ID

8577

Beschrijving

AMC Clinical Trials - Gleevec Administration & Compliance Form for Protocol #042 - PR4202 Imatinib Mesylate in Treating Patients With HIV-Related Kaposi's Sarcoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=EA0B255D-5729-3870-E034-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=EA0B255D-5729-3870-E034-0003BA3F9857

Trefwoorden

Versies (3)
  1. 19-09-12 19-09-12 - Philipp Bruland
  2. 09-01-15 09-01-15 - Martin Dugas
  3. 27-06-15 27-06-15 -
Geüploaded op

9 januari 2015

DOI

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Licentie

Creative Commons BY-NC 3.0 Legacy
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Sarcoma NCT00090987 Treatment - AMC Clinical Trials - Gleevec Administration & Compliance Form for Protocol #042 - PR4202 - 2264834v3.0

Engels

No Instruction available.

1 Formulieren  
  1. StudyEvent: AMC Clinical Trials - Gleevec Administration & Compliance Form for Protocol #042 - PR4202
    1. No Instruction available.
Unnamed 1
Beschrijving

Unnamed 1

Patient Initials
Beschrijving

Patient Initials

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986440
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25536
Patient Study ID
Beschrijving

Patient Study ID

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25462
NCI Thesaurus Property-2
C25364
Current Cycle Number
Beschrijving

Cycle Number Chemotherapeutics

Datatype

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 Evaluation
Beschrijving

LesionAssessmentDate

Datatype

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
Date tablets returned/dispensed
Beschrijving

PillsRemainingDate

Datatype

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C25394
UMLS 2011AA ObjectClass
C0994475
NCI Thesaurus Property
C25649
UMLS 2011AA Property
C1527428
Number of Gleevec tablets returned
Beschrijving

Numberoftabletsreturned

Datatype

text

Number of Gleevec tablets dispensed
Beschrijving

Numberoftabletsdispensed

Datatype

text

Were there any dose modifications/omissions to protocol treatment during this cycle?
Beschrijving

Dose Modification

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25180
UMLS CUI-1
C1707811
NCI Thesaurus ObjectClass
C25256
NCI Thesaurus Property
C25572
NCI Thesaurus ValueDomain-2
C25572
Were tablets returned at this visit?
Beschrijving

Weretabletsreturnedatthisvisit?

Datatype

boolean

Were tablets dispensed at this visit?
Beschrijving

Weretabletsdispensedatthisvisit?

Datatype

boolean

Dose assigned
Beschrijving

Doseassigned

Datatype

text

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Similar models

No Instruction available.

1 Formulieren
  1. StudyEvent: AMC Clinical Trials - Gleevec Administration & Compliance Form for Protocol #042 - PR4202
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Unnamed 1
Patient Initials
Item
Patient Initials
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
Patient Study ID
Item
Patient Study 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
Current Cycle Number
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 Evaluation
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)
PillsRemainingDate
Item
Date tablets returned/dispensed
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25394 (NCI Thesaurus ObjectClass)
C0994475 (UMLS 2011AA ObjectClass)
C25649 (NCI Thesaurus Property)
C1527428 (UMLS 2011AA Property)
Numberoftabletsreturned
Item
Number of Gleevec tablets returned
text
Numberoftabletsdispensed
Item
Number of Gleevec tablets dispensed
text
Item
Were there any dose modifications/omissions to protocol treatment during this cycle?
text
C25180 (NCI Thesaurus ValueDomain)
C1707811 (UMLS CUI-1)
C25256 (NCI Thesaurus ObjectClass)
C25572 (NCI Thesaurus Property)
C25572 (NCI Thesaurus ValueDomain-2)
CL.4
Code List
Were there any dose modifications/omissions to protocol treatment during this cycle?
CL Item
Yes, Planned (i.e., The Treatment Was Changed According To Protocol Guidelines) (Yes, planned)
CL Item
Yes, Unplanned (i.e., The Treatment Change Was Not Part Of Protocol Guidelines) (Yes, unplanned)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Weretabletsreturnedatthisvisit?
Item
Were tablets returned at this visit?
boolean
Weretabletsdispensedatthisvisit?
Item
Were tablets dispensed at this visit?
boolean
Item
Dose assigned
text
CL.3
Code List
Dose assigned
CL Item
400 mg per day (400 mg per day)
CL Item
600 mg per day (600 mg per day)
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