ID

8089

Beskrivning

CALGB: 80203 Blook Tracking Form Fluorouracil and Leucovorin Plus Either Irinotecan or Oxaliplatin With or Without Cetuximab in Treating Patients With Previously Untreated Metastatic Adenocarcinoma of the Colon or Rectum Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B4C3B265-93E2-0730-E034-0003BA12F5E7

Länk

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B4C3B265-93E2-0730-E034-0003BA12F5E7

Nyckelord

Versioner (2)
  1. 2014-12-18 2014-12-18 - Martin Dugas
  2. 2015-01-09 2015-01-09 - Martin Dugas
Uppladdad den

9 januari 2015

DOI

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Licens

Creative Commons BY-NC 3.0 Legacy
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Colorectal Cancer NCT00077233 Pathology - CALGB: 80203 Blook Tracking Form - 2078840v3.0

Engelsk

To complete this section, see instructions.

1 Formulär  
  1. StudyEvent: CALGB: 80203 Blook Tracking Form
    1. To complete this section, see instructions.
To Be Completed By Institution
Beskrivning

To Be Completed By Institution

Does specimen accompany this form?
Beskrivning

Specimenw/FormInd

Datatyp

boolean

If no, specify reason (no specimen)
Beskrivning

specifyreason(specimenwillnotbesubmitted)

Datatyp

text

Date sample collected
Beskrivning

SpecimenCollectionDate

Datatyp

date

Time sample collected
Beskrivning

SpecimenCollectionTime

Datatyp

date

Number of tubes of whole blood submitted with this form
Beskrivning

WholeBloodTubesSubmittedCount

Datatyp

float

Alias
NCI Thesaurus ValueDomain
C25463
UMLS 2011AA ValueDomain
C0750480
NCI Thesaurus ObjectClass
C41067
UMLS 2011AA ObjectClass
C1608383
NCI Thesaurus Property
C25695
UMLS 2011AA Property
C1515023
NCI Metathesaurus Property
C0175730
Sample time point
Beskrivning

SpecimenCollectionTime

Datatyp

text

Submitted by
Beskrivning

PersonSpecimenSubmittedName

Datatyp

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C19157
UMLS 2011AA Property
C0370003
NCI Thesaurus Property-2
C25695
UMLS 2011AA Property-2
C1515023
Date sample received
Beskrivning

SpecimenReceivedDate

Datatyp

date

Sample ID no.
Beskrivning

SpecimenID

Datatyp

float

Sample Condition
Beskrivning

SpecimenCondition

Datatyp

text

Is sample evaluable for analysis?
Beskrivning

SpecimenEvaluableInd

Datatyp

text

Received by
Beskrivning

ReceivingPathologistName

Datatyp

text

Phone number
Beskrivning

PhoneNumber

Datatyp

float

Phone number
Beskrivning

PhoneNumber

Datatyp

float

Comments
Beskrivning

Research Comments

Datatyp

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS CUI-1
C0947611
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
Ccrr Module For Calgb: 80203 Blook Tracking Form
Beskrivning

Ccrr Module For Calgb: 80203 Blook Tracking Form

CALGB Form
Beskrivning

CALGB Form

Datatyp

text

Alias
UMLS CUI-1
C3262252
UMLS CUI-2
C1516238
CALGB Study No.
Beskrivning

Protocol ID CALGB

Datatyp

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C3274381
NCI Thesaurus ObjectClass
C25320
UMLS CUI-2
C1516238
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C25442
CALGB Patient ID
Beskrivning

Trial subject ID CALGB

Datatyp

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
UMLS CUI-2
C1516238
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C25442
Date form submitted
Beskrivning

Dateformsubmitted

Datatyp

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
Are data amended?
Beskrivning

Data amended

Datatyp

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS CUI-1
C0680532
NCI Thesaurus ObjectClass
C25474
NCI Thesaurus Property
C25416
Patient Initials
Beskrivning

Patient Initials

Datatyp

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986440
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25536
Patient Hospital No.
Beskrivning

Medical Record Number

Datatyp

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C1301894
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25261
NCI Thesaurus Property-2
C25198
Institution/Affiliate
Beskrivning

Institution Name

Datatyp

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
Participating Group
Beskrivning

Participating Group

Datatyp

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2347449
NCI Thesaurus ObjectClass
C25608
NCI Thesaurus ObjectClass-2
C17005
NCI Thesaurus Property
C25364
Participating Group Protocol No.
Beskrivning

Study Number Participating Group

Datatyp

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
Beskrivning

Trial subject ID Participating Group

Datatyp

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
Tillbaka till toppen

Similar models

To complete this section, see instructions.

