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7593

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AMC-063 On-Study Form (F02) Bortezomib in Treating Patients With Relapsed or Refractory AIDS-Related Kaposi Sarcoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=8100CE37-2287-8765-E040-BB89AD431777

Länk

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=8100CE37-2287-8765-E040-BB89AD431777

Nyckelord

Versioner (2)
  1. 2012-09-20 2012-09-20 -
  2. 2015-01-09 2015-01-09 - Martin Dugas
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9 januari 2015

DOI

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Creative Commons BY-NC 3.0 Legacy
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    Sarcoma NCT01016730 On-Study - AMC-063 On-Study Form (F02) - 3019506v1.0

    Engelsk

    No Instruction available.

    1 Formulär  
    1. StudyEvent: AMC-063 On-Study Form (F02)
      1. No Instruction available.
    Header
    Beskrivning

    Header

    Visit number
    Beskrivning

    Visit number

    Datatyp

    float

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C1549755
    NCI Thesaurus ObjectClass
    C16696
    NCI Thesaurus Property
    C25385
    Hiv History
    Beskrivning

    Hiv History

    Date of HIV+ diagnosis (mm/dd/yyyy)
    Beskrivning

    HumanImmunodeficiencyVirusDiagnosisDate

    Datatyp

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ObjectClass
    C14219
    UMLS 2011AA ObjectClass
    C0019682
    NCI Thesaurus Property
    C15220
    UMLS 2011AA Property
    C0011900
    Date of AIDS diagnosis (mm/dd/yyyy)
    Beskrivning

    AcquiredImmunodeficiencySyndromeDiagnosisDate

    Datatyp

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus Property
    C15220
    UMLS 2011AA Property
    C0011900
    NCI Thesaurus ObjectClass
    C2851
    UMLS 2011AA ObjectClass
    C0001175
    CDC HIV Risk Group
    Beskrivning

    PatientHumanImmunodeficiencyVirusRiskCategory

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C14219
    UMLS 2011AA Property
    C0019682
    NCI Thesaurus Property-2
    C17102
    UMLS 2011AA Property-2
    C0035647
    NCI Thesaurus Property-3
    C25161
    UMLS 2011AA Property-3
    C0008902
    NCI Thesaurus ValueDomain
    C25372
    UMLS 2011AA ValueDomain
    C0683312
    Other, specify
    Beskrivning

    PatientHumanImmunodeficiencyVirusRiskCategorySpecify

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C14219
    UMLS 2011AA Property
    C0019682
    NCI Thesaurus Property-2
    C17102
    UMLS 2011AA Property-2
    C0035647
    NCI Thesaurus Property-3
    C25161
    UMLS 2011AA Property-3
    C0008902
    NCI Thesaurus ValueDomain
    C25685
    UMLS 2011AA ValueDomain
    C1521902
    Ccrr Module For On Study Form - Rf02b
    Beskrivning

    Ccrr Module For On Study Form - Rf02b

    Date of Initial Pathologic Diagnosis (mm/dd/yyyy)
    Beskrivning

    CancerInitialDiagnosisDate

    Datatyp

    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
    Primary site
    Beskrivning

    AcquiredImmunodeficiencySyndromeMalignantNeoplasmPrimarySite

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C9305
    UMLS 2011AA ObjectClass
    C0006826
    NCI Thesaurus ObjectClass-2
    C2851
    UMLS 2011AA ObjectClass-2
    C0001175
    NCI Thesaurus Property
    C25341
    UMLS 2011AA Property
    C0450429
    NCI Thesaurus Property-2
    C25251
    UMLS 2011AA Property-2
    C0205225
    NCI Thesaurus ValueDomain
    C37901
    UMLS 2011AA ValueDomain
    C0205145
    Other specify
    Beskrivning

    MalignantNeoplasmPrimarySiteSpecify

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    UMLS 2011AA ValueDomain
    C1521902
    NCI Thesaurus Property
    C25341
    UMLS 2011AA Property
    C0450429
    NCI Thesaurus Property-2
    C25251
    UMLS 2011AA Property-2
    C0205225
    NCI Thesaurus ObjectClass
    C9305
    UMLS 2011AA ObjectClass
    C0006826
    Specify tumor histologic category
    Beskrivning

    DominantTumorHistologicCategorySpecify

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C3262
    UMLS 2011AA ObjectClass
    C0027651
    NCI Thesaurus ObjectClass-2
    C25487
    UMLS 2011AA ObjectClass-2
    C1527180
    NCI Thesaurus Property
    C25526
    UMLS 2011AA Property
    C0205462
    NCI Thesaurus Property-2
    C25161
    UMLS 2011AA Property-2
    C0008902
    NCI Thesaurus ValueDomain
    C25685
    UMLS 2011AA ValueDomain
    C1521902
    Prior Treatment? (If "Yes", Check below)
    Beskrivning

