

Description

SOUTHWEST ONCOLOGY GROUP S0500 CTC Blood Draw and Results CRF Treatment Decision Making Based on Blood Levels of Tumor Cells in Women With Metastatic Breast Cancer Receiving Chemotherapy Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=234E9C42-5F69-15FD-E044-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=234E9C42-5F69-15FD-E044-0003BA3F9857

Keywords

Versions (2)
  1. 8/26/12 8/26/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
Uploaded on

January 9, 2015

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT00382018 Pathology - SOUTHWEST ONCOLOGY GROUP S0500 CTC Blood Draw and Results CRF - 2547492v1.0

English

No Instruction available.

1 forms  
  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP S0500 CTC Blood Draw and Results CRF
    1. No Instruction available.
Header
Description

Header

SWOG Patient ID
Description

Trial subject ID SWOG

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
UMLS CUI-2
C1519429
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C25699
SWOG Study No.
Description

Protocol ID SWOG

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C3274381
NCI Thesaurus ObjectClass
C25320
UMLS CUI-2
C1519429
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C25699
Registration Step
Description

Registration Number

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C1514821
NCI Thesaurus ObjectClass
C25646
UMLS CUI-2
C0237753
NCI Thesaurus Property
C16154
NCI Thesaurus ValueDomain-2
C16154
Patient Initials (L, F M)
Description

Patient Initials

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986440
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25536
State
Description

AddressState/ProvinceName

Data type

text

Alias
NCI Thesaurus ObjectClass
C25407
UMLS 2011AA ObjectClass
C1442065
NCI Thesaurus ValueDomain
C42614
UMLS 2011AA ValueDomain
C0027365
NCI Thesaurus Property
C87194
UMLS 2011AA Property
C1301808
Time Zone
Description

AddressTimeZoneName

Data type

text

Alias
NCI Thesaurus ObjectClass
C25407
UMLS 2011AA ObjectClass
C1442065
NCI Thesaurus ValueDomain
C42614
UMLS 2011AA ValueDomain
C0027365
NCI Thesaurus Property
C80453
UMLS 2011AA Property
C2825194
Institution/Affiliate
Description

Institution Name

Data type

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
Physician (Participating Group:)
Description

Investigator Name

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2826892
NCI Thesaurus Property
C25364
NCI Thesaurus ObjectClass
C17089
NCI Thesaurus ObjectClass-2
C25644
Group Name
Description

GroupName

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C17005
UMLS 2011AA ObjectClass
C1257890
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Participating Group Study No.
Description

Study Number Participating Group

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C3274381
NCI Thesaurus ObjectClass
C25320
UMLS CUI-2
C2347449
NCI Thesaurus Property
C25608
NCI Thesaurus Property-2
C25364
Participating Group Patient ID (Instructions: All dates are MONTH, DAY, YEAR. Explain any blank fields or blank dates in the Comments section. Place an X in appropriate boxes. Circle AMENDED items in red and write AMENDED across the top of the form.)
Description

Trial subject ID Participating Group

Data type

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
Blood Collection Information
Description

Blood Collection Information

Date Collected
Description

BloodSpecimenCollectionDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C12434
UMLS 2011AA ObjectClass
C0229664
NCI Thesaurus ObjectClass-2
C19157
UMLS 2011AA ObjectClass-2
C0370003
NCI Thesaurus Property
C25452
Time Collected
Description

BloodSpecimenCollectionTime

Data type

time

Alias
NCI Thesaurus ObjectClass
C12434
UMLS 2011AA ObjectClass
C0229664
NCI Thesaurus ValueDomain
C25207
UMLS 2011AA ValueDomain
C0040223
NCI Thesaurus ObjectClass-2
C19157
UMLS 2011AA ObjectClass-2
C0370003
NCI Thesaurus Property
C25452
Tube #
Description

BloodSpecimenVialIdenitifierNumber

Data type

float

Alias
NCI Thesaurus ObjectClass
C12434
UMLS 2011AA ObjectClass
C0229664
NCI Thesaurus ObjectClass-2
C19157
UMLS 2011AA ObjectClass-2
C0370003
NCI Thesaurus ObjectClass-3
C41275
UMLS 2011AA ObjectClass-3
C0184301
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
CellSave Lot #
Description

