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ID

8633

Descrizione

Phase II Breast Cancer Registration Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=23E49B63-1DBC-53B8-E044-0003BA3F9857

collegamento

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=23E49B63-1DBC-53B8-E044-0003BA3F9857

Keywords

versioni (5)
  1. 19/09/12 19/09/12 -
  2. 26/11/14 26/11/14 - Martin Dugas
  3. 09/01/15 09/01/15 - Martin Dugas
  4. 09/01/15 09/01/15 - Martin Dugas
  5. 17/09/21 17/09/21 -
Caricato su

9 gennaio 2015

DOI

Per favore, per richiedere un accesso.

Licenza

Creative Commons BY-NC 3.0 Legacy
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    Registration - Phase II Breast Cancer Registration Form - 2550280v1.0

    Inglese

    No Instruction available.

    1 moduli  
    1. StudyEvent: Phase II Breast Cancer Registration Form
      1. No Instruction available.
    Crf Header
    Descrizione

    Crf Header

    Coordinating Group Protocol No.
    Descrizione

    Protocol ID Coordinating Group

    Tipo di dati

    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
    Coordinating Group Code
    Descrizione

    Coordinating Group Code

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25162
    UMLS CUI-1
    C1711341
    NCI Thesaurus ObjectClass
    C17005
    UMLS CUI-2
    C0805701
    NCI Thesaurus ObjectClass-2
    C25462
    NCI Thesaurus Property
    C25364
    Protocol Title
    Descrizione

    Protocol Title

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2986303
    NCI Thesaurus ObjectClass
    C25320
    NCI Thesaurus Property
    C42774
    Patient Study ID
    Descrizione

    Patient Study ID

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2348585
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25462
    NCI Thesaurus Property-2
    C25364
    Registering Group Code
    Descrizione

    Registering Group Code

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25162
    UMLS CUI-1
    C2347449
    NCI Thesaurus ObjectClass
    C17005
    UMLS CUI-2
    C0805701
    NCI Thesaurus Property
    C25364
    NCI Thesaurus ObjectClass-2
    C25645
    Patient Medical Record Number
    Descrizione

    Medical Record Number

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C1301894
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25261
    NCI Thesaurus Property-2
    C25198
    Other Patient ID
    Descrizione

    Trial subject ID Participating Group

    Tipo di dati

    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
    Institution/Affiliate
    Descrizione

    Institution Name

    Tipo di dati

    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
    Registering Institution Code
    Descrizione

    Registering Institution Code

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25162
    UMLS CUI-1
    C1301943
    NCI Thesaurus ObjectClass
    C21541
    UMLS CUI-2
    C0805701
    NCI Thesaurus Property
    C25364
    NCI Thesaurus ObjectClass-2
    C25645
    Physician of Record
    Descrizione

    Investigator Name

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2826892
    NCI Thesaurus Property
    C25364
    NCI Thesaurus ObjectClass
    C17089
    NCI Thesaurus ObjectClass-2
    C25644
    Form Administration
    Descrizione

    Form Administration

    IRB/REB Approval Date
    Descrizione

    IRB Approval Date

    Tipo di dati

    date

    Alias
    NCI Thesaurus ObjectClass
    C25320
    UMLS CUI-1
    C2346500
    NCI Thesaurus Property
    C16741
    NCI Thesaurus Property-2
    C25425
    NCI Thesaurus ValueDomain
    C25164
    NCI Thesaurus ValueDomain-2
    C25367
    Date Informed Consent Signed
    Descrizione

    InformedConsentFormSignedDate

    Tipo di dati

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ValueDomain-2
    C25367
    NCI Thesaurus ObjectClass
    C16468
    UMLS 2011AA ObjectClass
    C0009797
    NCI Thesaurus Property
    C25679
    Date Informed Consent Expired
    Descrizione

    ConsentFormSignedEndDate

    Tipo di dati

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ObjectClass
    C16468
    UMLS 2011AA ObjectClass
    C0009797
    NCI Thesaurus Property
    C25679
    Projected Start Date of Treatment
    Descrizione

    Treatment Begin Date

    Tipo di dati

    date

    Alias
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus ObjectClass-2
    C25631
    NCI Thesaurus Property
    C25431
    UMLS CUI-1
    C3173309
    NCI Thesaurus Property-2
    C25275
    NCI Thesaurus ValueDomain
    C25164
    NCI Thesaurus ValueDomain-2
    C25431
    Date of Registration
    Descrizione

    PatientRegistrationDate

    Tipo di dati

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus ValueDomain-2
    C25367
    NCI Thesaurus Property
    C25646
    UMLS 2011AA Property
    C1514821
    HIPAA Authorization Date
    Descrizione

    PatientSignedDischargeMedicalRecordDate

    Tipo di dati

    date

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25679
    NCI Metathesaurus Property
    C0012621
    NCI Thesaurus Property-2
    C45258
    UMLS 2011AA Property
    C0025102
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    Date Form Completed
    Descrizione

    Date Form Completed

    Tipo di dati

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS CUI-1
    C1115437
    NCI Thesaurus ObjectClass
    C40988
    NCI Thesaurus Property
    C25250
    NCI Thesaurus ValueDomain-2
    C25367
    Person Completing Form, Last Name
    Descrizione

    Person Completing Form Last Name

    Tipo di dati

    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
    Person Completing Form, First Name
    Descrizione

    Person Completing Form First Name

    Tipo di dati

    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
    Person Completing Form, Phone
    Descrizione

    Person Completing Form Phone

    Tipo di dati

    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
    Person Completing Form, Fax
    Descrizione

    ResponsiblePersonFaxNumber

    Tipo di dati

    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
    Patient Demographics / Pre-treatment Characteristics
    Descrizione