    CancerPriorTreatmentInd-3

    Datatyp

    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 Systemic Chemotherapy
    Beskrivning

    PriorChemotherapyAdministeredInd-3

    Datatyp

    boolean

    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
    Prior Biological Response Modifiers or Cytokines
    Beskrivning

    PriorBiologicalTherapyAdministeredInd-3

    Datatyp

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS 2011AA ValueDomain
    C1512699
    NCI Thesaurus ObjectClass
    C25629
    UMLS 2011AA ObjectClass
    C0332152
    NCI Metathesaurus ObjectClass
    C0005527
    NCI Thesaurus Property
    C25382
    UMLS 2011AA Property
    C1521801
    Specify (If "Yes")
    Beskrivning

    PriorBiologicalTherapyAdministeredText

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704
    UMLS 2011AA ValueDomain
    C1527021
    NCI Thesaurus ObjectClass
    C25629
    UMLS 2011AA ObjectClass
    C0332152
    NCI Metathesaurus ObjectClass
    C0005527
    NCI Thesaurus Property
    C25382
    UMLS 2011AA Property
    C1521801
    Prior Surgery (excluding biopsy)
    Beskrivning

    Prior Surgery

    Datatyp

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS CUI-1
    C0744961
    NCI Thesaurus Property
    C38000
    NCI Thesaurus ObjectClass
    C15329
    NCI Thesaurus ObjectClass-2
    C25629
    Prior cryotherapy
    Beskrivning

    PriorTherapyCryotherapyAdministeredInd-2

    Datatyp

    boolean

    Alias
    NCI Thesaurus ObjectClass
    C25629
    UMLS 2011AA ObjectClass
    C0332152
    NCI Thesaurus ObjectClass-2
    C15368
    NCI Thesaurus Property
    C40030
    UMLS 2011AA Property
    C0010412
    NCI Thesaurus Property-2
    C25382
    UMLS 2011AA Property-2
    C1521801
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    Prior systemic steroid therapy
    Beskrivning

    PriorSteroidTherapyAdministeredInd-2

    Datatyp

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    NCI Thesaurus ObjectClass
    C25629
    UMLS 2011AA ObjectClass
    C0332152
    NCI Thesaurus Property
    C25382
    UMLS 2011AA Property
    C1521801
    NCI Thesaurus ObjectClass-2
    C15370
    UMLS 2011AA ObjectClass-2
    C0149783
    Prior Radiation Therapy
    Beskrivning

    Prior Radiation Therapy

    Datatyp

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS CUI-1
    C1522449
    NCI Thesaurus ObjectClass
    C15313
    UMLS CUI-2
    C0332152
    NCI Thesaurus ObjectClass-2
    C25629
    NCI Thesaurus Property
    C25382
    Prior topical/intralesional therapy
    Beskrivning

    PriorTherapyTopicalIntralesionalAdministeredInd-2

    Datatyp

    boolean

    Alias
    NCI Thesaurus ObjectClass
    C25629
    UMLS 2011AA ObjectClass
    C0332152
    NCI Thesaurus ObjectClass-2
    C15368
    NCI Thesaurus Property
    C13344
    UMLS 2011AA Property
    C0332237
    NCI Thesaurus Property-2
    C25382
    UMLS 2011AA Property-2
    C1521801
    NCI Thesaurus Property-3
    C28040
    UMLS 2011AA Property-3
    C1512954
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    Other Prior Therapy (e.g. Hyperthermia, etc.)
    Beskrivning

    PriorTherapyOtherAdministeredInd-3

    Datatyp

    boolean

    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
    C25382
    UMLS 2011AA Property-2
    C1521801
    NCI Thesaurus ValueDomain
    C38148
    UMLS 2011AA ValueDomain
    C1512699
    Other Prior Therapy (e.g. Hyperthermia, etc.)
    Beskrivning

    PriorTherapyOtherAdministeredInd-3

    Datatyp

    boolean

    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
    C25382
    UMLS 2011AA Property-2
    C1521801
    NCI Thesaurus ValueDomain
    C38148
    UMLS 2011AA ValueDomain
    C1512699
    Specify (If "Yes" 1 2 3)
    Beskrivning

    PriorTherapyOtherAdministeredSpecify

    Datatyp

    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
    C25382
    UMLS 2011AA Property-2
    C1521801
    NCI Thesaurus ValueDomain
    C25685
    UMLS 2011AA ValueDomain
    C1521902
    Name of other prior therapies (If "Yes")
    Beskrivning