CirculatingTumorCellSpecimenPreservationAgentLotIdentifierNumber

Data type

text

Alias
NCI Thesaurus ObjectClass
C1708
UMLS 2011AA ObjectClass
C0450442
NCI Thesaurus ObjectClass-2
C63797
UMLS 2011AA ObjectClass-2
C0027625
NCI Thesaurus ObjectClass-3
C19157
UMLS 2011AA ObjectClass-3
C0370003
NCI Thesaurus ObjectClass-4
C52243
UMLS 2011AA ObjectClass-4
C0033085
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus Property-2
C41396
UMLS 2011AA Property-2
C1518000
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
CellSave Expiration Date
Description

CirculatingTumorCellSpecimenPreservationAgentLotExpirationDate

Data type

date

Alias
NCI Thesaurus ObjectClass
C1708
UMLS 2011AA ObjectClass
C0450442
NCI Thesaurus ObjectClass-2
C63797
UMLS 2011AA ObjectClass-2
C0027625
NCI Thesaurus ObjectClass-3
C19157
UMLS 2011AA ObjectClass-3
C0370003
NCI Thesaurus ObjectClass-4
C52243
UMLS 2011AA ObjectClass-4
C0033085
NCI Thesaurus Property
C41396
UMLS 2011AA Property
C1518000
NCI Thesaurus Property-2
C48573
UMLS 2011AA Property-2
C1704631
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
Collection period
Description

BloodSpecimenCollectionPeriodType

Data type

text

Alias
NCI Thesaurus ObjectClass
C12434
UMLS 2011AA ObjectClass
C0229664
NCI Thesaurus ObjectClass-2
C19157
UMLS 2011AA ObjectClass-2
C0370003
NCI Thesaurus Property
C25616
UMLS 2011AA Property
C1948053
NCI Thesaurus Property-2
C25453
UMLS 2011AA Property-2
C1516698
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Comments
Description

Comments

Comments
Description

Research Comments

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS CUI-1
C0947611
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
This Section To Be Completed By Immunicon
Description

This Section To Be Completed By Immunicon

Date received
Description

SampleVialReceivedDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus Property
C25639
UMLS 2011AA Property
C1514756
NCI Metathesaurus ObjectClass
C0870078
NCI Metathesaurus ObjectClass-2
C0184301
Time Received
Description

SpecimenReceivedTime

Data type

time

Alias
NCI Thesaurus Property
C25639
UMLS 2011AA Property
C1514756
NCI Thesaurus ValueDomain
C25207
UMLS 2011AA ValueDomain
C0040223
NCI Thesaurus ObjectClass
C19157
UMLS 2011AA ObjectClass
C0370003
Sample ID
Description

SampleIDNumber

Data type

float

Alias
NCI Thesaurus Property
C25337
UMLS 2011AA Property
C0237753
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C25364
UMLS 2011AA ObjectClass
C0600091
NCI Thesaurus ObjectClass-2
C19697
UMLS 2011AA ObjectClass-2
C1292533
Quantity received
Description

CirculatingTumorCellSpecimenVialReceivedValue

Data type

float

Alias
NCI Thesaurus ObjectClass
C63797
UMLS 2011AA ObjectClass
C0027625
NCI Thesaurus ObjectClass-2
C19157
UMLS 2011AA ObjectClass-2
C0370003
NCI Thesaurus Property
C25639
UMLS 2011AA Property
C1514756
NCI Thesaurus Property-2
C41275
UMLS 2011AA Property-2
C0184301
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
Date of Processing
Description

BloodSpecimenProcessingDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C12434
UMLS 2011AA ObjectClass
C0229664
NCI Thesaurus Property
C48177
UMLS 2011AA Property
C1709694
NCI Thesaurus ObjectClass-2
C19157
UMLS 2011AA ObjectClass-2
C0370003
Time of Processing
Description

BloodSpecimenProcessingTime

Data type

time

Alias
NCI Thesaurus ObjectClass
C12434
UMLS 2011AA ObjectClass
C0229664
NCI Thesaurus ValueDomain
C25207
UMLS 2011AA ValueDomain
C0040223
NCI Thesaurus Property
C48177
UMLS 2011AA Property
C1709694
NCI Thesaurus ObjectClass-2
C19157
UMLS 2011AA ObjectClass-2
C0370003
CTC Result #
Description

LaboratoryProcedureCirculatingTumorCellResultCount

Data type

float

Alias
NCI Thesaurus Property
C20200
UMLS 2011AA Property
C1274040
NCI Thesaurus ValueDomain
C25463
UMLS 2011AA ValueDomain
C0750480
NCI Thesaurus Property-2
C63797
UMLS 2011AA Property-2
C0027625
NCI Thesaurus ObjectClass
C25294
UMLS 2011AA ObjectClass
C0022885
Sample analyzable
Description