    Patient Demographics / Pre-treatment Characteristics

    Patient Name (initials acceptable)
    Descrizione

    Patient Name

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C1299487
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25364
    Patient Birth Date
    Descrizione

    Patient Birth Date

    Tipo di dati

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS CUI-1
    C0421451
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus ValueDomain-2
    C25367
    NCI Thesaurus Property
    C25155
    Patient Gender
    Descrizione

    Gender

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25372
    UMLS CUI-1
    C0079399
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C17357
    Patient Race (check all that applyU.S. and Canada only)
    Descrizione

    Racial Group

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25372
    UMLS CUI-1
    C0034510
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C17049
    Patient Ethnicity (U.S. and Canada only)
    Descrizione

    Ethnic Group

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25372
    UMLS CUI-1
    C0015031
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C16564
    Patient Social Security Number (USA only)
    Descrizione

    Social Security Number

    Tipo di dati

    float

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C1301821
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25686
    Patient Zip Code (USA)
    Descrizione

    PatientAddressPostalCode

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25162
    UMLS 2011AA ValueDomain
    C0805701
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25407
    UMLS 2011AA Property
    C1442065
    Country of Residence (if not USA)
    Descrizione

    Country of current residence

    Tipo di dati

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS CUI-1
    C3258975
    NCI Thesaurus ValueDomain
    C25464
    NCI Thesaurus Property
    C25407
    NCI Thesaurus ValueDomain-2
    C42614
    Patient Height (cm)
    Descrizione

    Patient Height

    Tipo di dati

    float

    Unità di misura
    • cm
    Alias
    NCI Thesaurus ValueDomain
    C25209
    UMLS CUI-1
    C0489786
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25347
    cm
    Patient Weight (kg)
    Descrizione

    Patient Weight

    Tipo di dati

    float

    Unità di misura
    • Kg
    Alias
    NCI Thesaurus ValueDomain
    C25209
    UMLS CUI-1
    C0005910
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25208
    Kg
    Body Surface Area (m^2)
    Descrizione

    Body Surface Area

    Tipo di dati

    float

    Alias
    NCI Thesaurus ValueDomain
    C25209
    UMLS CUI-1
    C0005902
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25157
    ECOG Performance Status (check one)
    Descrizione

    ECOG Performance Status

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25664
    UMLS CUI-1
    C1520224
    NCI Thesaurus Property
    C25367
    NCI Thesaurus ValueDomain-2
    C25491
    NCI Thesaurus ObjectClass
    C20641
    Karnofsky Performance Status Score (check one)
    Descrizione

    KarnofskyPerformanceStatusScore

    Tipo di dati

    text

    Alias
    NCI Thesaurus Property
    C25367
    NCI Thesaurus ObjectClass
    C20641
    UMLS 2011AA ObjectClass
    C1518965
    NCI Thesaurus ValueDomain
    C25338
    UMLS 2011AA ValueDomain
    C0449820
    Method of Payment (check oneUSA only)
    Descrizione

    PatientPaymentType

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25371
    UMLS 2011AA Property
    C0680264
    Certification Of Eligibility
    Descrizione

    Certification Of Eligibility

    In the opinion of the investigator, is the patient eligible?
    Descrizione

    Eligibility for trial

    Tipo di dati

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS CUI-1
    C1302261
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25171
    Protocol Design
    Descrizione

    Protocol Design

    Stratification Factors (protocol specific)
    Descrizione

    StudyStratificationText

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704
    UMLS 2011AA ValueDomain
    C1527021
    NCI Thesaurus ObjectClass
    C15206
    UMLS 2011AA ObjectClass
    C0008972
    NCI Thesaurus Property
    C25689
    UMLS 2011AA Property
    C1514983
    Assigned Treatment Arm (protocol specific)
    Descrizione

    Protocol Treatment Arm

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C1522541
    NCI Thesaurus Property
    C32141
    NCI Thesaurus ObjectClass
    C15368
    Treatment Assignment Code (protocol specific)
    Descrizione

    TreatmentAssignmentCode

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25162
    UMLS 2011AA ValueDomain
    C0805701
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus Property
    C25426
    UMLS 2011AA Property
    C1516050
    NSC Number (Please check the CTEP Home Page for a list of agent NSC numbers.)
    Descrizione

    AgentNSC/GPIIdentifierNumber

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS 2011AA ValueDomain
    C0237753
    NCI Thesaurus Property
    C25364
    UMLS 2011AA Property
    C0600091
    NCI Thesaurus ObjectClass
    C1708
    UMLS 2011AA ObjectClass
    C0450442
    NCI Thesaurus Property-2
    C41244
    Agent Name
    Descrizione

    Agent

    Tipo di dati

    text

    Alias
    NCI Thesaurus Property
    C25364
    UMLS CUI-1
    C1521826
    NCI Thesaurus ObjectClass
    C1708
    NCI Thesaurus ValueDomain
    C1708
    NCI Thesaurus ValueDomain-2
    C42614
    Agent Dose
    Descrizione

    Medication Dose

    Tipo di dati

    float

    Alias
    NCI Thesaurus ValueDomain
    C25488
    UMLS CUI-1
    C3174092
    NCI Thesaurus ObjectClass
    C1708
    NCI Thesaurus ValueDomain-2
    C1708
    NCI Thesaurus Property
    C25382
    Units
    Descrizione

    Units

    Tipo di dati

    text

    Alias
    NCI Thesaurus ObjectClass
    C1708
    UMLS CUI-1
    C1519795
    NCI Thesaurus Property
    C25256
    NCI Thesaurus ValueDomain
    C25709
    Route
    Descrizione