    PriorTherapyOtherName

    Datatyp

    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
    Ccrr Module For On Study Form - Rf02b
    Beskrivning

    Ccrr Module For On Study Form - Rf02b

    History of Prior Malignancy
    Beskrivning

    PriorCancerDiagnosisInd-3

    Datatyp

    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 Diagnosis of Previous Malignancy (mm/dd/yyyy)
    Beskrivning

    PriorCancerDiagnosisDate

    Datatyp

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    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
    Primary site
    Beskrivning

    AcquiredImmunodeficiencySyndromeMalignantNeoplasmPrimarySite

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C9305
    UMLS 2011AA ObjectClass
    C0006826
    NCI Thesaurus ObjectClass-2
    C2851
    UMLS 2011AA ObjectClass-2
    C0001175
    NCI Thesaurus Property
    C25341
    UMLS 2011AA Property
    C0450429
    NCI Thesaurus Property-2
    C25251
    UMLS 2011AA Property-2
    C0205225
    NCI Thesaurus ValueDomain
    C37901
    UMLS 2011AA ValueDomain
    C0205145
    Other specify
    Beskrivning

    MalignantNeoplasmPrimarySiteSpecify

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    UMLS 2011AA ValueDomain
    C1521902
    NCI Thesaurus Property
    C25341
    UMLS 2011AA Property
    C0450429
    NCI Thesaurus Property-2
    C25251
    UMLS 2011AA Property-2
    C0205225
    NCI Thesaurus ObjectClass
    C9305
    UMLS 2011AA ObjectClass
    C0006826
    Specify tumor histologic category
    Beskrivning

    DominantTumorHistologicCategorySpecify

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C3262
    UMLS 2011AA ObjectClass
    C0027651
    NCI Thesaurus ObjectClass-2
    C25487
    UMLS 2011AA ObjectClass-2
    C1527180
    NCI Thesaurus Property
    C25526
    UMLS 2011AA Property
    C0205462
    NCI Thesaurus Property-2
    C25161
    UMLS 2011AA Property-2
    C0008902
    NCI Thesaurus ValueDomain
    C25685
    UMLS 2011AA ValueDomain
    C1521902
    Prior Treatment? (If "Yes", Check below)
    Beskrivning

    CancerPriorTreatmentInd-3

    Datatyp

    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 Systemic Chemotherapy
    Beskrivning

    PriorChemotherapyAdministeredInd-3

    Datatyp

    boolean

    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
    Prior Biological Response Modifiers or Cytokines
    Beskrivning

    PriorBiologicalTherapyAdministeredInd-3

    Datatyp

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS 2011AA ValueDomain
    C1512699
    NCI Thesaurus ObjectClass
    C25629
    UMLS 2011AA ObjectClass
    C0332152
    NCI Metathesaurus ObjectClass
    C0005527
    NCI Thesaurus Property
    C25382
    UMLS 2011AA Property
    C1521801
    Specify (If "Yes")
    Beskrivning

    PriorBiologicalTherapyAdministeredText

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704
    UMLS 2011AA ValueDomain
    C1527021
    NCI Thesaurus ObjectClass
    C25629
    UMLS 2011AA ObjectClass
    C0332152
    NCI Metathesaurus ObjectClass
    C0005527
    NCI Thesaurus Property
    C25382
    UMLS 2011AA Property
    C1521801
    Prior Surgery (excluding biopsy)
    Beskrivning

    Prior Surgery

    Datatyp

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS CUI-1
    C0744961
    NCI Thesaurus Property
    C38000
    NCI Thesaurus ObjectClass
    C15329
    NCI Thesaurus ObjectClass-2
    C25629
    Prior cryotherapy
    Beskrivning

    PriorTherapyCryotherapyAdministeredInd-2

    Datatyp

    boolean

    Alias
    NCI Thesaurus ObjectClass
    C25629
    UMLS 2011AA ObjectClass
    C0332152
    NCI Thesaurus ObjectClass-2
    C15368
    NCI Thesaurus Property
    C40030
    UMLS 2011AA Property
    C0010412
    NCI Thesaurus Property-2
    C25382
    UMLS 2011AA Property-2
    C1521801
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    Prior systemic steroid therapy
    Beskrivning

    PriorSteroidTherapyAdministeredInd-2

    Datatyp

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    NCI Thesaurus ObjectClass
    C25629
    UMLS 2011AA ObjectClass
    C0332152
    NCI Thesaurus Property
    C25382
    UMLS 2011AA Property
    C1521801
    NCI Thesaurus ObjectClass-2
    C15370
    UMLS 2011AA ObjectClass-2
    C0149783
    Prior Radiation Therapy
    Beskrivning