LaboratoryProcedureCirculatingTumorCellResultInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus Property
C20200
UMLS 2011AA Property
C1274040
NCI Thesaurus Property-2
C63797
UMLS 2011AA Property-2
C0027625
NCI Thesaurus ObjectClass
C25294
UMLS 2011AA ObjectClass
C0022885
If No, specify
Description

CirculatingTumorCellSpecimenNotAnalysisSpecify

Data type

text

Alias
NCI Thesaurus ObjectClass
C63797
UMLS 2011AA ObjectClass
C0027625
NCI Thesaurus ObjectClass-2
C19157
UMLS 2011AA ObjectClass-2
C0370003
NCI Thesaurus Property
C25391
UMLS 2011AA Property
C0936012
NCI Thesaurus Property-2
C25594
UMLS 2011AA Property-2
C1518422
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
CTC level (select one)
Description

LaboratoryProcedureCirculatingTumorCellResultType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus Property
C20200
UMLS 2011AA Property
C1274040
NCI Thesaurus Property-2
C63797
UMLS 2011AA Property-2
C0027625
NCI Thesaurus ObjectClass
C25294
UMLS 2011AA ObjectClass
C0022885
Reviewed by
Description

PersonCirculatingTumorCellSpecimenAnalysisName

Data type

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C25391
UMLS 2011AA Property
C0936012
NCI Thesaurus Property-2
C63797
UMLS 2011AA Property-2
C0027625
NCI Thesaurus Property-3
C19157
UMLS 2011AA Property-3
C0370003
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
Date
Description

LaboratoryProcedureCirculatingTumorCellResulteDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus Property
C20200
UMLS 2011AA Property
C1274040
NCI Thesaurus Property-2
C63797
UMLS 2011AA Property-2
C0027625
NCI Thesaurus ObjectClass
C25294
UMLS 2011AA ObjectClass
C0022885
Communication Of Results To Swog
Description

Communication Of Results To Swog

Method
Description

LaboratoryProcedureAnalysisSubmissionNotificationText

Data type

text

Alias
NCI Thesaurus ObjectClass
C25294
UMLS 2011AA ObjectClass
C0022885
NCI Thesaurus Property
C25391
UMLS 2011AA Property
C0936012
NCI Thesaurus Property-2
C25694
UMLS 2011AA Property-2
C1515022
NCI Thesaurus Property-3
C25297
UMLS 2011AA Property-3
C0422202
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ValueDomain-2
C20200
UMLS 2011AA ValueDomain-2
C1274040
Date
Description

LaboratoryProcedureAnalysisSubmissionNotificationDate

Data type

date

Alias
NCI Thesaurus ObjectClass
C25294
UMLS 2011AA ObjectClass
C0022885
NCI Thesaurus Property
C25391
UMLS 2011AA Property
C0936012
NCI Thesaurus Property-2
C25694
UMLS 2011AA Property-2
C1515022
NCI Thesaurus Property-3
C25297
UMLS 2011AA Property-3
C0422202
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
Sender name
Description

LaboratoryPersonAnalysisNotificationSubmitterName

Data type

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ObjectClass-2
C37984
UMLS 2011AA ObjectClass-2
C0022877
NCI Thesaurus Property
C25391
UMLS 2011AA Property
C0936012
NCI Thesaurus Property-2
C25297
UMLS 2011AA Property-2
C0422202
NCI Thesaurus Property-3
C54269
UMLS 2011AA Property-3
C1710230
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
Confirmation date
Description

LaboratoryProcedureAnalysisNotificationSubmissionConfirmedDate

Data type

date

Alias
NCI Thesaurus ObjectClass
C25294
UMLS 2011AA ObjectClass
C0022885
NCI Thesaurus Property
C25458
UMLS 2011AA Property
C0750484
NCI Thesaurus Property-2
C25391
UMLS 2011AA Property-2
C0936012
NCI Thesaurus Property-3
C25694
UMLS 2011AA Property-3
C1515022
NCI Thesaurus Property-4
C25297
UMLS 2011AA Property-4
C0422202
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
Person receiving confirmation
Description

