0 Evaluaciones
ID

7998

Descripción

AMC-046 Concomitant Medication Form (MED) Cidofovir in Treating HIV-Infected Patients With High-Grade Squamous Intraepithelial Lesions of the Skin Near the Anus Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=7D8985E5-2DD3-08A5-E040-BB89AD434A3B

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=7D8985E5-2DD3-08A5-E040-BB89AD434A3B

Palabras clave

Versiones (3)
  1. 26/8/12 26/8/12 -
  2. 9/1/15 9/1/15 - Martin Dugas
  3. 9/1/15 9/1/15 - Martin Dugas
Subido en

9 de enero de 2015

DOI

Para solicitar uno, por favor iniciar sesión.

Licencia

Creative Commons BY-NC 3.0 Legacy
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    Anal Cancer NCT00550589 Treatment - AMC-046 Concomitant Medication Form (MED) - 2989341v1.0

    Inglés

    No Instruction available.

    1 formularios  
    1. StudyEvent: AMC-046 Concomitant Medication Form (MED)
      1. No Instruction available.
    Ccrr Module For Concomitant Antiretroviral Medications - Rf08
    Descripción

    Ccrr Module For Concomitant Antiretroviral Medications - Rf08

    Agent Name
    Descripción

    Agent

    Tipo de datos

    text

    Alias
    NCI Thesaurus Property
    C25364
    UMLS CUI-1
    C1521826
    NCI Thesaurus ObjectClass
    C1708
    NCI Thesaurus ValueDomain
    C1708
    NCI Thesaurus ValueDomain-2
    C42614
    Dose Level Start Date
    Descripción

    AgentDoseLevelBeginDate

    Tipo de datos

    date

    Alias
    NCI Thesaurus ObjectClass
    C1708
    UMLS 2011AA ObjectClass
    C0450442
    NCI Thesaurus Property
    C25488
    UMLS 2011AA Property
    C0178602
    NCI Thesaurus Property-2
    C25554
    UMLS 2011AA Property-2
    C0441889
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ValueDomain-2
    C25431
    UMLS 2011AA ValueDomain-2
    C0439659
    Total Daily Dose of Agent (or Drug)
    Descripción

    Concomitant Medication Daily Dose

    Tipo de datos

    float

    Alias
    NCI Thesaurus ObjectClass
    C25473
    UMLS CUI-1
    C2826638
    NCI Thesaurus ObjectClass-2
    C1708
    NCI Thesaurus Property
    C25304
    NCI Thesaurus Property-2
    C25256
    NCI Thesaurus ValueDomain
    C25488
    NCI Thesaurus ValueDomain-2
    C1708
    Units
    Descripción

    Agent Unit

    Tipo de datos

    text

    Alias
    NCI Thesaurus ObjectClass
    C1708
    UMLS CUI-1
    C0450442
    NCI Thesaurus Property
    C25730
    UMLS CUI-2
    C1519795
    NCI Thesaurus Property-2
    C25409
    NCI Thesaurus ValueDomain
    C25709
    Other, specify
    Descripción

    AgentConcomitantAdministrationSpecify

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    UMLS 2011AA ValueDomain
    C1521902
    NCI Thesaurus ObjectClass
    C1708
    UMLS 2011AA ObjectClass
    C0450442
    NCI Thesaurus Property
    C25730
    UMLS 2011AA Property
    C0521115
    NCI Thesaurus Property-2
    C25409
    UMLS 2011AA Property-2
    C1533734
    Frequency
    Descripción

    Medication frequency

    Tipo de datos

    text

    Alias
    NCI Thesaurus ObjectClass
    C1708
    UMLS CUI-1
    C3476109
    NCI Thesaurus ValueDomain
    C25515
    NCI Thesaurus Property
    C25382
    Other, specify
    Descripción

    Medication frequency

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    UMLS CUI-1
    C3476109
    NCI Thesaurus ObjectClass
    C1708
    NCI Thesaurus ObjectClass-2
    C25409
    NCI Thesaurus Property
    C25275
    Is this an antiretroviral agent
    Descripción

    Anti-RetroviralAgentsAdministeredInd-2

    Tipo de datos

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    NCI Thesaurus Property
    C25382
    UMLS 2011AA Property
    C1521801
    NCI Metathesaurus ObjectClass
    C0599685
    Please provide indication (If "no")
    Descripción