    Prior Radiation Therapy

    Datatyp

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS CUI-1
    C1522449
    NCI Thesaurus ObjectClass
    C15313
    UMLS CUI-2
    C0332152
    NCI Thesaurus ObjectClass-2
    C25629
    NCI Thesaurus Property
    C25382
    Prior topical/intralesional therapy
    Beskrivning

    PriorTherapyTopicalIntralesionalAdministeredInd-2

    Datatyp

    boolean

    Alias
    NCI Thesaurus ObjectClass
    C25629
    UMLS 2011AA ObjectClass
    C0332152
    NCI Thesaurus ObjectClass-2
    C15368
    NCI Thesaurus Property
    C13344
    UMLS 2011AA Property
    C0332237
    NCI Thesaurus Property-2
    C25382
    UMLS 2011AA Property-2
    C1521801
    NCI Thesaurus Property-3
    C28040
    UMLS 2011AA Property-3
    C1512954
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    Other Prior Therapy (e.g. Hyperthermia, etc.)
    Beskrivning

    PriorTherapyOtherAdministeredInd-3

    Datatyp

    boolean

    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
    C25382
    UMLS 2011AA Property-2
    C1521801
    NCI Thesaurus ValueDomain
    C38148
    UMLS 2011AA ValueDomain
    C1512699
    Other Prior Therapy (e.g. Hyperthermia, etc.)
    Beskrivning

    PriorTherapyOtherAdministeredInd-3

    Datatyp

    boolean

    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
    C25382
    UMLS 2011AA Property-2
    C1521801
    NCI Thesaurus ValueDomain
    C38148
    UMLS 2011AA ValueDomain
    C1512699
    Specify (If "Yes" 1 2 3)
    Beskrivning

    PriorTherapyOtherAdministeredSpecify

    Datatyp

    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
    C25382
    UMLS 2011AA Property-2
    C1521801
    NCI Thesaurus ValueDomain
    C25685
    UMLS 2011AA ValueDomain
    C1521902
    Name of other prior therapies (If "Yes")
    Beskrivning

    PriorTherapyOtherName

    Datatyp

    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
    Antiretroviral Therapy
    Beskrivning

    Antiretroviral Therapy

    Agent Name
    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 (1 2)
    Beskrivning

    Anti-RetroviralAgentsAdministeredSpecify

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    UMLS 2011AA ValueDomain
    C1521902
    NCI Thesaurus Property
    C25382
    UMLS 2011AA Property
    C1521801
    NCI Thesaurus ValueDomain-2
    C25382
    UMLS 2011AA ValueDomain-2
    C1521801
    NCI Metathesaurus ObjectClass
    C0599685
    Agent use
    Beskrivning

    Anti-RetroviralAgentsAdministeredStatus

    Datatyp

    text

    Alias
    NCI Thesaurus Property
    C25382
    UMLS 2011AA Property
    C1521801
    NCI Thesaurus ValueDomain
    C25688
    UMLS 2011AA ValueDomain
    C0449438
    NCI Metathesaurus ObjectClass
    C0599685
    Duration if prior agents received
    Beskrivning

    Anti-RetroviralAgentsDurationAdministeredType

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    NCI Thesaurus Property
    C25382
    UMLS 2011AA Property
    C1521801
    NCI Metathesaurus ObjectClass
    C0599685
    NCI Thesaurus Property-2
    C25330
    UMLS 2011AA Property-2
    C0449238
    Comments
    Beskrivning