1 Formulär
  1. StudyEvent: CALGB: 80203 Blook Tracking Form
    1. To complete this section, see instructions.
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
To Be Completed By Institution
Specimenw/FormInd
Item
Does specimen accompany this form?
boolean
specifyreason(specimenwillnotbesubmitted)
Item
If no, specify reason (no specimen)
text
SpecimenCollectionDate
Item
Date sample collected
date
SpecimenCollectionTime
Item
Time sample collected
date
WholeBloodTubesSubmittedCount
Item
Number of tubes of whole blood submitted with this form
float
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C41067 (NCI Thesaurus ObjectClass)
C1608383 (UMLS 2011AA ObjectClass)
C25695 (NCI Thesaurus Property)
C1515023 (UMLS 2011AA Property)
C0175730 (NCI Metathesaurus Property)
Item
Sample time point
text
CL.2
Code List
Sample time point
CL Item
1-pre-study (pre-study)
PersonSpecimenSubmittedName
Item
Submitted by
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C19157 (NCI Thesaurus Property)
C0370003 (UMLS 2011AA Property)
C25695 (NCI Thesaurus Property-2)
C1515023 (UMLS 2011AA Property-2)
SpecimenReceivedDate
Item
Date sample received
date
SpecimenID
Item
Sample ID no.
float
Item
Sample Condition
text
CL.3
Code List
Sample Condition
CL Item
Useable (Okay)
CL Item
Damaged Or Unusable (damaged)
CL Item
No Specimen Received (missing)
CL Item
Insufficient Amount (insufficient amount)
CL Item
thawed (thawed)
CL Item
clotted (clotted)
Item
Is sample evaluable for analysis?
text
CL.4
Code List
Is sample evaluable for analysis?
CL Item
No, Procedural Deviations Definitely Affect Analysis (no, procedural deviates definitely affect analysis)
CL Item
Yes, Sample Is Evaluable (Yes, sample is evaluable)
CL Item
Unsure, Procedural Deviations May Affect Analysis (Unsure, procedural deviations may affect analysis)
ReceivingPathologistName
Item
Received by
text
PhoneNumber
Item
Phone number
float
PhoneNumber
Item
Phone number
float
Research Comments
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C0947611 (UMLS CUI-1)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
Item Group
Ccrr Module For Calgb: 80203 Blook Tracking Form
CALGB Form
Item
CALGB Form
text
C3262252 (UMLS CUI-1)
C1516238 (UMLS CUI-2)
Protocol ID CALGB
Item
CALGB Study No.
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1516238 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25442 (NCI Thesaurus Property-2)
Trial subject ID CALGB
Item
CALGB Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1516238 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25442 (NCI Thesaurus Property-2)
Dateformsubmitted
Item
Date form submitted
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
Data amended
Item
Are data amended?
boolean
C38148 (NCI Thesaurus ValueDomain)
C0680532 (UMLS CUI-1)
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)
Patient Initials
Item
Patient Initials
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
Medical Record Number
Item
Patient Hospital No.
text
C25337 (NCI Thesaurus ValueDomain)
C1301894 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25261 (NCI Thesaurus Property)
C25198 (NCI Thesaurus Property-2)
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)
Participating Group
Item
Participating Group
text
C25191 (NCI Thesaurus ValueDomain)
C2347449 (UMLS CUI-1)
C25608 (NCI Thesaurus ObjectClass)
C17005 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
Study Number Participating Group
Item
Participating Group Protocol 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
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)
Tillbaka till toppen 

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