ID
8444
Descrição
USMCI 8214/Z6091: Blood Sample Submission Form (Group 2 Only or crossover patients from Group 1) Standard Therapy With or Without Surgery and Mitomycin C in Treating Patients With Advanced Limited Peritoneal Dissemination of Colon Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=622E716B-38C7-5CAB-E040-BB89AD43601A
Link
Palavras-chave
Versões (2)
- 27/08/2012 27/08/2012 -
- 09/01/2015 09/01/2015 - Martin Dugas
Transferido a
9 de janeiro de 2015
DOI
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Licença
Creative Commons BY-NC 3.0 Legacy
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Colorectal Cancer NCT01167725 Transmittal - USMCI 8214/Z6091: Blood Sample Submission Form - 2833605v1.0
INSTRUCTIONS: For patients in group 2 who consented to blood specimen collection, submit form via RDC at time of registration, prior to study base treatment, immediately after operation, 6 weeks after operation, and at each follow up visit.
Descrição
Header
Descrição
BloodSpecimenCollectedInd-3
Tipo de dados
boolean
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
- NCI Thesaurus ObjectClass
- C12434
- UMLS 2011AA ObjectClass
- C0229664
- NCI Thesaurus ObjectClass-2
- C19157
- UMLS 2011AA ObjectClass-2
- C0370003
- NCI Thesaurus Property
- C25452
Descrição
BloodSpecimenNotCollectedSpecify
Tipo de dados
text
Alias
- NCI Thesaurus ObjectClass
- C12434
- UMLS 2011AA ObjectClass
- C0229664
- NCI Thesaurus ObjectClass-2
- C19157
- UMLS 2011AA ObjectClass-2
- C0370003
- NCI Thesaurus Property
- C25594
- UMLS 2011AA Property
- C1518422
- NCI Thesaurus Property-2
- C25453
- UMLS 2011AA Property-2
- C1516698
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
Descrição
SpecimenCollectedDate
Tipo de dados
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ObjectClass
- C19157
- UMLS 2011AA ObjectClass
- C0370003
- NCI Thesaurus Property
- C25452
- NCI Thesaurus Property-2
- C25275
- UMLS 2011AA Property
- C2745955
Descrição
Footern Module
Descrição
Person Completing Form First Name
Tipo de dados
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS CUI-1
- C1550483
- NCI Thesaurus ObjectClass-2
- C25657
- UMLS CUI-2
- C1443235
- NCI Thesaurus Property
- C25364
- NCI Thesaurus Property-2
- C25509
- NCI Thesaurus ValueDomain
- C25191
Descrição
Person Completing Form Last Name
Tipo de dados
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS CUI-1
- C1550483
- NCI Thesaurus ObjectClass-2
- C25657
- UMLS CUI-2
- C1301584
- NCI Thesaurus Property
- C25364
- NCI Thesaurus Property-2
- C25551
- NCI Thesaurus ValueDomain
- C25191
Descrição
SpecimenLabSubmittedDate
Tipo de dados
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus Property
- C25294
- UMLS 2011AA Property
- C0022885
- NCI Thesaurus ObjectClass
- C19157
- UMLS 2011AA ObjectClass
- C0370003
- NCI Thesaurus Property-2
- C25695
- UMLS 2011AA Property-2
- C1515023
Descrição
ResponsiblePersonE-mailAddressText
Tipo de dados
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ObjectClass
- C25657
- UMLS 2011AA ObjectClass
- C1273518
- NCI Thesaurus Property
- C42775
- UMLS 2011AA Property
- C1705961
Descrição
Person Completing Form Phone
Tipo de dados
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS CUI-1
- C1550483
- NCI Thesaurus ObjectClass
- C25190
- UMLS CUI-2
- C1515258
- NCI Thesaurus ObjectClass-2
- C25657
- NCI Thesaurus Property
- C25395
Descrição
ResponsiblePersonFaxNumber
Tipo de dados
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus ObjectClass-2
- C25657
- UMLS 2011AA ObjectClass-2
- C1273518
- NCI Thesaurus Property
- C25210
- UMLS 2011AA Property
- C0085205
Descrição
SpecimenLaboratoryReceivedDate
Tipo de dados
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus Property
- C25639
- UMLS 2011AA Property
- C1514756
- NCI Thesaurus Property-2
- C37984
- UMLS 2011AA Property-2
- C0022877
- NCI Thesaurus ObjectClass
- C19157
- UMLS 2011AA ObjectClass
- C0370003
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INSTRUCTIONS: For patients in group 2 who consented to blood specimen collection, submit form via RDC at time of registration, prior to study base treatment, immediately after operation, 6 weeks after operation, and at each follow up visit.
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