    Comments

    Comments
    Beskrivning

    Research Comments

    Datatyp

    text

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

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    1 Formulär
    1. StudyEvent: AMC-063 On-Study Form (F02)
      1. No Instruction available.
    Name
    Typ
    Description | Question | Decode (Coded Value)
    Datatyp
    Alias
    Item Group
    Header
    Visit number
    Item
    Visit number
    float
    C25337 (NCI Thesaurus ValueDomain)
    C1549755 (UMLS CUI-1)
    C16696 (NCI Thesaurus ObjectClass)
    C25385 (NCI Thesaurus Property)
    Item Group
    Hiv History
    HumanImmunodeficiencyVirusDiagnosisDate
    Item
    Date of HIV+ diagnosis (mm/dd/yyyy)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C14219 (NCI Thesaurus ObjectClass)
    C0019682 (UMLS 2011AA ObjectClass)
    C15220 (NCI Thesaurus Property)
    C0011900 (UMLS 2011AA Property)
    AcquiredImmunodeficiencySyndromeDiagnosisDate
    Item
    Date of AIDS diagnosis (mm/dd/yyyy)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C15220 (NCI Thesaurus Property)
    C0011900 (UMLS 2011AA Property)
    C2851 (NCI Thesaurus ObjectClass)
    C0001175 (UMLS 2011AA ObjectClass)
    Item
    CDC HIV Risk Group
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C14219 (NCI Thesaurus Property)
    C0019682 (UMLS 2011AA Property)
    C17102 (NCI Thesaurus Property-2)
    C0035647 (UMLS 2011AA Property-2)
    C25161 (NCI Thesaurus Property-3)
    C0008902 (UMLS 2011AA Property-3)
    C25372 (NCI Thesaurus ValueDomain)
    C0683312 (UMLS 2011AA ValueDomain)
    CL.1
    Code List
    CDC HIV Risk Group
    CL Item
    Homosexual Or Bisexual Contact (Homosexual or bisexual contact)
    CL Item
    Heterosexual Contact (Heterosexual contact)
    CL Item
    Iv Drug User (IV drug user)
    CL Item
    Transfusion Recipient (Transfusion recipient)
    CL Item
    Hemophilia (Hemophiliac)
    C3093 (NCI Thesaurus)
    C0684275 (UMLS 2011AA)
    CL Item
    Other (Other)
    C17649 (NCI Thesaurus)
    C0205394 (UMLS 2011AA)
    PatientHumanImmunodeficiencyVirusRiskCategorySpecify
    Item
    Other, specify
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C14219 (NCI Thesaurus Property)
    C0019682 (UMLS 2011AA Property)
    C17102 (NCI Thesaurus Property-2)
    C0035647 (UMLS 2011AA Property-2)
    C25161 (NCI Thesaurus Property-3)
    C0008902 (UMLS 2011AA Property-3)
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    Item Group
    Ccrr Module For On Study Form - Rf02b
    CancerInitialDiagnosisDate
    Item
    Date of Initial Pathologic Diagnosis (mm/dd/yyyy)
    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)
    Item
    Primary site
    text
    C9305 (NCI Thesaurus ObjectClass)
    C0006826 (UMLS 2011AA ObjectClass)
    C2851 (NCI Thesaurus ObjectClass-2)
    C0001175 (UMLS 2011AA ObjectClass-2)
    C25341 (NCI Thesaurus Property)
    C0450429 (UMLS 2011AA Property)
    C25251 (NCI Thesaurus Property-2)
    C0205225 (UMLS 2011AA Property-2)
    C37901 (NCI Thesaurus ValueDomain)
    C0205145 (UMLS 2011AA ValueDomain)
    CL.14
    Code List
    Primary site
    CL Item
    Kaposi Sarcoma (KS)
    C9087 (NCI Thesaurus)
    C0036220 (UMLS 2011AA)
    CL Item
    Non-hodgkin's Lymphoma (NHL)
    C3211 (NCI Thesaurus)
    C0024305 (UMLS 2011AA)
    CL Item
    Hd (HD)
    CL Item
    Anal Canal (Anal)
    C12375 (NCI Thesaurus)
    C0227411 (UMLS 2011AA)
    CL Item
    Cervical (Cervical)
    C12844 (NCI Thesaurus)
    C0205064 (UMLS 2011AA)
    CL Item
    Other Primary Site (Other primary site)
    MalignantNeoplasmPrimarySiteSpecify
    Item
    Other specify
    text
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    C25341 (NCI Thesaurus Property)
    C0450429 (UMLS 2011AA Property)
    C25251 (NCI Thesaurus Property-2)
    C0205225 (UMLS 2011AA Property-2)
    C9305 (NCI Thesaurus ObjectClass)
    C0006826 (UMLS 2011AA ObjectClass)
    DominantTumorHistologicCategorySpecify
    Item
    Specify tumor histologic category
    text
    C3262 (NCI Thesaurus ObjectClass)
    C0027651 (UMLS 2011AA ObjectClass)