    Drug Administration Route

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS CUI-1
    C0013153
    NCI Thesaurus ObjectClass
    C459
    NCI Thesaurus ObjectClass-2
    C25409
    NCI Thesaurus Property
    C25169
    Frequency
    Descrizione

    Medication frequency

    Tipo di dati

    text

    Alias
    NCI Thesaurus ObjectClass
    C1708
    UMLS CUI-1
    C3476109
    NCI Thesaurus ValueDomain
    C25515
    NCI Thesaurus Property
    C25382
    Schedule
    Descrizione

    TherapeuticAgentsAdministeredScheduleText

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704
    UMLS 2011AA ValueDomain
    C1527021
    NCI Thesaurus Property
    C25211
    UMLS 2011AA Property
    C0086960
    NCI Thesaurus Property-2
    C25382
    UMLS 2011AA Property-2
    C1521801
    NCI Thesaurus ObjectClass
    C17935
    UMLS 2011AA ObjectClass
    C1611640
    Initial Patient Consent For Specimen Use
    Descrizione

    Initial Patient Consent For Specimen Use

    Patient's Initial Consent given for specimen use for research on the patient's cancer?
    Descrizione

    SpecimenResearchConsentRelatedInd-3

    Tipo di dati

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS 2011AA ValueDomain
    C1512699
    NCI Thesaurus Property
    C15319
    NCI Thesaurus ObjectClass
    C19157
    UMLS 2011AA ObjectClass
    C0370003
    NCI Thesaurus Property-2
    C25460
    UMLS 2011AA Property
    C1511481
    Patient's Initial Consent given for specimen use for research unrelated to the patient's cancer?
    Descrizione

    BloodTissueSpecimenOtherDiseasesandDisordersResearchConsentInd-3

    Tipo di dati

    boolean

    Alias
    NCI Thesaurus ObjectClass
    C12801
    UMLS 2011AA ObjectClass
    C0040300
    NCI Thesaurus ObjectClass-2
    C12434
    UMLS 2011AA ObjectClass-2
    C0229664
    NCI Thesaurus ObjectClass-3
    C19157
    UMLS 2011AA ObjectClass-3
    C0370003
    NCI Thesaurus Property
    C17649
    UMLS 2011AA Property
    C0205394
    NCI Thesaurus Property-2
    C15319
    NCI Thesaurus Property-3
    C2991
    UMLS 2011AA Property-2
    C0012634
    NCI Thesaurus Property-4
    C25460
    UMLS 2011AA Property-3
    C1511481
    NCI Thesaurus ValueDomain
    C38148
    UMLS 2011AA ValueDomain
    C1512699
    Patient's initial consent given for further contact regarding specimen?
    Descrizione

    Permission to contact Patient

    Tipo di dati

    boolean

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS CUI-1
    C1522577
    NCI Thesaurus Property
    C67527
    UMLS CUI-2
    C0521104
    NCI Thesaurus Property-2
    C25460
    NCI Thesaurus Property-3
    C16452
    NCI Thesaurus ValueDomain
    C38148
    Date of Consent for Specimen Use
    Descrizione

    SpecimenICFSignedDate

    Tipo di dati

    date

    Alias
    NCI Thesaurus ObjectClass
    C16468
    UMLS 2011AA ObjectClass
    C0009797
    NCI Thesaurus ObjectClass-2
    C19157
    UMLS 2011AA ObjectClass-2
    C0370003
    NCI Thesaurus Property
    C25679
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ValueDomain-2
    C25367
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    Similar models

    No Instruction available.

