ID

7579

Description

On Study Form - RF02B Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=CCE2BABD-1F19-494E-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=CCE2BABD-1F19-494E-E034-0003BA12F5E7

Keywords

Versions (2)
  1. 9/19/12 9/19/12 -
  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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Sarcoma, Kaposi xxx On-Study - On Study Form - RF02B - 2266958v3.0

English

No Instruction available.

1 forms  
  1. StudyEvent: On Study Form - RF02B
    1. No Instruction available.
Ccrr Module For On Study Form - Rf02b
Description

Ccrr Module For On Study Form - Rf02b

Patient Initials
Description

Patient Initials

Data type

text

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

Protocol ID Coordinating Group

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C3274381
NCI Thesaurus ObjectClass
C25320
UMLS CUI-2
C1711341
NCI Thesaurus Property
C25462
NCI Thesaurus Property-2
C25364
Site#
Description

NCIInstitutionIdentifierCode

Data type

text

Alias
NCI Thesaurus ValueDomain
C25162
UMLS 2011AA ValueDomain
C0805701
NCI Thesaurus ObjectClass
C21541
UMLS 2011AA ObjectClass
C0018704
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ObjectClass-2
C19202
UMLS 2011AA ObjectClass-2
C1513882
ID#
Description

Patient Study ID

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25462
NCI Thesaurus Property-2
C25364
Date of Enrollment
Description

PatientRegistrationDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ValueDomain-2
C25367
NCI Thesaurus Property
C25646
UMLS 2011AA Property
C1514821
Institution Name
Description

Institution Name

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C1301943
NCI Thesaurus ObjectClass
C21541
NCI Thesaurus ValueDomain-2
C21541
NCI Thesaurus Property
C25364
Date of Malignancy Diagnosis
Description

CancerInitialDiagnosisDate

Data type

date

Alias
NCI Thesaurus ObjectClass
C9305
UMLS 2011AA ObjectClass
C0006826
NCI Thesaurus Property
C25509
UMLS 2011AA Property
C1279901
NCI Thesaurus Property-2
C15220
UMLS 2011AA Property-2
C0011900
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ValueDomain-2
C25367
Other therapy (e.g. hyperthermia, etc.), Specify
Description

PriorOtherTherapyName

Data type

text

Prior or concurrent other malignancy?
Description

PriorCancerDiagnosisInd-3

Data type

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
Date of Malignancy Diagnosis
Description

PriorCancerDiagnosisDate

Data type

date

Malignancy/Primary Site
Description

DiseasePrimarySiteICD-OCode

Data type

text

Alias
NCI Thesaurus ValueDomain
C25162
UMLS 2011AA ValueDomain
C0805701
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus Property-2
C25251
UMLS 2011AA Property-2
C0205225
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
Malignancy/Primary Site
Description

DiseasePrimarySiteICD-OCode

Data type

text

Alias
NCI Thesaurus ValueDomain
C25162
UMLS 2011AA ValueDomain
C0805701
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus Property-2
C25251
UMLS 2011AA Property-2
C0205225
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
Other, Specify
Description

DiseasePrimarySiteText

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus Property-2
C25251
UMLS 2011AA Property-2
C0205225
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
Other, Specify
Description

DiseasePrimarySiteText

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus Property-2
C25251
UMLS 2011AA Property-2
C0205225
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
Histology
Description

Histologic Type, other

Data type

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS CUI-1
C1299220
NCI Thesaurus ObjectClass
C3262
NCI Thesaurus Property
C25526
NCI Thesaurus Property-2
C25161
Histology
Description

Histologic Type, other

Data type

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS CUI-1
C1299220
NCI Thesaurus ObjectClass
C3262
NCI Thesaurus Property
C25526
NCI Thesaurus Property-2
C25161
Prior therapy for this malignancy?
Description

CancerPriorTreatmentInd-3

Data type

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
Prior therapy for this malignancy?
Description

CancerPriorTreatmentInd-3

Data type

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
If Yes, check all that apply
Description

PriorChemotherapyAdministeredInd-3

Data type

text

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass
C15632
UMLS 2011AA ObjectClass
C0392920
NCI Thesaurus ObjectClass-2
C25629
UMLS 2011AA ObjectClass-2
C0332152
NCI Thesaurus Property
C25382
UMLS 2011AA Property
C1521801
If Yes, check all that apply
Description