    Anti-RetroviralAgentsNotAdministeredReason

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25638
    UMLS 2011AA ValueDomain
    C0392360
    NCI Thesaurus Property
    C25594
    UMLS 2011AA Property
    C1518422
    NCI Thesaurus Property-2
    C25382
    UMLS 2011AA Property-2
    C1521801
    NCI Metathesaurus ObjectClass
    C0599685
    Is use of this agent ongoing
    Descripción

    ConcomitantMedicationAdministrationCurrentInd-3

    Tipo de datos

    boolean

    Alias
    NCI Thesaurus ObjectClass
    C459
    UMLS 2011AA ObjectClass
    C0013227
    NCI Thesaurus ObjectClass-2
    C25730
    UMLS 2011AA ObjectClass-2
    C0521115
    NCI Thesaurus Property
    C25409
    UMLS 2011AA Property
    C1533734
    NCI Thesaurus ValueDomain
    C38148
    UMLS 2011AA ValueDomain
    C1512699
    NCI Thesaurus ValueDomain-2
    C25471
    UMLS 2011AA ValueDomain-2
    C0521116
    Date last taken (If "no" mm/dd/yyyy)
    Descripción

    ConcomitantMedicationAdministrationLastDate

    Tipo de datos

    date

    Alias
    NCI Thesaurus ObjectClass
    C459
    UMLS 2011AA ObjectClass
    C0013227
    NCI Thesaurus ObjectClass-2
    C25730
    UMLS 2011AA ObjectClass-2
    C0521115
    NCI Thesaurus Property
    C25409
    UMLS 2011AA Property
    C1533734
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ValueDomain-2
    C25551
    UMLS 2011AA ValueDomain-2
    C1517741
    Comments
    Descripción