ConfirmationPersonAnalysisNotificationSubmissionRecipientName

Data type

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ObjectClass-2
C25458
UMLS 2011AA ObjectClass-2
C0750484
NCI Thesaurus Property
C25391
UMLS 2011AA Property
C0936012
NCI Thesaurus Property-2
C53268
UMLS 2011AA Property-2
C1709854
NCI Thesaurus Property-3
C25694
UMLS 2011AA Property-3
C1515022
NCI Thesaurus Property-4
C25297
UMLS 2011AA Property-4
C0422202
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
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1 forms
  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP S0500 CTC Blood Draw and Results CRF
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Header
Trial subject ID SWOG
Item
SWOG Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1519429 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25699 (NCI Thesaurus Property-2)
Protocol ID SWOG
Item
SWOG Study No.
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1519429 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25699 (NCI Thesaurus Property-2)
Registration Number
Item
Registration Step
text
C25337 (NCI Thesaurus ValueDomain)
C1514821 (UMLS CUI-1)
C25646 (NCI Thesaurus ObjectClass)
C0237753 (UMLS CUI-2)
C16154 (NCI Thesaurus Property)
C16154 (NCI Thesaurus ValueDomain-2)
Patient Initials
Item
Patient Initials (L, F M)
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
Item
State
text
C25407 (NCI Thesaurus ObjectClass)
C1442065 (UMLS 2011AA ObjectClass)
C42614 (NCI Thesaurus ValueDomain)
C0027365 (UMLS 2011AA ValueDomain)
C87194 (NCI Thesaurus Property)
C1301808 (UMLS 2011AA Property)
CL.1
Code List
State
CL Item
Aguascalientes (Aguascalientes)
CL Item
Alabama (Alabama)
C0001895 (NCI Metathesaurus)
CL Item
Alaska (Alaska)
C0001905 (NCI Metathesaurus)
CL Item
Alberta (Alberta)
CL Item
American Samoa (American Samoa)
C17739 (NCI Thesaurus)
C0242536 (UMLS 2011AA)
CL Item
Arizona (Arizona)
C0003787 (NCI Metathesaurus)
CL Item
Arkansas (Arkansas)
C0003790 (NCI Metathesaurus)
CL Item
Baja California (Baja California)
CL Item
Baja California Sur (Baja California Sur)
CL Item
British Columbia (British Columbia)
C0006193 (NCI Metathesaurus)
CL Item
California (California)
C0006754 (NCI Metathesaurus)
CL Item
Campeche (Campeche)
CL Item
Chiapas (Chiapas)
CL Item
Chihuahua (Chihuahua)
CL Item
Coahuila De Zaragoza (Coahuila de Zaragoza)
CL Item
Colima (Colima)
CL Item
Colorado (Colorado)
C43501 (NCI Thesaurus)
C0009399 (UMLS 2011AA)
CL Item
Connecticut (Connecticut)
C0009778 (NCI Metathesaurus)
CL Item
Delaware (Delaware)
C0011198 (NCI Metathesaurus)
CL Item
District Of Columbia (District of Columbia)
C43456 (NCI Thesaurus)
C0012764 (UMLS 2011AA)
CL Item
Distrito Federal (Distrito Federal)
CL Item
Durango (Durango)
CL Item
Florida (Florida)
C43478 (NCI Thesaurus)
C0016253 (UMLS 2011AA)
CL Item
Georgia (Georgia)
C43477 (NCI Thesaurus)
C0017452 (UMLS 2011AA)
CL Item
Guam (Guam)
C16652 (NCI Thesaurus)
C0018309 (UMLS 2011AA)
CL Item
Guanajuato (Guanajuato)
CL Item
Guerrero (Guerrero)
CL Item
Hawaii (Hawaii)
C43510 (NCI Thesaurus)
C0018619 (UMLS 2011AA)
CL Item
Hildalgo (Hildalgo)
CL Item
Idaho (Idaho)
C43499 (NCI Thesaurus)
C0020787 (UMLS 2011AA)
CL Item
Illinois (Illinois)
C43491 (NCI Thesaurus)
C0020898 (UMLS 2011AA)
CL Item
Indiana (Indiana)
C43483 (NCI Thesaurus)
C0021206 (UMLS 2011AA)
CL Item
Iowa (Iowa)
C43487 (NCI Thesaurus)
C0022037 (UMLS 2011AA)
CL Item
Jalisco (Jalisco)
CL Item
Kansas (Kansas)
C43493 (NCI Thesaurus)
C0022497 (UMLS 2011AA)
CL Item
Kentucky (Kentucky)
C43484 (NCI Thesaurus)
C0022557 (UMLS 2011AA)
CL Item
Louisiana (Louisiana)
