ID

8649

Description

GOG-0262: Medical History Form (Form MEDH) Paclitaxel and Carboplatin With or Without Bevacizumab in Treating Patients With Stage II, Stage III, or Stage IV Ovarian Epithelial Cancer, Primary Peritoneal Cancer, or Fallopian Tube Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=6E5EB14F-2030-D8EE-E040-BB89AD4349C7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=6E5EB14F-2030-D8EE-E040-BB89AD4349C7

Keywords

Versions (4)
  1. 9/19/12 9/19/12 -
  2. 8/11/14 8/11/14 - Martin Dugas
  3. 8/11/14 8/11/14 - Martin Dugas
  4. 1/9/15 1/9/15 - Martin Dugas
Uploaded on

January 9, 2015

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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Fallopian Tube Cancer NCT01167712 Pre-Study - GOG-0262: Medical History Form (Form MEDH) - 2917582v1.0

English

No Instruction available.

1 forms  
  1. StudyEvent: GOG-0262: Medical History Form (Form MEDH)
    1. No Instruction available.
Header Module
Description

Header Module

Date form originally completed
Description

Form Completion Date

Data type

date

Alias
NCI Thesaurus ObjectClass
C19464
UMLS CUI-1
C1549507
NCI Thesaurus Property
C25250
NCI Thesaurus Property-2
C25604
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ValueDomain-2
C25367
Date form amended
Description

Amendment date

Data type

date

Alias
NCI Thesaurus ObjectClass
C19464
UMLS CUI-1
C0680532
NCI Thesaurus Property
C25250
UMLS CUI-2
C0011008
NCI Thesaurus Property-2
C25416
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ValueDomain-2
C25367
Person amending form, last name
Description

Person Amending Form

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C0680532
NCI Thesaurus ObjectClass
C25190
UMLS CUI-2
C1547383
NCI Thesaurus Property
C25364
Patient Initials
Description

Patient Initials

Data type

text

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

Patient Study ID

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25462
NCI Thesaurus Property-2
C25364
Person Completing Form, Last Name
Description

Person Completing Form Last Name

Data type

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
Ovarian: Disease Description
Description

Ovarian: Disease Description

Have you ever been treated for hypertension that required medication
Description

PersonHypertensionTherapeuticProcedurePersonalMedicalHistoryIndicator

Data type

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C3117
UMLS 2011AA Property
C0020538
NCI Thesaurus Property-2
C49236
UMLS 2011AA Property-2
C0087111
NCI Thesaurus Property-3
C18772
UMLS 2011AA Property-3
C0262926
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
Peripheral vascular disease with claudication
Description

HistoryofPeripheralVascularDiseasePresentInd-3

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus ObjectClass
C66923
UMLS 2011AA ObjectClass
C1881056
Myocardial infarction or cerebrovascular accident
Description

PatientCerebrovascularAccidentMyocardialInfarctionPersonalMedicalHistoryInd-3

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C27996
UMLS 2011AA Property
C0027051
NCI Thesaurus Property-2
C3390
UMLS 2011AA Property-2
C0038454
NCI Thesaurus Property-3
C18772
UMLS 2011AA Property-3
C0262926
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Have you smoked during the past year
Description

Current Smoker

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS CUI-1
C3241966
NCI Thesaurus Property
C25471
NCI Thesaurus ObjectClass
C17934
NCI Metathesaurus Property
C0449865
If you smoke, how many packs of cigarettes do you average per day
Description

CigaretteAverageDailyPackUseCount

Data type

float

Alias
NCI Thesaurus ObjectClass
C1802
UMLS 2011AA ObjectClass
C0677453
NCI Thesaurus Property
C25473
UMLS 2011AA Property
C0332173
NCI Thesaurus Property-2
C62653
UMLS 2011AA Property-2
C2825051
NCI Thesaurus Property-3
C37917
UMLS 2011AA Property-3
C1510992
NCI Thesaurus Property-4
C25340
UMLS 2011AA Property-4
C0457083
NCI Thesaurus ValueDomain
C25463
UMLS 2011AA ValueDomain
C0750480
How many cigars/pipes do you average per day
Description