    1 moduli
    1. StudyEvent: Phase II Breast Cancer Registration Form
      1. No Instruction available.
    Name
    genere
    Description | Question | Decode (Coded Value)
    Tipo di dati
    Alias
    Item Group
    Crf Header
    Protocol ID Coordinating Group
    Item
    Coordinating Group Protocol No.
    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)
    Coordinating Group Code
    Item
    Coordinating Group Code
    text
    C25162 (NCI Thesaurus ValueDomain)
    C1711341 (UMLS CUI-1)
    C17005 (NCI Thesaurus ObjectClass)
    C0805701 (UMLS CUI-2)
    C25462 (NCI Thesaurus ObjectClass-2)
    C25364 (NCI Thesaurus Property)
    Protocol Title
    Item
    Protocol Title
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2986303 (UMLS CUI-1)
    C25320 (NCI Thesaurus ObjectClass)
    C42774 (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)
    Registering Group Code
    Item
    Registering Group Code
    text
    C25162 (NCI Thesaurus ValueDomain)
    C2347449 (UMLS CUI-1)
    C17005 (NCI Thesaurus ObjectClass)
    C0805701 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25645 (NCI Thesaurus ObjectClass-2)
    Medical Record Number
    Item
    Patient Medical Record Number
    text
    C25337 (NCI Thesaurus ValueDomain)
    C1301894 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25261 (NCI Thesaurus Property)
    C25198 (NCI Thesaurus Property-2)
    Trial subject ID Participating Group
    Item
    Other 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)
    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)
    Registering Institution Code
    Item
    Registering Institution Code
    text
    C25162 (NCI Thesaurus ValueDomain)
    C1301943 (UMLS CUI-1)
    C21541 (NCI Thesaurus ObjectClass)
    C0805701 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25645 (NCI Thesaurus ObjectClass-2)
    Investigator Name
    Item
    Physician of Record
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2826892 (UMLS CUI-1)
    C25364 (NCI Thesaurus Property)
    C17089 (NCI Thesaurus ObjectClass)
    C25644 (NCI Thesaurus ObjectClass-2)
    Item Group
    Form Administration
    IRB Approval Date
    Item
    IRB/REB Approval Date
    date
    C25320 (NCI Thesaurus ObjectClass)
    C2346500 (UMLS CUI-1)
    C16741 (NCI Thesaurus Property)
    C25425 (NCI Thesaurus Property-2)
    C25164 (NCI Thesaurus ValueDomain)
    C25367 (NCI Thesaurus ValueDomain-2)
    InformedConsentFormSignedDate
    Item
    Date Informed Consent Signed
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C25367 (NCI Thesaurus ValueDomain-2)
    C16468 (NCI Thesaurus ObjectClass)
    C0009797 (UMLS 2011AA ObjectClass)
    C25679 (NCI Thesaurus Property)
    ConsentFormSignedEndDate
    Item
    Date Informed Consent Expired
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C16468 (NCI Thesaurus ObjectClass)
    C0009797 (UMLS 2011AA ObjectClass)
    C25679 (NCI Thesaurus Property)
    Treatment Begin Date
    Item
    Projected Start Date of Treatment
    date
    C15368 (NCI Thesaurus ObjectClass)
    C25631 (NCI Thesaurus ObjectClass-2)
    C25431 (NCI Thesaurus Property)
    C3173309 (UMLS CUI-1)
    C25275 (NCI Thesaurus Property-2)
    C25164 (NCI Thesaurus ValueDomain)
    C25431 (NCI Thesaurus ValueDomain-2)
    PatientRegistrationDate
    Item
    Date of Registration
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25367 (NCI Thesaurus ValueDomain-2)
    C25646 (NCI Thesaurus Property)
    C1514821 (UMLS 2011AA Property)
    PatientSignedDischargeMedicalRecordDate
    Item
    HIPAA Authorization Date
    date
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25679 (NCI Thesaurus Property)
    C0012621 (NCI Metathesaurus Property)
    C45258 (NCI Thesaurus Property-2)
    C0025102 (UMLS 2011AA Property)
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    Date Form Completed
    Item
    Date Form Completed
    date
    C25164 (NCI Thesaurus ValueDomain)
    C1115437 (UMLS CUI-1)
    C40988 (NCI Thesaurus ObjectClass)
    C25250 (NCI Thesaurus Property)
    C25367 (NCI Thesaurus ValueDomain-2)
    Person Completing Form Last Name
    Item
    Person Completing Form, Last Name
    text
    C25190 (NCI Thesaurus ObjectClass)
    C1550483 (UMLS CUI-1)
    C25657 (NCI Thesaurus ObjectClass-2)
    C1301584 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25551 (NCI Thesaurus Property-2)
    C25191 (NCI Thesaurus ValueDomain)
    Person Completing Form First Name
    Item
    Person Completing Form, First Name
    text
    C25190 (NCI Thesaurus ObjectClass)
    C1550483 (UMLS CUI-1)
    C25657 (NCI Thesaurus ObjectClass-2)
    C1443235 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25509 (NCI Thesaurus Property-2)
    C25191 (NCI Thesaurus ValueDomain)
    Person Completing Form Phone
    Item
    Person Completing Form, Phone
    text
    C25337 (NCI Thesaurus ValueDomain)
    C1550483 (UMLS CUI-1)
    C25190 (NCI Thesaurus ObjectClass)
    C1515258 (UMLS CUI-2)
    C25657 (NCI Thesaurus ObjectClass-2)