C43496 (NCI Thesaurus)
C0024024 (UMLS 2011AA)
CL Item
Maine (Maine)
C43457 (NCI Thesaurus)
C0024497 (UMLS 2011AA)
CL Item
Manitoba (Manitoba)
C0024726 (NCI Metathesaurus)
CL Item
Marshall Islands (Marshall Islands)
C16822 (NCI Thesaurus)
C0024851 (UMLS 2011AA)
CL Item
Maryland (Maryland)
C43471 (NCI Thesaurus)
C0024858 (UMLS 2011AA)
CL Item
Massachusetts (Massachusetts)
C43463 (NCI Thesaurus)
C0024874 (UMLS 2011AA)
CL Item
Mexico (Mexico)
C16850 (NCI Thesaurus)
C0025885 (UMLS 2011AA)
CL Item
Michigan (Michigan)
C43481 (NCI Thesaurus)
C0025939 (UMLS 2011AA)
CL Item
Michoacan De Ocampo (Michoacan de Ocampo)
CL Item
Micronesia (Micronesia)
C0026001 (NCI Metathesaurus)
CL Item
Minnesota (Minnesota)
C43486 (NCI Thesaurus)
C0026183 (UMLS 2011AA)
CL Item
Mississippi (Mississippi)
C43480 (NCI Thesaurus)
C0026221 (UMLS 2011AA)
CL Item
Missouri (Missouri)
C43492 (NCI Thesaurus)
C0026222 (UMLS 2011AA)
CL Item
Montana (Montana)
C43490 (NCI Thesaurus)
C0026506 (UMLS 2011AA)
CL Item
Morelos (Morelos)
CL Item
Nayarit (Nayarit)
CL Item
Nebraska (Nebraska)
C43494 (NCI Thesaurus)
C0027523 (UMLS 2011AA)
CL Item
Nevada (Nevada)
C43503 (NCI Thesaurus)
C0027951 (UMLS 2011AA)
CL Item
New Brunswick (New Brunswick)
C0027963 (NCI Metathesaurus)
CL Item
New Hampshire (New Hampshire)
C43460 (NCI Thesaurus)
C0027969 (UMLS 2011AA)
CL Item
New Jersey (New Jersey)
C43467 (NCI Thesaurus)
C0027971 (UMLS 2011AA)
CL Item
New Mexico (New Mexico)
C43504 (NCI Thesaurus)
C0027972 (UMLS 2011AA)
CL Item
New York (New York)
C43468 (NCI Thesaurus)
C0027976 (UMLS 2011AA)
CL Item
Newfoundland (Newfoundland)
C0027985 (NCI Metathesaurus)
CL Item
North Carolina (North Carolina)
C43474 (NCI Thesaurus)
C0028407 (UMLS 2011AA)
CL Item
North Dakota (North Dakota)
C43488 (NCI Thesaurus)
C0028408 (UMLS 2011AA)
CL Item
Northern Mariana Islands (Northern Mariana Islands)
C17882 (NCI Thesaurus)
C0282245 (UMLS 2011AA)
CL Item
Northwest Territories (Northwest Territories)
C0028417 (NCI Metathesaurus)
CL Item
Nova Scotia (Nova Scotia)
C0028441 (NCI Metathesaurus)
CL Item
Nuevo Leon (Nuevo Leon)
CL Item
Nunavut (Nunavut)
C0752343 (NCI Metathesaurus)
CL Item
Oaxaca (Oaxaca)
CL Item
Ohio (Ohio)
C43482 (NCI Thesaurus)
C0028905 (UMLS 2011AA)
CL Item
Oklahoma (Oklahoma)
C43497 (NCI Thesaurus)
C0028914 (UMLS 2011AA)
CL Item
Ontario (Ontario)
C0029040 (NCI Metathesaurus)
CL Item
Oregon (Oregon)
C43508 (NCI Thesaurus)
C0029195 (UMLS 2011AA)
CL Item
Palau (Palau)
C17733 (NCI Thesaurus)
C0242397 (UMLS 2011AA)
CL Item
Pennsylvania (Pennsylvania)
C43469 (NCI Thesaurus)
C0030853 (UMLS 2011AA)
CL Item
Prince Edward Island (Prince Edward Island)
C0033157 (NCI Metathesaurus)
CL Item
Puebla (Puebla)
CL Item
Puerto Rico (Puerto Rico)
C17043 (NCI Thesaurus)
C0034044 (UMLS 2011AA)
CL Item
Quebec (Quebec)
C0034390 (NCI Metathesaurus)
CL Item
Queretaro De Arteaga (Queretaro de Arteaga)
CL Item
Quintana Roo (Quintana Roo)
CL Item
Rhode Island (Rhode Island)
C43464 (NCI Thesaurus)
C0035487 (UMLS 2011AA)
CL Item
San Luis Potosi (San Luis Potosi)
CL Item
Saskatchewan (Saskatchewan)
C0036234 (NCI Metathesaurus)
CL Item
Sinaloa (Sinaloa)
CL Item
Sonora (Sonora)
CL Item
South Carolina (South Carolina)
C43475 (NCI Thesaurus)
C0037716 (UMLS 2011AA)
CL Item
South Dakota (South Dakota)
C43489 (NCI Thesaurus)
C0037717 (UMLS 2011AA)
CL Item
Tabasco (Tabasco)
CL Item
Tamaulipas (Tamaulipas)
CL Item
Tennessee (Tennessee)
C43476 (NCI Thesaurus)
C0039514 (UMLS 2011AA)
CL Item
Texas (Texas)
C43498 (NCI Thesaurus)
C0039711 (UMLS 2011AA)
CL Item
Tlaxcala (Tlaxcala)
CL Item
Us Minor Outlying Islands (US Minor Outlying Islands)