PriorChemotherapyAdministeredInd-3

Data type

text

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass
C15632
UMLS 2011AA ObjectClass
C0392920
NCI Thesaurus ObjectClass-2
C25629
UMLS 2011AA ObjectClass-2
C0332152
NCI Thesaurus Property
C25382
UMLS 2011AA Property
C1521801
Other 2, Specify
Description

PriorTherapyOtherName

Data type

text

Alias
NCI Thesaurus ObjectClass
C25629
UMLS 2011AA ObjectClass
C0332152
NCI Thesaurus ObjectClass-2
C15368
NCI Thesaurus Property
C17649
UMLS 2011AA Property
C0205394
NCI Thesaurus Property-2
C25364
UMLS 2011AA Property-2
C0600091
NCI Thesaurus ValueDomain
C42614
UMLS 2011AA ValueDomain
C0027365
Other 2, Specify
Description

PriorTherapyOtherName

Data type

text

Alias
NCI Thesaurus ObjectClass
C25629
UMLS 2011AA ObjectClass
C0332152
NCI Thesaurus ObjectClass-2
C15368
NCI Thesaurus Property
C17649
UMLS 2011AA Property
C0205394
NCI Thesaurus Property-2
C25364
UMLS 2011AA Property-2
C0600091
NCI Thesaurus ValueDomain
C42614
UMLS 2011AA ValueDomain
C0027365
Other 2, Specify
Description

PriorTherapyOtherName

Data type

text

Alias
NCI Thesaurus ObjectClass
C25629
UMLS 2011AA ObjectClass
C0332152
NCI Thesaurus ObjectClass-2
C15368
NCI Thesaurus Property
C17649
UMLS 2011AA Property
C0205394
NCI Thesaurus Property-2
C25364
UMLS 2011AA Property-2
C0600091
NCI Thesaurus ValueDomain
C42614
UMLS 2011AA ValueDomain
C0027365
Agent Name - unnamed
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 Name - unnamed
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 Name - unnamed
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 Name - unnamed
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
Date of HIV+ diagnosis
Description

DateofHIV+diagnosis

Data type

text

Date of AIDS diagnosis
Description

DateofAIDSdiagnosis

Data type

text

CDC HIV Risk Group
Description

CDCHIVRiskGroup

Data type

text

Other, Specify
Description

Other,Specify

Data type

text

Biological response modifiers or cytokines, Specify
Description

Biologicalresponsemodifiersorcytokines,Specify

Data type

text

Biological response modifiers or cytokines, Specify
Description

Biologicalresponsemodifiersorcytokines,Specify

Data type

text

Is patient receiving antiretroviral therapy concurrently?
Description

Ispatientreceivingantiretroviraltherapyconcurrently?

Data type

boolean

Has patient received any antiretroviral therapy prescribed prior to registration?
Description

Haspatientreceivedanyantiretroviraltherapyprescribedpriortoregistration?