    C25395 (NCI Thesaurus Property)
    ResponsiblePersonFaxNumber
    Item
    Person Completing Form, Fax
    text
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    C25190 (NCI Thesaurus ObjectClass)
    C0027361 (UMLS 2011AA ObjectClass)
    C25657 (NCI Thesaurus ObjectClass-2)
    C1273518 (UMLS 2011AA ObjectClass-2)
    C25210 (NCI Thesaurus Property)
    C0085205 (UMLS 2011AA Property)
    Item Group
    Patient Demographics / Pre-treatment Characteristics
    Patient Name
    Item
    Patient Name (initials acceptable)
    text
    C25191 (NCI Thesaurus ValueDomain)
    C1299487 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25364 (NCI Thesaurus Property)
    Patient Birth Date
    Item
    Patient Birth Date
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0421451 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25367 (NCI Thesaurus ValueDomain-2)
    C25155 (NCI Thesaurus Property)
    Item
    Patient Gender
    text
    C25372 (NCI Thesaurus ValueDomain)
    C0079399 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C17357 (NCI Thesaurus Property)
    CL.1
    Code List
    Patient Gender
    CL Item
    Male (MALE)
    C46109 (NCI Thesaurus)
    C1706180 (UMLS 2011AA)
    CL Item
    Female (FEMALE)
    C46110 (NCI Thesaurus)
    C0015780 (UMLS 2011AA)
    Item
    Patient Race (check all that applyU.S. and Canada only)
    text
    C25372 (NCI Thesaurus ValueDomain)
    C0034510 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C17049 (NCI Thesaurus Property)
    CL.2
    Code List
    Patient Race (check all that applyU.S. and Canada only)
    CL Item
    A Person Having Origins In Any Of The Original Peoples Of Europe, The Middle East, Or North Africa. (White)
    C41261 (NCI Thesaurus)
    C0007457 (UMLS 2011AA)
    CL Item
    A Person Having Origins In Any Of The Black Racial Groups Of Africa. Terms Such As "haitian" Or "negro" Can Be Used In Addition To "black Or African American." (Black or African American)
    C16352 (NCI Thesaurus)
    C0085756 (UMLS 2011AA)
    CL Item
    A Person Having Origins In Any Of The Original Peoples Of The Far East, Southeast Asia, Or The Indian Subcontinent Including, For Example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, The Philippine Islands, Thailand, And Vietnam. (Asian)
    C41260 (NCI Thesaurus)
    C0078988 (UMLS 2011AA)
    CL Item
    Not Provided Or Available (Not Reported)
    C43234 (NCI Thesaurus)
    C1706613 (UMLS 2011AA)
    CL Item
    A Person Having Origins In Any Of The Original Peoples Of Hawaii, Guam, Samoa, Or Other Pacific Islands. (Native Hawaiian or other Pacific Islander)
    C41219 (NCI Thesaurus)
    C1513907 (UMLS 2011AA)
    CL Item
    A Person Having Origins In Any Of The Original Peoples Of North And South America (including Central America), And Who Maintains Tribal Affiliation Or Community Attachment. (American Indian or Alaska Native)
    C41259 (NCI Thesaurus)
    C1515945 (UMLS 2011AA)
    CL Item
    Could Not Be Determined Or Unsure (Unknown)
    C17998 (NCI Thesaurus)
    C0439673 (UMLS 2011AA)
    Item
    Patient Ethnicity (U.S. and Canada only)
    text
    C25372 (NCI Thesaurus ValueDomain)
    C0015031 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C16564 (NCI Thesaurus Property)
    CL.3
    Code List
    Patient Ethnicity (U.S. and Canada only)
    CL Item
    A Person Of Mexican, Puerto Rican, Cuban, Central Or South American Or Other Spanish Culture Or Origin, Regardless Of Race. (HISPANIC OR LATINO)
    C17459 (NCI Thesaurus)
    C0086409 (UMLS 2011AA)
    CL Item
    A Person Not Meeting The Definition For Hispanic Or Latino. (NOT HISPANIC OR LATINO)
    C41222 (NCI Thesaurus)
    C1518424 (UMLS 2011AA)
    CL Item
    Could Not Be Determined Or Unsure (UNKNOWN)
    C17998 (NCI Thesaurus)
    C0439673 (UMLS 2011AA)
    Social Security Number
    Item
    Patient Social Security Number (USA only)
    float
    C25337 (NCI Thesaurus ValueDomain)
    C1301821 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25686 (NCI Thesaurus Property)
    PatientAddressPostalCode
    Item
    Patient Zip Code (USA)
    text
    C25162 (NCI Thesaurus ValueDomain)
    C0805701 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25407 (NCI Thesaurus Property)
    C1442065 (UMLS 2011AA Property)
    Country of current residence
    Item
    Country of Residence (if not USA)
    text
    C16960 (NCI Thesaurus ObjectClass)
    C3258975 (UMLS CUI-1)
    C25464 (NCI Thesaurus ValueDomain)
    C25407 (NCI Thesaurus Property)
    C42614 (NCI Thesaurus ValueDomain-2)
    Patient Height
    Item
    Patient Height (cm)
    float
    C25209 (NCI Thesaurus ValueDomain)
    C0489786 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25347 (NCI Thesaurus Property)
    Patient Weight
    Item
    Patient Weight (kg)
    float
    C25209 (NCI Thesaurus ValueDomain)
    C0005910 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25208 (NCI Thesaurus Property)
    Body Surface Area
    Item
    Body Surface Area (m^2)
    float
    C25209 (NCI Thesaurus ValueDomain)