CL Item
Utah (Utah)
C43502 (NCI Thesaurus)
C0042124 (UMLS 2011AA)
CL Item
Veracruz-llave (Veracruz-Llave)
CL Item
Vermont (Vermont)
C43462 (NCI Thesaurus)
C0042537 (UMLS 2011AA)
CL Item
Virgin Islands Of The Us (Virgin Islands of the US)
CL Item
Virginia (Virginia)
C43472 (NCI Thesaurus)
C0042753 (UMLS 2011AA)
CL Item
Washington (Washington)
C43507 (NCI Thesaurus)
C0043038 (UMLS 2011AA)
CL Item
West Virginia (West Virginia)
C43473 (NCI Thesaurus)
C0043127 (UMLS 2011AA)
CL Item
Wisconsin (Wisconsin)
C43485 (NCI Thesaurus)
C0043193 (UMLS 2011AA)
CL Item
Wyoming (Wyoming)
C43500 (NCI Thesaurus)
C0043287 (UMLS 2011AA)
CL Item
Yucatan (Yucatan)
CL Item
Yukon Territory (Yukon Territory)
C0043438 (NCI Metathesaurus)
CL Item
Zacatecas (Zacatecas)
AddressTimeZoneName
Item
Time Zone
text
C25407 (NCI Thesaurus ObjectClass)
C1442065 (UMLS 2011AA ObjectClass)
C42614 (NCI Thesaurus ValueDomain)
C0027365 (UMLS 2011AA ValueDomain)
C80453 (NCI Thesaurus Property)
C2825194 (UMLS 2011AA Property)
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)
Investigator Name
Item
Physician (Participating Group:)
text
C25191 (NCI Thesaurus ValueDomain)
C2826892 (UMLS CUI-1)
C25364 (NCI Thesaurus Property)
C17089 (NCI Thesaurus ObjectClass)
C25644 (NCI Thesaurus ObjectClass-2)
GroupName
Item
Group Name
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C17005 (NCI Thesaurus ObjectClass)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
Study Number Participating Group
Item
Participating Group Study No.
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Trial subject ID Participating Group
Item
Participating Group Patient ID (Instructions: All dates are MONTH, DAY, YEAR. Explain any blank fields or blank dates in the Comments section. Place an X in appropriate boxes. Circle AMENDED items in red and write AMENDED across the top of the form.)
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)
Item Group
Blood Collection Information
BloodSpecimenCollectionDate
Item
Date Collected
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C12434 (NCI Thesaurus ObjectClass)
C0229664 (UMLS 2011AA ObjectClass)
C19157 (NCI Thesaurus ObjectClass-2)
C0370003 (UMLS 2011AA ObjectClass-2)
C25452 (NCI Thesaurus Property)
BloodSpecimenCollectionTime
Item
Time Collected
time
C12434 (NCI Thesaurus ObjectClass)
C0229664 (UMLS 2011AA ObjectClass)
C25207 (NCI Thesaurus ValueDomain)
C0040223 (UMLS 2011AA ValueDomain)
C19157 (NCI Thesaurus ObjectClass-2)
C0370003 (UMLS 2011AA ObjectClass-2)
C25452 (NCI Thesaurus Property)
BloodSpecimenVialIdenitifierNumber
Item
Tube #
float
C12434 (NCI Thesaurus ObjectClass)
C0229664 (UMLS 2011AA ObjectClass)
C19157 (NCI Thesaurus ObjectClass-2)
C0370003 (UMLS 2011AA ObjectClass-2)
C41275 (NCI Thesaurus ObjectClass-3)
C0184301 (UMLS 2011AA ObjectClass-3)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
CirculatingTumorCellSpecimenPreservationAgentLotIdentifierNumber
Item
CellSave Lot #
text
C1708 (NCI Thesaurus ObjectClass)
C0450442 (UMLS 2011AA ObjectClass)
C63797 (NCI Thesaurus ObjectClass-2)
C0027625 (UMLS 2011AA ObjectClass-2)
C19157 (NCI Thesaurus ObjectClass-3)
C0370003 (UMLS 2011AA ObjectClass-3)
C52243 (NCI Thesaurus ObjectClass-4)
C0033085 (UMLS 2011AA ObjectClass-4)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C41396 (NCI Thesaurus Property-2)
C1518000 (UMLS 2011AA Property-2)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
CirculatingTumorCellSpecimenPreservationAgentLotExpirationDate
Item
CellSave Expiration Date
date
C1708 (NCI Thesaurus ObjectClass)
C0450442 (UMLS 2011AA ObjectClass)
C63797 (NCI Thesaurus ObjectClass-2)
