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ID

7574

Description

AMC-050 Study Drug Therapy Form (SD1) Liposomal Daunorubicin in Treating Patients With HIV-Related Kaposi's Sarcoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=49597C4E-12B8-38E4-E044-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=49597C4E-12B8-38E4-E044-0003BA3F9857

Keywords

Versions (2)
  1. 9/19/12 9/19/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
Uploaded on

January 9, 2015

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Creative Commons BY-NC 3.0 Legacy
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    Sarcoma NCT00427414 Treatment - AMC-050 Study Drug Therapy Form (SD1) - 2737061v1.0

    English

    No Instruction available.

    1 forms  
    1. StudyEvent: AMC-050 Study Drug Therapy Form (SD1)
      1. No Instruction available.
    Enter Total Dose Of Study Drug Received This Cycle And Dose Modification Codes
    Description

    Enter Total Dose Of Study Drug Received This Cycle And Dose Modification Codes

    Visit number
    Description

    Visit number

    Data type

    float

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C1549755
    NCI Thesaurus ObjectClass
    C16696
    NCI Thesaurus Property
    C25385
    Agent Name
    Description

    Agent

    Data type

    text

    Alias
    NCI Thesaurus Property
    C25364
    UMLS CUI-1
    C1521826
    NCI Thesaurus ObjectClass
    C1708
    NCI Thesaurus ValueDomain
    C1708
    NCI Thesaurus ValueDomain-2
    C42614
    Agent Start Date
    Description

    Medication Start Date

    Data type

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS CUI-1
    C1521826
    NCI Thesaurus ValueDomain-2
    C25431
    UMLS CUI-2
    C0808070
    NCI Thesaurus ObjectClass
    C1708
    NCI Thesaurus Property
    C25275
    Total Dose of Agents/Drugs for this Cycle (mg/m^2)
    Description

    Agent Total Dose

    Data type

    float

    Alias
    NCI Thesaurus ValueDomain
    C25304
    UMLS CUI-1
    C2986497
    NCI Thesaurus Property
    C25379
    NCI Thesaurus ValueDomain-2
    C25488
    NCI Thesaurus ObjectClass
    C1708
    Dose Modification
    Description

    Dose Modification Status

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C25488
    UMLS CUI-1
    C1707811
    NCI Thesaurus ValueDomain
    C25688
    NCI Thesaurus Property
    C25572
    Duration Delay (Days)
    Description

    Delay of drug therapy

    Data type

    float

    Alias
    NCI Thesaurus Property
    C25477
    NCI Thesaurus ObjectClass
    C1708
    UMLS CUI-1
    C1299700
    NCI Thesaurus Property-2
    C25409
    NCI Thesaurus ValueDomain
    C25330
    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
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    Similar models

    No Instruction available.

    1 forms
    1. StudyEvent: AMC-050 Study Drug Therapy Form (SD1)
      1. No Instruction available.
    Name
    Type
    Description | Question | Decode (Coded Value)
    Data type
    Alias
    Item Group
    Enter Total Dose Of Study Drug Received This Cycle And Dose Modification Codes
    Visit number
    Item
    Visit number
    float
    C25337 (NCI Thesaurus ValueDomain)
    C1549755 (UMLS CUI-1)
    C16696 (NCI Thesaurus ObjectClass)
    C25385 (NCI Thesaurus Property)
    Agent
    Item
    Agent Name
    text
    C25364 (NCI Thesaurus Property)
    C1521826 (UMLS CUI-1)
    C1708 (NCI Thesaurus ObjectClass)
    C1708 (NCI Thesaurus ValueDomain)
    C42614 (NCI Thesaurus ValueDomain-2)
    Medication Start Date
    Item
    Agent Start Date
    date
    C25164 (NCI Thesaurus ValueDomain)
    C1521826 (UMLS CUI-1)
    C25431 (NCI Thesaurus ValueDomain-2)
    C0808070 (UMLS CUI-2)
    C1708 (NCI Thesaurus ObjectClass)
    C25275 (NCI Thesaurus Property)
    Agent Total Dose
    Item
    Total Dose of Agents/Drugs for this Cycle (mg/m^2)
    float
    C25304 (NCI Thesaurus ValueDomain)
    C2986497 (UMLS CUI-1)
    C25379 (NCI Thesaurus Property)
    C25488 (NCI Thesaurus ValueDomain-2)
    C1708 (NCI Thesaurus ObjectClass)
    Item
    Dose Modification
    text
    C25488 (NCI Thesaurus ObjectClass)
    C1707811 (UMLS CUI-1)
    C25688 (NCI Thesaurus ValueDomain)
    C25572 (NCI Thesaurus Property)
    CL.1
    Code List
    Dose Modification
    CL Item
    No Dose Modification (No dose modification)
    CL Item
    Dose Delayed (Dose delayed)
    CL Item
    Dose Escalated (Dose escalated)
    CL Item
    Dose Reduced (Dose reduced)
    C49505 (NCI Thesaurus)
    C1707814 (UMLS 2011AA)
    C49505 (NCI Thesaurus-3)
    C1707814 (UMLS 2011AA-4)
    CL Item
    Dose Delayed And Reduced (Dose delayed and reduced)
    CL Item
    Drug Discontinued (Drug discontinued)
    Delay of drug therapy
    Item
    Duration Delay (Days)
    float
    C25477 (NCI Thesaurus Property)
    C1708 (NCI Thesaurus ObjectClass)
    C1299700 (UMLS CUI-1)
    C25409 (NCI Thesaurus Property-2)
    C25330 (NCI Thesaurus ValueDomain)
    Item Group
    Comments
    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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