CigarAverageDailyUseCount

Data type

float

Alias
NCI Thesaurus ObjectClass
C1813
UMLS 2011AA ObjectClass
C0182504
NCI Thesaurus Property
C25473
UMLS 2011AA Property
C0332173
NCI Thesaurus Property-2
C37917
UMLS 2011AA Property-2
C1510992
NCI Thesaurus Property-3
C25340
UMLS 2011AA Property-3
C0457083
NCI Thesaurus ValueDomain
C25463
UMLS 2011AA ValueDomain
C0750480
How many years have you smoked
Description

Smoking Duration

Data type

float

Alias
NCI Thesaurus ValueDomain
C25463
UMLS CUI-1
C3694955
NCI Thesaurus ObjectClass
C17934
NCI Thesaurus Property
C25330
Do you currently take medication for diabetes
Description

PersonDiabetesMellitusTherapeuticProcedurePersonalMedicalHistoryIndicator

Data type

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C2985
UMLS 2011AA Property
C0011849
NCI Thesaurus Property-2
C49236
UMLS 2011AA Property-2
C0087111
NCI Thesaurus Property-3
C18772
UMLS 2011AA Property-3
C0262926
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
Ovarian: Findings From Primary Surgery
Description

Ovarian: Findings From Primary Surgery

Have you ever been diagnosed with an autoimmune disease
Description

DiseasesandDisordersPatientSelf-ReportAutoimmuneDiseaseDiagnosisInd-3

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus Property
C15220
UMLS 2011AA Property
C0011900
NCI Thesaurus Property-2
C2889
UMLS 2011AA Property-2
C0004364
NCI Thesaurus Property-3
C21089
UMLS 2011AA Property-3
C0681906
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Ovarian: Post-operative Findings Following Primary Surgery
Description

Ovarian: Post-operative Findings Following Primary Surgery

Have you ever had peptic ulcer disease, documented by endoscopy
Description

PatientUlcerationPersonalMedicalHistoryInd-3

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C18772
UMLS 2011AA Property
C0262926
NCI Thesaurus Property-2
C25757
UMLS 2011AA Property-2
C0041582
Have you ever had an intestinal obstruction, documented radiographically
Description

TumorIntestinalObstructionInd-3

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass
C3262
UMLS 2011AA ObjectClass
C0027651
NCI Thesaurus Property
C25266
UMLS 2011AA Property
C0021853
NCI Thesaurus Property-2
C3284
UMLS 2011AA Property-2
C0028778
Have you ever had inflammatory bowel disease
Description

PatientInflammatoryBowelDiseasePersonalMedicalHistoryIndicator

Data type

text

Alias
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C3138
UMLS 2011AA Property
C0021390
NCI Thesaurus Property-2
C18772
UMLS 2011AA Property-2
C0262926
If you have had inflammatory bowel disease, did you require medication and/or surgery
Description

PatientInflammatoryBowelDiseaseTreatmentPersonalMedicalHistoryInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C15368
NCI Thesaurus Property-2
C3138
UMLS 2011AA Property
C0021390
NCI Thesaurus Property-3
C18772
UMLS 2011AA Property-2
C0262926
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Have you ever had diverticulitis that required hospitalization or outpatient antibiotics and dietary modification
Description

PatientDiverticulitisTreatmentPersonalMedicalHistoryInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C15368
NCI Thesaurus Property-2
C18772
UMLS 2011AA Property
C0262926
NCI Thesaurus Property-3
C26752
UMLS 2011AA Property-2
C0012813
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Have you ever had C. difficile colitis
Description

PatientC.DifficileColitisPersonalMedicalHistoryInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C18772
UMLS 2011AA Property
C0262926
NCI Thesaurus Property-2
C35286
UMLS 2011AA Property-2
C0238106
Have you ever had small bowel resection with anastomosis
Description

PatientSmallIntestineExcisionAnastomosisPersonalMedicalHistoryInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C12386
UMLS 2011AA Property
C0021852
NCI Thesaurus Property-2
C15609
UMLS 2011AA Property-2
C0677554
NCI Thesaurus Property-3
C15232
UMLS 2011AA Property-3
C0728940
NCI Thesaurus Property-4
C18772
UMLS 2011AA Property-4
C0262926
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
At primary debulking surgery
Description