C0027625 (UMLS 2011AA ObjectClass-2)
C19157 (NCI Thesaurus ObjectClass-3)
C0370003 (UMLS 2011AA ObjectClass-3)
C52243 (NCI Thesaurus ObjectClass-4)
C0033085 (UMLS 2011AA ObjectClass-4)
C41396 (NCI Thesaurus Property)
C1518000 (UMLS 2011AA Property)
C48573 (NCI Thesaurus Property-2)
C1704631 (UMLS 2011AA Property-2)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
Item
Collection period
text
C12434 (NCI Thesaurus ObjectClass)
C0229664 (UMLS 2011AA ObjectClass)
C19157 (NCI Thesaurus ObjectClass-2)
C0370003 (UMLS 2011AA ObjectClass-2)
C25616 (NCI Thesaurus Property)
C1948053 (UMLS 2011AA Property)
C25453 (NCI Thesaurus Property-2)
C1516698 (UMLS 2011AA Property-2)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.2
Code List
Collection period
CL Item
Pre-treatment (Pre-Treatment)
CL Item
Day 22 (Day 22)
CL Item
Day 50/57 (Day 50/57)
CL Item
Day 85 (Day 85)
CL Item
Day 169 (Day 169)
CL Item
Day 253 (Day 253)
CL Item
Time Of Disease Progression/end Of Study (Time of disease progression/end of study)
Item Group
Comments
Research Comments
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C0947611 (UMLS CUI-1)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
Item Group
This Section To Be Completed By Immunicon
SampleVialReceivedDate
Item
Date received
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25639 (NCI Thesaurus Property)
C1514756 (UMLS 2011AA Property)
C0870078 (NCI Metathesaurus ObjectClass)
C0184301 (NCI Metathesaurus ObjectClass-2)
SpecimenReceivedTime
Item
Time Received
time
C25639 (NCI Thesaurus Property)
C1514756 (UMLS 2011AA Property)
C25207 (NCI Thesaurus ValueDomain)
C0040223 (UMLS 2011AA ValueDomain)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
SampleIDNumber
Item
Sample ID
float
C25337 (NCI Thesaurus Property)
C0237753 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25364 (NCI Thesaurus ObjectClass)
C0600091 (UMLS 2011AA ObjectClass)
C19697 (NCI Thesaurus ObjectClass-2)
C1292533 (UMLS 2011AA ObjectClass-2)
CirculatingTumorCellSpecimenVialReceivedValue
Item
Quantity received
float
C63797 (NCI Thesaurus ObjectClass)
C0027625 (UMLS 2011AA ObjectClass)
C19157 (NCI Thesaurus ObjectClass-2)
C0370003 (UMLS 2011AA ObjectClass-2)
C25639 (NCI Thesaurus Property)
C1514756 (UMLS 2011AA Property)
C41275 (NCI Thesaurus Property-2)
C0184301 (UMLS 2011AA Property-2)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
BloodSpecimenProcessingDate
Item
Date of Processing
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C12434 (NCI Thesaurus ObjectClass)
C0229664 (UMLS 2011AA ObjectClass)
C48177 (NCI Thesaurus Property)
C1709694 (UMLS 2011AA Property)
C19157 (NCI Thesaurus ObjectClass-2)
C0370003 (UMLS 2011AA ObjectClass-2)
BloodSpecimenProcessingTime
Item
Time of Processing
time
C12434 (NCI Thesaurus ObjectClass)
C0229664 (UMLS 2011AA ObjectClass)
C25207 (NCI Thesaurus ValueDomain)
C0040223 (UMLS 2011AA ValueDomain)
C48177 (NCI Thesaurus Property)
C1709694 (UMLS 2011AA Property)
C19157 (NCI Thesaurus ObjectClass-2)
C0370003 (UMLS 2011AA ObjectClass-2)
LaboratoryProcedureCirculatingTumorCellResultCount
Item
CTC Result #
float
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C63797 (NCI Thesaurus Property-2)
C0027625 (UMLS 2011AA Property-2)
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
LaboratoryProcedureCirculatingTumorCellResultInd-2
Item
Sample analyzable
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C63797 (NCI Thesaurus Property-2)
C0027625 (UMLS 2011AA Property-2)
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
CirculatingTumorCellSpecimenNotAnalysisSpecify
Item
If No, specify