    C0005902 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25157 (NCI Thesaurus Property)
    Item
    ECOG Performance Status (check one)
    text
    C25664 (NCI Thesaurus ValueDomain)
    C1520224 (UMLS CUI-1)
    C25367 (NCI Thesaurus Property)
    C25491 (NCI Thesaurus ValueDomain-2)
    C20641 (NCI Thesaurus ObjectClass)
    CL.4
    Code List
    ECOG Performance Status (check one)
    CL Item
    Fully Active, Able To Carry On All Pre-disease Performance Without Restriction. (0)
    CL Item
    Restricted In Physically Strenuous Activity But Ambulatory And Able To Carry Out Work Of A Light Or Sedentary Nature, E.g., Light Housework, Office Work. (1)
    CL Item
    Ambulatory And Capable Of All Selfcare But Unable To Carry Out Any Work Activities. Up And About More Than 50% Of Waking Hours. (2)
    CL Item
    Capable Of Only Limited Selfcare, Confined To Bed Or Chair More Than 50% Of Waking Hours. (3)
    CL Item
    Completely Disabled. Cannot Carry On Any Selfcare. Totally Confined To Bed Or Chair. (4)
    Item
    Karnofsky Performance Status Score (check one)
    text
    C25367 (NCI Thesaurus Property)
    C20641 (NCI Thesaurus ObjectClass)
    C1518965 (UMLS 2011AA ObjectClass)
    C25338 (NCI Thesaurus ValueDomain)
    C0449820 (UMLS 2011AA ValueDomain)
    CL.5
    Code List
    Karnofsky Performance Status Score (check one)
    CL Item
    Normal, No Complaints, No Evidence Of Disease (100)
    CL Item
    Able To Carry On Normal Activity; Minor Signs Or Symptoms Of Disease (90)
    CL Item
    Normal Activity With Effort; Some Signs Or Symptoms Of Disease (80)
    CL Item
    Cares For Self, Unable To Carry On Normal Activity Or To Do Active Work (70)
    CL Item
    Requires Occasional Assistance, But Is Able To Care For Most Of His/her Needs (60)
    CL Item
    Requires Considerable Assistance And Frequent Medical Care (50)
    CL Item
    Disabled, Requires Special Care And Assistance (40)
    CL Item
    Severely Disabled, Hospitalization Indicated. Death Not Imminent (30)
    CL Item
    Very Sick, Hospitalization Indicated. Death Not Imminent (20)
    CL Item
    Moribund, Fatal Processes Progressing Rapidly (10)
    Item
    Method of Payment (check oneUSA only)
    text
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25371 (NCI Thesaurus Property)
    C0680264 (UMLS 2011AA Property)
    CL.6
    Code List
    Method of Payment (check oneUSA only)
    CL Item
    Private Insurance (Private Insurance)
    CL Item
    Medicare (Medicare)
    C16665 (NCI Thesaurus)
    C0018717 (UMLS 2011AA)
    CL Item
    Medicaid (Medicaid)
    C0025071 (NCI Metathesaurus)
    CL Item
    Medicaid And Medicare (Medicaid and Medicare)
    CL Item
    Medicare And Private Insurance (Medicare and Private Insurance)
    CL Item
    Military Or Veterans Sponsored Nos (Military or Veterans Sponsored, Not Otherwise Specified (NOS))
    CL Item
    Military Sponsored (including Champus & Tricare) (Military Sponsored (including CHAMPUS & TRICARE))
    CL Item
    Veterans Sponsored (Veterans Sponsored)
    CL Item
    Self Pay (no Insurance) (Self Pay (No Insurance))
    CL Item
    No Means Of Payment (no Insurance) (No means of payment (no insurance))
    CL Item
    Other (Other)
    C17649 (NCI Thesaurus)
    C0205394 (UMLS 2011AA)
    CL Item
    Unknown (Unknown)
    C17998 (NCI Thesaurus)
    C0439673 (UMLS 2011AA)
    Item Group
    Certification Of Eligibility
    Eligibility for trial
    Item
    In the opinion of the investigator, is the patient eligible?
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C1302261 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25171 (NCI Thesaurus Property)
    Item Group
    Protocol Design
    StudyStratificationText
    Item
    Stratification Factors (protocol specific)
    text
    C25704 (NCI Thesaurus ValueDomain)
    C1527021 (UMLS 2011AA ValueDomain)
    C15206 (NCI Thesaurus ObjectClass)
    C0008972 (UMLS 2011AA ObjectClass)
    C25689 (NCI Thesaurus Property)
    C1514983 (UMLS 2011AA Property)
    Protocol Treatment Arm
    Item
    Assigned Treatment Arm (protocol specific)
    text
    C25337 (NCI Thesaurus ValueDomain)
    C1522541 (UMLS CUI-1)
    C32141 (NCI Thesaurus Property)
    C15368 (NCI Thesaurus ObjectClass)
    TreatmentAssignmentCode
    Item
    Treatment Assignment Code (protocol specific)
    text
    C25162 (NCI Thesaurus ValueDomain)
    C0805701 (UMLS 2011AA ValueDomain)
    C15368 (NCI Thesaurus ObjectClass)
    C25426 (NCI Thesaurus Property)
    C1516050 (UMLS 2011AA Property)
    AgentNSC/GPIIdentifierNumber
    Item
    NSC Number (Please check the CTEP Home Page for a list of agent NSC numbers.)
    text
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    C1708 (NCI Thesaurus ObjectClass)
    C0450442 (UMLS 2011AA ObjectClass)
    C41244 (NCI Thesaurus Property-2)
    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)
    Medication Dose
    Item
    Agent Dose
    float
    C25488 (NCI Thesaurus ValueDomain)
    C3174092 (UMLS CUI-1)