    C25487 (NCI Thesaurus ObjectClass-2)
    C1527180 (UMLS 2011AA ObjectClass-2)
    C25526 (NCI Thesaurus Property)
    C0205462 (UMLS 2011AA Property)
    C25161 (NCI Thesaurus Property-2)
    C0008902 (UMLS 2011AA Property-2)
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    CancerPriorTreatmentInd-3
    Item
    Prior Treatment? (If "Yes", Check below)
    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)
    PriorChemotherapyAdministeredInd-3
    Item
    Prior Systemic Chemotherapy
    boolean
    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)
    PriorBiologicalTherapyAdministeredInd-3
    Item
    Prior Biological Response Modifiers or Cytokines
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C1512699 (UMLS 2011AA ValueDomain)
    C25629 (NCI Thesaurus ObjectClass)
    C0332152 (UMLS 2011AA ObjectClass)
    C0005527 (NCI Metathesaurus ObjectClass)
    C25382 (NCI Thesaurus Property)
    C1521801 (UMLS 2011AA Property)
    PriorBiologicalTherapyAdministeredText
    Item
    Specify (If "Yes")
    text
    C25704 (NCI Thesaurus ValueDomain)
    C1527021 (UMLS 2011AA ValueDomain)
    C25629 (NCI Thesaurus ObjectClass)
    C0332152 (UMLS 2011AA ObjectClass)
    C0005527 (NCI Metathesaurus ObjectClass)
    C25382 (NCI Thesaurus Property)
    C1521801 (UMLS 2011AA Property)
    Prior Surgery
    Item
    Prior Surgery (excluding biopsy)
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C0744961 (UMLS CUI-1)
    C38000 (NCI Thesaurus Property)
    C15329 (NCI Thesaurus ObjectClass)
    C25629 (NCI Thesaurus ObjectClass-2)
    PriorTherapyCryotherapyAdministeredInd-2
    Item
    Prior cryotherapy
    boolean
    C25629 (NCI Thesaurus ObjectClass)
    C0332152 (UMLS 2011AA ObjectClass)
    C15368 (NCI Thesaurus ObjectClass-2)
    C40030 (NCI Thesaurus Property)
    C0010412 (UMLS 2011AA Property)
    C25382 (NCI Thesaurus Property-2)
    C1521801 (UMLS 2011AA Property-2)
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    PriorSteroidTherapyAdministeredInd-2
    Item
    Prior systemic steroid therapy
    boolean
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    C25629 (NCI Thesaurus ObjectClass)
    C0332152 (UMLS 2011AA ObjectClass)
    C25382 (NCI Thesaurus Property)
    C1521801 (UMLS 2011AA Property)
    C15370 (NCI Thesaurus ObjectClass-2)
    C0149783 (UMLS 2011AA ObjectClass-2)
    Prior Radiation Therapy
    Item
    Prior Radiation Therapy
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C1522449 (UMLS CUI-1)
    C15313 (NCI Thesaurus ObjectClass)
    C0332152 (UMLS CUI-2)
    C25629 (NCI Thesaurus ObjectClass-2)
    C25382 (NCI Thesaurus Property)
    PriorTherapyTopicalIntralesionalAdministeredInd-2
    Item
    Prior topical/intralesional therapy
    boolean
    C25629 (NCI Thesaurus ObjectClass)
    C0332152 (UMLS 2011AA ObjectClass)
    C15368 (NCI Thesaurus ObjectClass-2)
    C13344 (NCI Thesaurus Property)
    C0332237 (UMLS 2011AA Property)
    C25382 (NCI Thesaurus Property-2)
    C1521801 (UMLS 2011AA Property-2)
    C28040 (NCI Thesaurus Property-3)
    C1512954 (UMLS 2011AA Property-3)
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    PriorTherapyOtherAdministeredInd-3
    Item
    Other Prior Therapy (e.g. Hyperthermia, etc.)
    boolean
    C25629 (NCI Thesaurus ObjectClass)
    C0332152 (UMLS 2011AA ObjectClass)
    C15368 (NCI Thesaurus ObjectClass-2)
    C17649 (NCI Thesaurus Property)
    C0205394 (UMLS 2011AA Property)
    C25382 (NCI Thesaurus Property-2)
    C1521801 (UMLS 2011AA Property-2)
    C38148 (NCI Thesaurus ValueDomain)
    C1512699 (UMLS 2011AA ValueDomain)
    PriorTherapyOtherAdministeredInd-3
    Item
    Other Prior Therapy (e.g. Hyperthermia, etc.)
    boolean
    C25629 (NCI Thesaurus ObjectClass)
    C0332152 (UMLS 2011AA ObjectClass)
    C15368 (NCI Thesaurus ObjectClass-2)
    C17649 (NCI Thesaurus Property)
    C0205394 (UMLS 2011AA Property)
    C25382 (NCI Thesaurus Property-2)
    C1521801 (UMLS 2011AA Property-2)
    C38148 (NCI Thesaurus ValueDomain)
    C1512699 (UMLS 2011AA ValueDomain)
    PriorTherapyOtherAdministeredSpecify
    Item