text
C63797 (NCI Thesaurus ObjectClass)
C0027625 (UMLS 2011AA ObjectClass)
C19157 (NCI Thesaurus ObjectClass-2)
C0370003 (UMLS 2011AA ObjectClass-2)
C25391 (NCI Thesaurus Property)
C0936012 (UMLS 2011AA Property)
C25594 (NCI Thesaurus Property-2)
C1518422 (UMLS 2011AA Property-2)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
Item
CTC level (select one)
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C63797 (NCI Thesaurus Property-2)
C0027625 (UMLS 2011AA Property-2)
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
CL.4
Code List
CTC level (select one)
CL Item
<5 (<5)
CL Item
>=5 (>=5)
PersonCirculatingTumorCellSpecimenAnalysisName
Item
Reviewed by
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25391 (NCI Thesaurus Property)
C0936012 (UMLS 2011AA Property)
C63797 (NCI Thesaurus Property-2)
C0027625 (UMLS 2011AA Property-2)
C19157 (NCI Thesaurus Property-3)
C0370003 (UMLS 2011AA Property-3)
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
LaboratoryProcedureCirculatingTumorCellResulteDate
Item
Date
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C63797 (NCI Thesaurus Property-2)
C0027625 (UMLS 2011AA Property-2)
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
Item Group
Communication Of Results To Swog
LaboratoryProcedureAnalysisSubmissionNotificationText
Item
Method
text
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
C25391 (NCI Thesaurus Property)
C0936012 (UMLS 2011AA Property)
C25694 (NCI Thesaurus Property-2)
C1515022 (UMLS 2011AA Property-2)
C25297 (NCI Thesaurus Property-3)
C0422202 (UMLS 2011AA Property-3)
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C20200 (NCI Thesaurus ValueDomain-2)
C1274040 (UMLS 2011AA ValueDomain-2)
LaboratoryProcedureAnalysisSubmissionNotificationDate
Item
Date
date
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
C25391 (NCI Thesaurus Property)
C0936012 (UMLS 2011AA Property)
C25694 (NCI Thesaurus Property-2)
C1515022 (UMLS 2011AA Property-2)
C25297 (NCI Thesaurus Property-3)
C0422202 (UMLS 2011AA Property-3)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
LaboratoryPersonAnalysisNotificationSubmitterName
Item
Sender name
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C37984 (NCI Thesaurus ObjectClass-2)
C0022877 (UMLS 2011AA ObjectClass-2)
C25391 (NCI Thesaurus Property)
C0936012 (UMLS 2011AA Property)
C25297 (NCI Thesaurus Property-2)
C0422202 (UMLS 2011AA Property-2)
C54269 (NCI Thesaurus Property-3)
C1710230 (UMLS 2011AA Property-3)
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
LaboratoryProcedureAnalysisNotificationSubmissionConfirmedDate
Item
Confirmation date
date
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
C25458 (NCI Thesaurus Property)
C0750484 (UMLS 2011AA Property)
C25391 (NCI Thesaurus Property-2)
C0936012 (UMLS 2011AA Property-2)
C25694 (NCI Thesaurus Property-3)
C1515022 (UMLS 2011AA Property-3)
C25297 (NCI Thesaurus Property-4)
C0422202 (UMLS 2011AA Property-4)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
ConfirmationPersonAnalysisNotificationSubmissionRecipientName
Item
Person receiving confirmation
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25458 (NCI Thesaurus ObjectClass-2)
C0750484 (UMLS 2011AA ObjectClass-2)
C25391 (NCI Thesaurus Property)
C0936012 (UMLS 2011AA Property)
C53268 (NCI Thesaurus Property-2)
C1709854 (UMLS 2011AA Property-2)
C25694 (NCI Thesaurus Property-3)
C1515022 (UMLS 2011AA Property-3)
C25297 (NCI Thesaurus Property-4)
C0422202 (UMLS 2011AA Property-4)
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
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