    C1708 (NCI Thesaurus ObjectClass)
    C1708 (NCI Thesaurus ValueDomain-2)
    C25382 (NCI Thesaurus Property)
    Item
    Units
    text
    C1708 (NCI Thesaurus ObjectClass)
    C1519795 (UMLS CUI-1)
    C25256 (NCI Thesaurus Property)
    C25709 (NCI Thesaurus ValueDomain)
    CL.8
    Code List
    Units
    CL Item
    Billion Pfu (billion pfu)
    CL Item
    Cells (cells)
    CL Item
    Centigrays (cGy)
    CL Item
    Curie (Ci)
    C0700085 (NCI Metathesaurus)
    CL Item
    Centimeter (cm)
    C49668 (NCI Thesaurus)
    C0475210 (UMLS 2011AA)
    CL Item
    Deciliter (dL)
    CL Item
    Decimeter (dm)
    CL Item
    Gram-equivalent Weight (Eq)
    CL Item
    Gram (g)
    C0439208 (NCI Metathesaurus)
    CL Item
    Gravity (in Centrifugation) (gravity)
    CL Item
    Grays (Gy)
    CL Item
    Hertz (Hz)
    CL Item
    International Unit (IU)
    C28255 (NCI Thesaurus)
    CL Item
    Joules Per Centimeter Square (J/cm^2)
    CL Item
    Kilo-electron Volt (keV)
    CL Item
    Kilogram (kg)
    C28252 (NCI Thesaurus)
    C0439209 (UMLS 2011AA)
    CL Item
    Kilohertz (kHz)
    CL Item
    Kilopascal (kPa)
    CL Item
    Liter (L)
    CL Item
    Meter (m)
    C0475209 (NCI Metathesaurus)
    CL Item
    Microcurie (mcCi)
    CL Item
    Microgram (mcg)
    CL Item
    Millicurie (mCi)
    CL Item
    Microliter (mcL)
    CL Item
    Micrometer (mcm)
    CL Item
    Micromole (mcmol)
    C48509 (NCI Thesaurus)
    C0439194 (UMLS 2011AA)
    CL Item
    Milliequivalent (mEq)
    CL Item
    Million Electron Volts (MeV)
    CL Item
    Milligram (mg)
    C28253 (NCI Thesaurus)
    C0439210 (UMLS 2011AA)
    CL Item
    Megahertz (MHz)
    CL Item
    Million International Units (million IU)
    CL Item
    Million Pfu (million pfu)
    CL Item
    Milliunit (milliunit)
    CL Item
    Milliliter (mL)
    C28254 (NCI Thesaurus)
    C0439242 (UMLS 2011AA)
    CL Item
    Millimeter (mm)
    C28251 (NCI Thesaurus)
    C0439200 (UMLS 2011AA)
    CL Item
    Milligrams Per Milliliter Per Minute (MMM)
    CL Item
    Millimole (mmol)
    CL Item
    Gram-molecular Weight (mole) (mol)
    CL Item
    Milliosmole (mOsmol)
    CL Item
    Megarad (Mrad)
    CL Item
    Million Unit (MU)
    CL Item
    Millivolt (mV)
    C0456691 (NCI Metathesaurus)
    CL Item
    Million Viral Particles (mVP)
    C67351 (NCI Thesaurus)
    C1881847 (UMLS 2011AA)
    CL Item
    Not Applicable (N/A)
    C48660 (NCI Thesaurus)
    C1272460 (UMLS 2011AA)
    CL Item
    Nanocurie (nCi)
    C0560007 (NCI Metathesaurus)
    CL Item
    Nanogram (ng)
    CL Item
    Nanometer (nm)
    C0439202 (NCI Metathesaurus)
    CL Item
    Nanometers Of Light (nm light)
    CL Item
    Osmole (Osmol)
    CL Item
    Pascal (Pa)
    C42547 (NCI Thesaurus)
    C0439473 (UMLS 2011AA)
    CL Item
    Percent (percent)
    C48570 (NCI Thesaurus)
    C0439165 (UMLS 2011AA)
    CL Item
    Plaque Forming Unit (pfu)
    CL Item
    Picogram (pg)
    C0439213 (NCI Metathesaurus)
    CL Item
    Pounds Per Square Inch (psi)
    C0439472 (NCI Metathesaurus)
    CL Item
    Tissue Culture Infections Dose (TCID)
    CL Item
    Unit (unit)
    C44278 (NCI Thesaurus)
    C0439148 (UMLS 2011AA)
    CL Item
    Viral Particles (VP)
    Item
    Route
    text
    C25284 (NCI Thesaurus ValueDomain)
    C0013153 (UMLS CUI-1)
    C459 (NCI Thesaurus ObjectClass)
    C25409 (NCI Thesaurus ObjectClass-2)
    C25169 (NCI Thesaurus Property)
    CL.9
    Code List
    Route
    CL Item
    Intramuscular (IM)
    C27974 (NCI Thesaurus)
    C0442117 (UMLS 2011AA)
    C27974 (NCI Thesaurus-3)
    C0442117 (UMLS 2011AA-4)
    CL Item
    Intravenous (IV)
    X-MO-6794 (MGED)
    X-MO-6794 (MGED-2)
    CL Item
    Oral (PO)
    C25311 (NCI Thesaurus)
    C0442027 (UMLS 2011AA)
    C25311 (NCI Thesaurus-3)
    C0442027 (UMLS 2011AA-4)
    CL Item
    Oral (oral)
    C25311 (NCI Thesaurus)
    C0442027 (UMLS 2011AA)
    C25311 (NCI Thesaurus-3)
    C0442027 (UMLS 2011AA-4)
    CL Item
    Transdermal (Transdermal)
    C28017 (NCI Thesaurus)
    C0694643 (UMLS 2011AA)
    CL Item
    Topical (Topical)
    C13344 (NCI Thesaurus)
    C0332237 (UMLS 2011AA)
    C13344 (NCI Thesaurus-3)
    C0332237 (UMLS 2011AA-4)
    CL Item
    Intravenous (intravenous)
    X-MO-6794 (MGED)
    X-MO-6794 (MGED-2)
    CL Item
    Subcutaneous (Subcutaneous)
    C13353 (NCI Thesaurus)
    C0443315 (UMLS 2011AA)
    C13353 (NCI Thesaurus-3)
    C0443315 (UMLS 2011AA-4)
    CL Item
    Vaginal (vaginal)
    CL Item
    Nasal (Nasal)
    C27958 (NCI Thesaurus)
    C0028429 (UMLS 2011AA)
    Item
    Frequency
    text
    C1708 (NCI Thesaurus ObjectClass)
    C3476109 (UMLS CUI-1)
    C25515 (NCI Thesaurus ValueDomain)
    C25382 (NCI Thesaurus Property)
    CL.10
    Code List
    Frequency
    CL Item
    After Meals (p.c.) (after meals (P.C.))
    CL Item
    Am (AM)
    CL Item
    As Needed (p.r.n) (as needed (P.R.N))
    CL Item
    At Bedtime Or Hour Of Sleep (h.s.) (at bedtime or hour of sleep (H.S.))
    CL Item