    Specify (If "Yes" 1 2 3)
    text
    C25629 (NCI Thesaurus ObjectClass)
    C0332152 (UMLS 2011AA ObjectClass)
    C15368 (NCI Thesaurus ObjectClass-2)
    C17649 (NCI Thesaurus Property)
    C0205394 (UMLS 2011AA Property)
    C25382 (NCI Thesaurus Property-2)
    C1521801 (UMLS 2011AA Property-2)
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    PriorTherapyOtherName
    Item
    Name of other prior therapies (If "Yes")
    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 Group
    Ccrr Module For On Study Form - Rf02b
    PriorCancerDiagnosisInd-3
    Item
    History of Prior 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 Diagnosis of Previous Malignancy (mm/dd/yyyy)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (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)
    Item
    Primary site
    text
    C9305 (NCI Thesaurus ObjectClass)
    C0006826 (UMLS 2011AA ObjectClass)
    C2851 (NCI Thesaurus ObjectClass-2)
    C0001175 (UMLS 2011AA ObjectClass-2)
    C25341 (NCI Thesaurus Property)
    C0450429 (UMLS 2011AA Property)
    C25251 (NCI Thesaurus Property-2)
    C0205225 (UMLS 2011AA Property-2)
    C37901 (NCI Thesaurus ValueDomain)
    C0205145 (UMLS 2011AA ValueDomain)
    CL.14
    Code List
    Primary site
    CL Item
    Kaposi Sarcoma (KS)
    C9087 (NCI Thesaurus)
    C0036220 (UMLS 2011AA)
    CL Item
    Non-hodgkin's Lymphoma (NHL)
    C3211 (NCI Thesaurus)
    C0024305 (UMLS 2011AA)
    CL Item
    Hd (HD)
    CL Item
    Anal Canal (Anal)
    C12375 (NCI Thesaurus)
    C0227411 (UMLS 2011AA)
    CL Item
    Cervical (Cervical)
    C12844 (NCI Thesaurus)
    C0205064 (UMLS 2011AA)
    CL Item
    Other Primary Site (Other primary site)
    MalignantNeoplasmPrimarySiteSpecify
    Item
    Other specify
    text
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    C25341 (NCI Thesaurus Property)
    C0450429 (UMLS 2011AA Property)
    C25251 (NCI Thesaurus Property-2)
    C0205225 (UMLS 2011AA Property-2)
    C9305 (NCI Thesaurus ObjectClass)
    C0006826 (UMLS 2011AA ObjectClass)
    DominantTumorHistologicCategorySpecify
    Item
    Specify tumor histologic category
    text
    C3262 (NCI Thesaurus ObjectClass)
    C0027651 (UMLS 2011AA ObjectClass)
    C25487 (NCI Thesaurus ObjectClass-2)
    C1527180 (UMLS 2011AA ObjectClass-2)
    C25526 (NCI Thesaurus Property)
    C0205462 (UMLS 2011AA Property)
    C25161 (NCI Thesaurus Property-2)
    C0008902 (UMLS 2011AA Property-2)
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    CancerPriorTreatmentInd-3
    Item
    Prior Treatment? (If "Yes", Check below)
    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)
    PriorChemotherapyAdministeredInd-3
    Item
    Prior Systemic Chemotherapy
    boolean
    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)
    PriorBiologicalTherapyAdministeredInd-3
    Item
    Prior Biological Response Modifiers or Cytokines
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C1512699 (UMLS 2011AA ValueDomain)
    C25629 (NCI Thesaurus ObjectClass)
    C0332152 (UMLS 2011AA ObjectClass)
    C0005527 (NCI Metathesaurus ObjectClass)
    C25382 (NCI Thesaurus Property)
    C1521801 (UMLS 2011AA Property)
    PriorBiologicalTherapyAdministeredText
    Item
    Specify (If "Yes")
    text
    C25704 (NCI Thesaurus ValueDomain)
    C1527021 (UMLS 2011AA ValueDomain)
    C25629 (NCI Thesaurus ObjectClass)
    C0332152 (UMLS 2011AA ObjectClass)
    C0005527 (NCI Metathesaurus ObjectClass)
    C25382 (NCI Thesaurus Property)
    C1521801 (UMLS 2011AA Property)
    Prior Surgery
    Item
    Prior Surgery (excluding biopsy)
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C0744961 (UMLS CUI-1)
    C38000 (NCI Thesaurus Property)
    C15329 (NCI Thesaurus ObjectClass)
    C25629 (NCI Thesaurus ObjectClass-2)
    PriorTherapyCryotherapyAdministeredInd-2
    Item
    Prior cryotherapy
    boolean
    C25629 (NCI Thesaurus ObjectClass)
    C0332152 (UMLS 2011AA ObjectClass)
    C15368 (NCI Thesaurus ObjectClass-2)
    C40030 (NCI Thesaurus Property)
    C0010412 (UMLS 2011AA Property)
    C25382 (NCI Thesaurus Property-2)