Data type

boolean

Duration of Prior Antiretroviral Therapy
Description

DurationofPriorAntiretroviralTherapy

Data type

text

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1 forms
  1. StudyEvent: On Study Form - RF02B
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Ccrr Module For On Study Form - Rf02b
Patient Initials
Item
Patient Initials
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
Protocol ID Coordinating Group
Item
Study#
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1711341 (UMLS CUI-2)
C25462 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
NCIInstitutionIdentifierCode
Item
Site#
text
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
C21541 (NCI Thesaurus ObjectClass)
C0018704 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C19202 (NCI Thesaurus ObjectClass-2)
C1513882 (UMLS 2011AA ObjectClass-2)
Patient Study ID
Item
ID#
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25462 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
PatientRegistrationDate
Item
Date of Enrollment
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus ValueDomain-2)
C25646 (NCI Thesaurus Property)
C1514821 (UMLS 2011AA Property)
Institution Name
Item
Institution Name
text
C25191 (NCI Thesaurus ValueDomain)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass)
C21541 (NCI Thesaurus ValueDomain-2)
C25364 (NCI Thesaurus Property)
CancerInitialDiagnosisDate
Item
Date of Malignancy Diagnosis
date
C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C25509 (NCI Thesaurus Property)
C1279901 (UMLS 2011AA Property)
C15220 (NCI Thesaurus Property-2)
C0011900 (UMLS 2011AA Property-2)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
PriorOtherTherapyName
Item
Other therapy (e.g. hyperthermia, etc.), Specify
text
PriorCancerDiagnosisInd-3
Item
Prior or concurrent other malignancy?
boolean
C38148 (NCI Thesaurus 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)
PriorCancerDiagnosisDate
Item
Date of Malignancy Diagnosis
date
Item
Malignancy/Primary Site
text
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C25251 (NCI Thesaurus Property-2)
C0205225 (UMLS 2011AA Property-2)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
CL.6
Code List
Malignancy/Primary Site
CL Item
KS (KS)
CL Item
NHL (NHL)
CL Item
HD (HD)
CL Item
Anal (Anal)
CL Item
Cervical (Cervical)
CL Item
Other (Other)
Item
Malignancy/Primary Site
text
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C25251 (NCI Thesaurus Property-2)
C0205225 (UMLS 2011AA Property-2)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
CL.6
Code List
Malignancy/Primary Site
CL Item
KS (KS)
CL Item
NHL (NHL)
CL Item
HD (HD)
CL Item
Anal (Anal)
CL Item
Cervical (Cervical)
CL Item
Other (Other)
DiseasePrimarySiteText
Item
Other, Specify
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C25251 (NCI Thesaurus Property-2)
C0205225 (UMLS 2011AA Property-2)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
DiseasePrimarySiteText
Item
Other, Specify
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C25251 (NCI Thesaurus Property-2)
C0205225 (UMLS 2011AA Property-2)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
Histologic Type, other
Item
Histology
text
C25685 (NCI Thesaurus ValueDomain)
C1299220 (UMLS CUI-1)
C3262 (NCI Thesaurus ObjectClass)
C25526 (NCI Thesaurus Property)
C25161 (NCI Thesaurus Property-2)
Histologic Type, other
Item
Histology
text
C25685 (NCI Thesaurus ValueDomain)
C1299220 (UMLS CUI-1)
C3262 (NCI Thesaurus ObjectClass)
C25526 (NCI Thesaurus Property)
C25161 (NCI Thesaurus Property-2)
CancerPriorTreatmentInd-3
Item
Prior therapy for this malignancy?
boolean
C38148 (NCI Thesaurus 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)
CancerPriorTreatmentInd-3
Item
Prior therapy for this malignancy?
boolean
C38148 (NCI Thesaurus 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)
Item
If Yes, check all that apply
text
