0 Avaliações

ID

8565

Descrição

Complete Physical Exam - RF21 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=CCE1D1CA-AC78-42E9-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=CCE1D1CA-AC78-42E9-E034-0003BA12F5E7

Palavras-chave

  1. 19/09/2012 19/09/2012 -
  2. 09/01/2015 09/01/2015 - Martin Dugas
Transferido a

9 de janeiro de 2015

DOI

Para um pedido faça login.

Licença

Creative Commons BY-NC 3.0 Legacy

Comentários do modelo :

Aqui pode comentar o modelo. Pode comentá-lo especificamente através dos balões de texto nos grupos de itens e itens.

Comentários do grupo de itens para :

Comentários do item para :


    Sem comentários

    Para descarregar formulários, precisa de ter uma sessão iniciada. Por favor faça login ou registe-se gratuitamente.

    Sarcoma, Kaposi xxx On-Study - Complete Physical Exam - RF21 - 2266187v3.0

    No Instruction available.

    1. StudyEvent: Complete Physical Exam - RF21
      1. No Instruction available.
    Ccrr Module For Complete Physical Exam - Rf21
    Descrição

    Ccrr Module For Complete Physical Exam - Rf21

    Patient Initials
    Descrição

    Patient Initials

    Tipo de dados

    text

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

    Protocol ID Coordinating Group

    Tipo de dados

    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#
    Descrição

    NCIInstitutionIdentifierCode

    Tipo de dados

    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#
    Descrição

    Patient Study ID

    Tipo de dados

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2348585
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25462
    NCI Thesaurus Property-2
    C25364
    Cycle#
    Descrição

    Cycle Number Chemotherapeutics

    Tipo de dados

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2045829
    NCI Thesaurus Property
    C25471
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus Property-2
    C25379
    Date of Visit
    Descrição

    LesionAssessmentDate

    Tipo de dados

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ObjectClass
    C3824
    UMLS 2011AA ObjectClass
    C0221198
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus ValueDomain-2
    C25367
    Which evaluation does this represent?
    Descrição

    TimePeriod

    Tipo de dados

    text

    Site
    Descrição

    DiseasePrimarySiteICD-OCode

    Tipo de dados

    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
    Descrição

    BaselineCancerICD9OtherText

    Tipo de dados

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704
    UMLS 2011AA ValueDomain
    C1527021
    NCI Thesaurus ObjectClass
    C25213
    UMLS 2011AA ObjectClass
    C1442488
    NCI Thesaurus Property
    C18849
    UMLS 2011AA Property
    C1512706
    If this is not a baseline evaluation and if there are no changes from the previous exam, check here
    Descrição

    Ifthisisnotabaselineevaluationandiftherearenochangesfromthepreviousexam,checkhere

    Tipo de dados

    text

    Unnamed
    Descrição

    Unnamed

    Tipo de dados

    text

    Describe abnormal findings
    Descrição

    Describeabnormalfindings

    Tipo de dados

    text

    Similar models

    No Instruction available.

    1. StudyEvent: Complete Physical Exam - RF21
      1. No Instruction available.
    Name
    Tipo
    Description | Question | Decode (Coded Value)
    Tipo de dados
    Alias
    Item Group
    Ccrr Module For Complete Physical Exam - Rf21
    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)
    Cycle Number Chemotherapeutics
    Item
    Cycle#
    text
    C25337 (NCI Thesaurus ValueDomain)
    C2045829 (UMLS CUI-1)
    C25471 (NCI Thesaurus Property)
    C15368 (NCI Thesaurus ObjectClass)
    C25379 (NCI Thesaurus Property-2)
    LesionAssessmentDate
    Item
    Date of Visit
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C3824 (NCI Thesaurus ObjectClass)
    C0221198 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C25367 (NCI Thesaurus ValueDomain-2)
    Item
    Which evaluation does this represent?
    text
    Code List
    Which evaluation does this represent?
    CL Item
    Entry/Baseline (Entry/Baseline)
    CL Item
    On Treatment (On Treatment)
    CL Item
    Post Therapy Evaluation (Post Therapy Evaluation)
    Item
    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)
    Code List
    Site
    CL Item
    Skin (Skin)
    CL Item
    Lymph Nodes (Lymph Nodes)
    CL Item
    Head (Head)
    CL Item
    Eyes (Eyes)
    CL Item
    Ears (Ears)
    CL Item
    Mouth (Mouth)
    CL Item
    Neck (Neck)
    CL Item
    Chest (Chest)
    CL Item
    Heart (Heart)
    CL Item
    Lungs (Lungs)
    CL Item
    Abdomen (Abdomen)
    CL Item
    Liver (Liver)
    CL Item
    Spleen (Spleen)
    CL Item
    Genital (Genital)
    CL Item
    Rectal (Rectal)
    CL Item
    Extremities (Extremities)
    CL Item
    Neurological (Neurological)
    CL Item
    Other (Other)
    BaselineCancerICD9OtherText
    Item
    Other, specify
    text
    C25704 (NCI Thesaurus ValueDomain)
    C1527021 (UMLS 2011AA ValueDomain)
    C25213 (NCI Thesaurus ObjectClass)
    C1442488 (UMLS 2011AA ObjectClass)
    C18849 (NCI Thesaurus Property)
    C1512706 (UMLS 2011AA Property)
    Ifthisisnotabaselineevaluationandiftherearenochangesfromthepreviousexam,checkhere
    Item
    If this is not a baseline evaluation and if there are no changes from the previous exam, check here
    text
    Item
    Unnamed
    text
    Code List
    Unnamed
    CL Item
    Normal (Normal)
    CL Item
    Abnormal (Abnormal)
    CL Item
    Not Evaluated (Not Evaluated)
    Describeabnormalfindings
    Item
    Describe abnormal findings
    text

    Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

    Watch Tutorial