    Before Meals (a.c.) (before meals (A.C.))
    CL Item
    Daily (Daily)
    C25473 (NCI Thesaurus)
    C0332173 (UMLS 2011AA)
    CL Item
    Every 1 To 2 Hours (Every 1 to 2 hours)
    CL Item
    Every 10 Hours (Every 10 hours)
    CL Item
    Every 11 Hours (Every 11 hours)
    CL Item
    Every 12 Hours (q12hr) (every 12 hours (Q12hr))
    CL Item
    Every 13 Hours (Every 13 hours)
    CL Item
    Every 14 Hours (Every 14 hours)
    CL Item
    Every 15 Hours (Every 15 hours)
    CL Item
    Every 16 Hours (Every 16 hours)
    CL Item
    Every 17 Hours (Every 17 hours)
    CL Item
    Every 18 Hours (Every 18 hours)
    CL Item
    Every 19 Hours (Every 19 hours)
    CL Item
    Every 2 Hours (Every 2 hours)
    CL Item
    Every 20 Hours (Every 20 hours)
    CL Item
    Every 21 Hours (Every 21 hours)
    CL Item
    Every 22 Hours (Every 22 hours)
    CL Item
    Every 23 Hours (Every 23 hours)
    CL Item
    Every 24 Hours (Every 24 hours)
    CL Item
    Every 3 Hours (Every 3 hours)
    CL Item
    Every 3 To 4 Hours (Every 3 to 4 hours)
    CL Item
    Every 4 Hours (q4hr) (every 4 hours (Q4hr))
    CL Item
    Every 4 To 5 Hours (Every 4 to 5 hours)
    CL Item
    Every 4 To 6 Hours (Every 4 to 6 hours)
    CL Item
    Every 5 Hours (Every 5 hours)
    CL Item
    Every 6 Hours (Every 6 hours)
    CL Item
    Every 6 Hours (q6hr) (every 6 hours (Q6hr))
    CL Item
    Every 7 Hours (Every 7 hours)
    CL Item
    Every 8 Hours (q8hr) (every 8 hours (Q8hr))
    CL Item
    Every 9 Hours (Every 9 hours)
    CL Item
    Every Day (q.d.) (every day (Q.D.))
    CL Item
    Every Evening (Every evening)
    CL Item
    Every Hour (Every hour)
    CL Item
    Every Morning (Every morning)
    CL Item
    Every Other Day (q.o.d.) (every other day (Q.O.D.))
    CL Item
    Five Times Daily (Five times daily)
    CL Item
    Four Times A Day (q.i.d) (four times a day (Q.I.D))
    CL Item
    Immediately (stat) (immediately (Stat))
    CL Item
    Monthly (Monthly)
    CL Item
    Not Specified (Not specified)
    CL Item
    Once A Day (q.d.) (Once a day (Q.D.))
    CL Item
    Other (Other)
    C17649 (NCI Thesaurus)
    C0205394 (UMLS 2011AA)
    CL Item
    Pm/bedtime (PM/bedtime)
    CL Item
    Three Times A Day (t.i.d) (three times a day (T.I.D))
    CL Item
    Three Times A Week (t.i.w) (three times a week (T.I.W))
    CL Item
    Twice A Day (b.i.d) (twice a day (B.I.D))
    CL Item
    Twice A Week (b.i.w) (twice a week (B.I.W))
    CL Item
    Unknown (Unknown)
    C17998 (NCI Thesaurus)
    C0439673 (UMLS 2011AA)
    CL Item
    Weekly (Weekly)
    CL158132 (NCI Metathesaurus)
    TherapeuticAgentsAdministeredScheduleText
    Item
    Schedule
    text
    C25704 (NCI Thesaurus ValueDomain)
    C1527021 (UMLS 2011AA ValueDomain)
    C25211 (NCI Thesaurus Property)
    C0086960 (UMLS 2011AA Property)
    C25382 (NCI Thesaurus Property-2)
    C1521801 (UMLS 2011AA Property-2)
    C17935 (NCI Thesaurus ObjectClass)
    C1611640 (UMLS 2011AA ObjectClass)
    Item Group
    Initial Patient Consent For Specimen Use
    SpecimenResearchConsentRelatedInd-3
    Item
    Patient's Initial Consent given for specimen use for research on the patient's cancer?
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C1512699 (UMLS 2011AA ValueDomain)
    C15319 (NCI Thesaurus Property)
    C19157 (NCI Thesaurus ObjectClass)
    C0370003 (UMLS 2011AA ObjectClass)
    C25460 (NCI Thesaurus Property-2)
    C1511481 (UMLS 2011AA Property)
    BloodTissueSpecimenOtherDiseasesandDisordersResearchConsentInd-3
    Item
    Patient's Initial Consent given for specimen use for research unrelated to the patient's cancer?
    boolean
    C12801 (NCI Thesaurus ObjectClass)
    C0040300 (UMLS 2011AA ObjectClass)
    C12434 (NCI Thesaurus ObjectClass-2)
    C0229664 (UMLS 2011AA ObjectClass-2)
    C19157 (NCI Thesaurus ObjectClass-3)
    C0370003 (UMLS 2011AA ObjectClass-3)
    C17649 (NCI Thesaurus Property)
    C0205394 (UMLS 2011AA Property)
    C15319 (NCI Thesaurus Property-2)
    C2991 (NCI Thesaurus Property-3)
    C0012634 (UMLS 2011AA Property-2)
    C25460 (NCI Thesaurus Property-4)
    C1511481 (UMLS 2011AA Property-3)
    C38148 (NCI Thesaurus ValueDomain)
    C1512699 (UMLS 2011AA ValueDomain)
    Permission to contact Patient
    Item
    Patient's initial consent given for further contact regarding specimen?
    boolean
    C16960 (NCI Thesaurus ObjectClass)
    C1522577 (UMLS CUI-1)
    C67527 (NCI Thesaurus Property)
    C0521104 (UMLS CUI-2)
    C25460 (NCI Thesaurus Property-2)
    C16452 (NCI Thesaurus Property-3)
    C38148 (NCI Thesaurus ValueDomain)
    SpecimenICFSignedDate
    Item
    Date of Consent for Specimen Use
    date
    C16468 (NCI Thesaurus ObjectClass)
    C0009797 (UMLS 2011AA ObjectClass)
    C19157 (NCI Thesaurus ObjectClass-2)
    C0370003 (UMLS 2011AA ObjectClass-2)
    C25679 (NCI Thesaurus Property)
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C25367 (NCI Thesaurus ValueDomain-2)
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