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C15632 (NCI Thesaurus ObjectClass)
C0392920 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus ObjectClass-2)
C0332152 (UMLS 2011AA ObjectClass-2)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
CL.8
Code List
If Yes, check all that apply
CL Item
Systemic chemotherapy (Systemic chemotherapy)
CL Item
Biological response modifiers or cytokines (Biological response modifiers or cytokines)
CL Item
Surgery (excluding biopsy) (Surgery (excluding biopsy))
CL Item
Cryotherapy (Cryotherapy)
CL Item
Systemic steroid therapy (Systemic steroid therapy)
CL Item
Radiotherapy (Radiotherapy)
CL Item
Topical/Intralesional Therapy (Topical/Intralesional Therapy)
CL Item
Investigational Drug (Antitumor) (Investigational Drug (Antitumor))
CL Item
Other therapy (e.g. hyperthermia, etc.) (Other therapy (e.g. hyperthermia, etc.))
Item
If Yes, check all that apply
text
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C15632 (NCI Thesaurus ObjectClass)
C0392920 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus ObjectClass-2)
C0332152 (UMLS 2011AA ObjectClass-2)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
CL.8
Code List
If Yes, check all that apply
CL Item
Systemic chemotherapy (Systemic chemotherapy)
CL Item
Biological response modifiers or cytokines (Biological response modifiers or cytokines)
CL Item
Surgery (excluding biopsy) (Surgery (excluding biopsy))
CL Item
Cryotherapy (Cryotherapy)
CL Item
Systemic steroid therapy (Systemic steroid therapy)
CL Item
Radiotherapy (Radiotherapy)
CL Item
Topical/Intralesional Therapy (Topical/Intralesional Therapy)
CL Item
Investigational Drug (Antitumor) (Investigational Drug (Antitumor))
CL Item
Other therapy (e.g. hyperthermia, etc.) (Other therapy (e.g. hyperthermia, etc.))
PriorTherapyOtherName
Item
Other 2, Specify
text
C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass-2)
C17649 (NCI Thesaurus Property)
C0205394 (UMLS 2011AA Property)
C25364 (NCI Thesaurus Property-2)
C0600091 (UMLS 2011AA Property-2)
C42614 (NCI Thesaurus ValueDomain)
C0027365 (UMLS 2011AA ValueDomain)
PriorTherapyOtherName
Item
Other 2, Specify
text
C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass-2)
C17649 (NCI Thesaurus Property)
C0205394 (UMLS 2011AA Property)
C25364 (NCI Thesaurus Property-2)
C0600091 (UMLS 2011AA Property-2)
C42614 (NCI Thesaurus ValueDomain)
C0027365 (UMLS 2011AA ValueDomain)
PriorTherapyOtherName
Item
Other 2, Specify
text
C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass-2)
C17649 (NCI Thesaurus Property)
C0205394 (UMLS 2011AA Property)
C25364 (NCI Thesaurus Property-2)
C0600091 (UMLS 2011AA Property-2)
C42614 (NCI Thesaurus ValueDomain)
C0027365 (UMLS 2011AA ValueDomain)
Item
Agent Name - unnamed
text
C25364 (NCI Thesaurus Property)
C1521826 (UMLS CUI-1)
C1708 (NCI Thesaurus ObjectClass)
C1708 (NCI Thesaurus ValueDomain)
C42614 (NCI Thesaurus ValueDomain-2)
CL.12
Code List
Agent Name - unnamed
CL Item
Enfuvirtide (Enfuvirtide)
CL Item
Delavirdine (Delavirdine)
CL Item
Efavirenz (Efavirenz)
CL Item
Nevirapine (Nevirapine)
CL Item
Abacavir (Abacavir)
CL Item
Trizivir (Trizivir)
CL Item
ddI (ddI)
CL Item
Didanosine (Didanosine)
CL Item
Emtricitabine (Emtricitabine)
CL Item
3TC (3TC)
CL Item
Combivir (Combivir)
CL Item
d4T (d4T)
CL Item
Tenofovir DF (Tenofovir DF)
CL Item
ddC (ddC)
CL Item
AZT (AZT)
CL Item
Amprenavir (Amprenavir)
CL Item
Atazanavir (Atazanavir)
CL Item
Fosamaprenavir (Fosamaprenavir)
CL Item
Indinavir (Indinavir)
CL Item
Kaletra (Kaletra)
CL Item
Nelfinavir (Nelfinavir)
CL Item
Ritonavir (Ritonavir)
CL Item
Saquinavir (Saquinavir)
CL Item
Other (Other)
CL Item
Other, Specify (Other, Specify)
Item
Agent Name - unnamed
text
C25364 (NCI Thesaurus Property)
C1521826 (UMLS CUI-1)
C1708 (NCI Thesaurus ObjectClass)
C1708 (NCI Thesaurus ValueDomain)
C42614 (NCI Thesaurus ValueDomain-2)
CL.12
Code List
Agent Name - unnamed