    C1521801 (UMLS 2011AA Property-2)
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    PriorSteroidTherapyAdministeredInd-2
    Item
    Prior systemic steroid therapy
    boolean
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    C25629 (NCI Thesaurus ObjectClass)
    C0332152 (UMLS 2011AA ObjectClass)
    C25382 (NCI Thesaurus Property)
    C1521801 (UMLS 2011AA Property)
    C15370 (NCI Thesaurus ObjectClass-2)
    C0149783 (UMLS 2011AA ObjectClass-2)
    Prior Radiation Therapy
    Item
    Prior Radiation Therapy
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C1522449 (UMLS CUI-1)
    C15313 (NCI Thesaurus ObjectClass)
    C0332152 (UMLS CUI-2)
    C25629 (NCI Thesaurus ObjectClass-2)
    C25382 (NCI Thesaurus Property)
    PriorTherapyTopicalIntralesionalAdministeredInd-2
    Item
    Prior topical/intralesional therapy
    boolean
    C25629 (NCI Thesaurus ObjectClass)
    C0332152 (UMLS 2011AA ObjectClass)
    C15368 (NCI Thesaurus ObjectClass-2)
    C13344 (NCI Thesaurus Property)
    C0332237 (UMLS 2011AA Property)
    C25382 (NCI Thesaurus Property-2)
    C1521801 (UMLS 2011AA Property-2)
    C28040 (NCI Thesaurus Property-3)
    C1512954 (UMLS 2011AA Property-3)
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    PriorTherapyOtherAdministeredInd-3
    Item
    Other Prior Therapy (e.g. Hyperthermia, etc.)
    boolean
    C25629 (NCI Thesaurus ObjectClass)
    C0332152 (UMLS 2011AA ObjectClass)
    C15368 (NCI Thesaurus ObjectClass-2)
    C17649 (NCI Thesaurus Property)
    C0205394 (UMLS 2011AA Property)
    C25382 (NCI Thesaurus Property-2)
    C1521801 (UMLS 2011AA Property-2)
    C38148 (NCI Thesaurus ValueDomain)
    C1512699 (UMLS 2011AA ValueDomain)
    PriorTherapyOtherAdministeredInd-3
    Item
    Other Prior Therapy (e.g. Hyperthermia, etc.)
    boolean
    C25629 (NCI Thesaurus ObjectClass)
    C0332152 (UMLS 2011AA ObjectClass)
    C15368 (NCI Thesaurus ObjectClass-2)
    C17649 (NCI Thesaurus Property)
    C0205394 (UMLS 2011AA Property)
    C25382 (NCI Thesaurus Property-2)
    C1521801 (UMLS 2011AA Property-2)
    C38148 (NCI Thesaurus ValueDomain)
    C1512699 (UMLS 2011AA ValueDomain)
    PriorTherapyOtherAdministeredSpecify
    Item
    Specify (If "Yes" 1 2 3)
    text
    C25629 (NCI Thesaurus ObjectClass)
    C0332152 (UMLS 2011AA ObjectClass)
    C15368 (NCI Thesaurus ObjectClass-2)
    C17649 (NCI Thesaurus Property)
    C0205394 (UMLS 2011AA Property)
    C25382 (NCI Thesaurus Property-2)
    C1521801 (UMLS 2011AA Property-2)
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    PriorTherapyOtherName
    Item
    Name of other prior therapies (If "Yes")
    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 Group
    Antiretroviral Therapy
    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)
    Anti-RetroviralAgentsAdministeredSpecify
    Item
    Other, specify (1 2)
    text
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    C25382 (NCI Thesaurus Property)
    C1521801 (UMLS 2011AA Property)
    C25382 (NCI Thesaurus ValueDomain-2)
    C1521801 (UMLS 2011AA ValueDomain-2)
    C0599685 (NCI Metathesaurus ObjectClass)
    Item
    Agent use
    text
    C25382 (NCI Thesaurus Property)
    C1521801 (UMLS 2011AA Property)
    C25688 (NCI Thesaurus ValueDomain)
    C0449438 (UMLS 2011AA ValueDomain)
    C0599685 (NCI Metathesaurus ObjectClass)
    CL.25
    Code List
    Agent use
    CL Item
    Currently Receiving (Currently receiving)
    CL Item
    Previously Received (Previously received)
    CL Item
    Never Received (Never received)
    Item
    Duration if prior agents received
    text
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    C25382 (NCI Thesaurus Property)
    C1521801 (UMLS 2011AA Property)
    C0599685 (NCI Metathesaurus ObjectClass)
    C25330 (NCI Thesaurus Property-2)
    C0449238 (UMLS 2011AA Property-2)
    CL.26
    Code List
    Duration if prior agents received
    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)
    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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