    Comments

    Comments
    Descripción

    Research Comments

    Tipo de datos

    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 formularios
    1. StudyEvent: AMC-046 Concomitant Medication Form (MED)
      1. No Instruction available.
    Name
    Tipo
    Description | Question | Decode (Coded Value)
    Tipo de datos
    Alias
    Item Group
    Ccrr Module For Concomitant Antiretroviral Medications - Rf08
    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)
    AgentDoseLevelBeginDate
    Item
    Dose Level Start Date
    date
    C1708 (NCI Thesaurus ObjectClass)
    C0450442 (UMLS 2011AA ObjectClass)
    C25488 (NCI Thesaurus Property)
    C0178602 (UMLS 2011AA Property)
    C25554 (NCI Thesaurus Property-2)
    C0441889 (UMLS 2011AA Property-2)
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C25431 (NCI Thesaurus ValueDomain-2)
    C0439659 (UMLS 2011AA ValueDomain-2)
    Concomitant Medication Daily Dose
    Item
    Total Daily Dose of Agent (or Drug)
    float
    C25473 (NCI Thesaurus ObjectClass)
    C2826638 (UMLS CUI-1)
    C1708 (NCI Thesaurus ObjectClass-2)
    C25304 (NCI Thesaurus Property)
    C25256 (NCI Thesaurus Property-2)
    C25488 (NCI Thesaurus ValueDomain)
    C1708 (NCI Thesaurus ValueDomain-2)
    Item
    Units
    text
    C1708 (NCI Thesaurus ObjectClass)
    C0450442 (UMLS CUI-1)
    C25730 (NCI Thesaurus Property)
    C1519795 (UMLS CUI-2)
    C25409 (NCI Thesaurus Property-2)
    C25709 (NCI Thesaurus ValueDomain)
    CL.1
    Code List
    Units
    CL Item
    Milligram (Milligram)
    C28253 (NCI Thesaurus)
    C0439210 (UMLS 2011AA)
    CL Item
    Microgram (Microgram)
    CL Item
    Milliliter (Milliliter)
    C28254 (NCI Thesaurus)
    C0439242 (UMLS 2011AA)
    CL Item
    Unit (Unit)
    C44278 (NCI Thesaurus)
    C0439148 (UMLS 2011AA)
    CL Item
    International Unit (International Unit)
    C28255 (NCI Thesaurus)
    CL Item
    Capsules (Capsules)
    CL Item
    Tablets (Tablets)
    CL Item
    Drops (Drops)
    C69442 (NCI Thesaurus)
    C2347093 (UMLS 2011AA)
    CL Item
    Other (Other)
    C17649 (NCI Thesaurus)
    C0205394 (UMLS 2011AA)
    AgentConcomitantAdministrationSpecify
    Item
    Other, specify
    text
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    C1708 (NCI Thesaurus ObjectClass)
    C0450442 (UMLS 2011AA ObjectClass)
    C25730 (NCI Thesaurus Property)
    C0521115 (UMLS 2011AA Property)
    C25409 (NCI Thesaurus Property-2)
    C1533734 (UMLS 2011AA Property-2)
    Item
    Frequency
    text
    C1708 (NCI Thesaurus ObjectClass)
    C3476109 (UMLS CUI-1)
    C25515 (NCI Thesaurus ValueDomain)
    C25382 (NCI Thesaurus Property)
    CL.2
    Code List
    Frequency
    CL Item
    Once A Day (q.d.) (Once a day (Q.D.))
    CL Item
    Twice A Day (b.i.d) (twice a day (B.I.D))
    CL Item
    Three Times A Day (t.i.d) (three times a day (T.I.D))
    CL Item
    Four Times A Day (q.i.d) (four times a day (Q.I.D))
    CL Item
    >4x/day (>4X/day)
    CL Item
    Every 4 Hours (q4hr) (every 4 hours (Q4hr))
    CL Item
    Every 6 Hours (q6hr) (every 6 hours (Q6hr))
    CL Item
    Every 8 Hours (q8hr) (every 8 hours (Q8hr))
    CL Item
    Every 12 Hours (q12hr) (every 12 hours (Q12hr))
    CL Item
    At Bedtime Or Hour Of Sleep (h.s.) (at bedtime or hour of sleep (H.S.))
    CL Item
    Every Other Day (q.o.d.) (every other day (Q.O.D.))
    CL Item
    Weekly (Weekly)
    CL158132 (NCI Metathesaurus)
    CL Item
    Monthly (Monthly)
    CL Item
    As Needed (p.r.n) (as needed (P.R.N))
    CL Item
    Other (Other)
    C17649 (NCI Thesaurus)
    C0205394 (UMLS 2011AA)
    Medication frequency
    Item
    Other, specify
    text
    C25685 (NCI Thesaurus ValueDomain)
    C3476109 (UMLS CUI-1)
    C1708 (NCI Thesaurus ObjectClass)
    C25409 (NCI Thesaurus ObjectClass-2)
    C25275 (NCI Thesaurus Property)
    Anti-RetroviralAgentsAdministeredInd-2
    Item
    Is this an antiretroviral agent
    boolean
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    C25382 (NCI Thesaurus Property)
    C1521801 (UMLS 2011AA Property)
    C0599685 (NCI Metathesaurus ObjectClass)
    Anti-RetroviralAgentsNotAdministeredReason
    Item
    Please provide indication (If "no")
    text
    C25638 (NCI Thesaurus ValueDomain)
    C0392360 (UMLS 2011AA ValueDomain)
    C25594 (NCI Thesaurus Property)
    C1518422 (UMLS 2011AA Property)
    C25382 (NCI Thesaurus Property-2)
    C1521801 (UMLS 2011AA Property-2)
    C0599685 (NCI Metathesaurus ObjectClass)
    ConcomitantMedicationAdministrationCurrentInd-3
    Item
    Is use of this agent ongoing
    boolean
    C459 (NCI Thesaurus ObjectClass)
    C0013227 (UMLS 2011AA ObjectClass)
    C25730 (NCI Thesaurus ObjectClass-2)
    C0521115 (UMLS 2011AA ObjectClass-2)
    C25409 (NCI Thesaurus Property)
    C1533734 (UMLS 2011AA Property)
    C38148 (NCI Thesaurus ValueDomain)
    C1512699 (UMLS 2011AA ValueDomain)
    C25471 (NCI Thesaurus ValueDomain-2)
    C0521116 (UMLS 2011AA ValueDomain-2)
    ConcomitantMedicationAdministrationLastDate
    Item
    Date last taken (If "no" mm/dd/yyyy)
    date
    C459 (NCI Thesaurus ObjectClass)
    C0013227 (UMLS 2011AA ObjectClass)
    C25730 (NCI Thesaurus ObjectClass-2)
    C0521115 (UMLS 2011AA ObjectClass-2)
    C25409 (NCI Thesaurus Property)
    C1533734 (UMLS 2011AA Property)
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C25551 (NCI Thesaurus ValueDomain-2)
    C1517741 (UMLS 2011AA ValueDomain-2)
    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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