CL Item
Enfuvirtide (Enfuvirtide)
CL Item
Delavirdine (Delavirdine)
CL Item
Efavirenz (Efavirenz)
CL Item
Nevirapine (Nevirapine)
CL Item
Abacavir (Abacavir)
CL Item
Trizivir (Trizivir)
CL Item
ddI (ddI)
CL Item
Didanosine (Didanosine)
CL Item
Emtricitabine (Emtricitabine)
CL Item
3TC (3TC)
CL Item
Combivir (Combivir)
CL Item
d4T (d4T)
CL Item
Tenofovir DF (Tenofovir DF)
CL Item
ddC (ddC)
CL Item
AZT (AZT)
CL Item
Amprenavir (Amprenavir)
CL Item
Atazanavir (Atazanavir)
CL Item
Fosamaprenavir (Fosamaprenavir)
CL Item
Indinavir (Indinavir)
CL Item
Kaletra (Kaletra)
CL Item
Nelfinavir (Nelfinavir)
CL Item
Ritonavir (Ritonavir)
CL Item
Saquinavir (Saquinavir)
CL Item
Other (Other)
CL Item
Other, Specify (Other, Specify)
Item
Agent Name - unnamed
text
C25364 (NCI Thesaurus Property)
C1521826 (UMLS CUI-1)
C1708 (NCI Thesaurus ObjectClass)
C1708 (NCI Thesaurus ValueDomain)
C42614 (NCI Thesaurus ValueDomain-2)
CL.12
Code List
Agent Name - unnamed
CL Item
Enfuvirtide (Enfuvirtide)
CL Item
Delavirdine (Delavirdine)
CL Item
Efavirenz (Efavirenz)
CL Item
Nevirapine (Nevirapine)
CL Item
Abacavir (Abacavir)
CL Item
Trizivir (Trizivir)
CL Item
ddI (ddI)
CL Item
Didanosine (Didanosine)
CL Item
Emtricitabine (Emtricitabine)
CL Item
3TC (3TC)
CL Item
Combivir (Combivir)
CL Item
d4T (d4T)
CL Item
Tenofovir DF (Tenofovir DF)
CL Item
ddC (ddC)
CL Item
AZT (AZT)
CL Item
Amprenavir (Amprenavir)
CL Item
Atazanavir (Atazanavir)
CL Item
Fosamaprenavir (Fosamaprenavir)
CL Item
Indinavir (Indinavir)
CL Item
Kaletra (Kaletra)
CL Item
Nelfinavir (Nelfinavir)
CL Item
Ritonavir (Ritonavir)
CL Item
Saquinavir (Saquinavir)
CL Item
Other (Other)
CL Item
Other, Specify (Other, Specify)
Item
Agent Name - unnamed
text
C25364 (NCI Thesaurus Property)
C1521826 (UMLS CUI-1)
C1708 (NCI Thesaurus ObjectClass)
C1708 (NCI Thesaurus ValueDomain)
C42614 (NCI Thesaurus ValueDomain-2)
CL.12
Code List
Agent Name - unnamed
CL Item
Enfuvirtide (Enfuvirtide)
CL Item
Delavirdine (Delavirdine)
CL Item
Efavirenz (Efavirenz)
CL Item
Nevirapine (Nevirapine)
CL Item
Abacavir (Abacavir)
CL Item
Trizivir (Trizivir)
CL Item
ddI (ddI)
CL Item
Didanosine (Didanosine)
CL Item
Emtricitabine (Emtricitabine)
CL Item
3TC (3TC)
CL Item
Combivir (Combivir)
CL Item
d4T (d4T)
CL Item
Tenofovir DF (Tenofovir DF)
CL Item
ddC (ddC)
CL Item
AZT (AZT)
CL Item
Amprenavir (Amprenavir)
CL Item
Atazanavir (Atazanavir)
CL Item
Fosamaprenavir (Fosamaprenavir)
CL Item
Indinavir (Indinavir)
CL Item
Kaletra (Kaletra)
CL Item
Nelfinavir (Nelfinavir)
CL Item
Ritonavir (Ritonavir)
CL Item
Saquinavir (Saquinavir)
CL Item
Other (Other)
CL Item
Other, Specify (Other, Specify)
DateofHIV+diagnosis
Item
Date of HIV+ diagnosis
text
DateofAIDSdiagnosis
Item
Date of AIDS diagnosis
text
Item
CDC HIV Risk Group
text
CL.1
Code List
CDC HIV Risk Group
CL Item
Homosexual or bisexual contact (Homosexual or bisexual contact)
CL Item
Hetersexual contact (Hetersexual contact)
CL Item
IV drug user (IV drug user)
CL Item
Transfusion recipient (Transfusion recipient)
CL Item
Hemophiliac (Hemophiliac)
CL Item
Other (Other)
Other,Specify
Item
Other, Specify
text
Biologicalresponsemodifiersorcytokines,Specify
Item
Biological response modifiers or cytokines, Specify
text
Biologicalresponsemodifiersorcytokines,Specify
Item
Biological response modifiers or cytokines, Specify
text
Ispatientreceivingantiretroviraltherapyconcurrently?
Item
Is patient receiving antiretroviral therapy concurrently?
boolean
Haspatientreceivedanyantiretroviraltherapyprescribedpriortoregistration?
Item
Has patient received any antiretroviral therapy prescribed prior to registration?
boolean
Item
Duration of Prior Antiretroviral Therapy
text
CL.13
Code List
Duration of Prior Antiretroviral Therapy
CL Item
<3 Months (<3 Months)
CL Item
3-6 Months (3-6 Months)
CL Item
>6-12 Months (>6-12 Months)
CL Item
>12 Months (>12 Months)
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