PatientSmallBowelExcisionAnastomosisDebulkingPersonalMedicalHistoryInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C12386
UMLS 2011AA Property
C0021852
NCI Thesaurus Property-2
C15609
UMLS 2011AA Property-2
C0677554
NCI Thesaurus Property-3
C15232
UMLS 2011AA Property-3
C0728940
NCI Thesaurus Property-4
C18772
UMLS 2011AA Property-4
C0262926
NCI Thesaurus Property-5
C15749
UMLS 2011AA Property-5
C0439805
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Have you ever had large bowel resection with anastomosis
Description

PatientLargeIntestineExcisionAnastomosisPersonalMedicalHistoryInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C15609
UMLS 2011AA Property
C0677554
NCI Thesaurus Property-2
C12379
UMLS 2011AA Property-2
C0021851
NCI Thesaurus Property-3
C15232
UMLS 2011AA Property-3
C0728940
NCI Thesaurus Property-4
C18772
UMLS 2011AA Property-4
C0262926
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
At primary debulking surgery
Description

PatientLargeIntestineExcisionAnastomosisDebulkingPersonalMedicalHistoryInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C15609
UMLS 2011AA Property
C0677554
NCI Thesaurus Property-2
C12379
UMLS 2011AA Property-2
C0021851
NCI Thesaurus Property-3
C15232
UMLS 2011AA Property-3
C0728940
NCI Thesaurus Property-4
C18772
UMLS 2011AA Property-4
C0262926
NCI Thesaurus Property-5
C15749
UMLS 2011AA Property-5
C0439805
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Footer Module
Description

Footer Module

Do you use corticosteroids for a chronic condition
Description

PatientCorticosteroidUsePersonalMedicalHistoryInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C2322
UMLS 2011AA Property
C0001617
NCI Thesaurus Property-2
C18772
UMLS 2011AA Property-2
C0262926
NCI Thesaurus Property-3
C25340
UMLS 2011AA Property-3
C0457083
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Do you use NSAID chronically
Description

PatientNonsteroidalAntiinflammatoryDrugRegularUsePersonalMedicalHistoryInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C18772
UMLS 2011AA Property
C0262926
NCI Thesaurus Property-2
C257
UMLS 2011AA Property-2
C0003211
NCI Thesaurus Property-3
C25340
UMLS 2011AA Property-3
C0457083
NCI Thesaurus Property-4
C25647
UMLS 2011AA Property-4
C0205272
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Comments
Description

Comments

COMMENTS
Description

Research Comments

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS CUI-1
C0947611
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
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1 forms
  1. StudyEvent: GOG-0262: Medical History Form (Form MEDH)
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Header Module
Form Completion Date
Item
Date form originally completed
date
C19464 (NCI Thesaurus ObjectClass)
C1549507 (UMLS CUI-1)
C25250 (NCI Thesaurus Property)
C25604 (NCI Thesaurus Property-2)
C25164 (NCI Thesaurus ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
Amendment date
Item
Date form amended
date
C19464 (NCI Thesaurus ObjectClass)
C0680532 (UMLS CUI-1)
C25250 (NCI Thesaurus Property)
C0011008 (UMLS CUI-2)
C25416 (NCI Thesaurus Property-2)
C25164 (NCI Thesaurus ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
Person Amending Form
Item
Person amending form, last name
text
C25191 (NCI Thesaurus ValueDomain)
C0680532 (UMLS CUI-1)
C25190 (NCI Thesaurus ObjectClass)
C1547383 (UMLS CUI-2)
C25364 (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)
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)
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)
Item Group
Ovarian: Disease Description
Item
Have you ever been treated for hypertension that required medication
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C3117 (NCI Thesaurus Property)
C0020538 (UMLS 2011AA Property)
C49236 (NCI Thesaurus Property-2)
C0087111 (UMLS 2011AA Property-2)
C18772 (NCI Thesaurus Property-3)
C0262926 (UMLS 2011AA Property-3)
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
CL.1
Code List
Have you ever been treated for hypertension that required medication
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes, Currently (Yes, currently)
CL Item
Yes, In The Past (Yes, in the past)
HistoryofPeripheralVascularDiseasePresentInd-3
Item
Peripheral vascular disease with claudication
boolean
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C66923 (NCI Thesaurus ObjectClass)
C1881056 (UMLS 2011AA ObjectClass)
PatientCerebrovascularAccidentMyocardialInfarctionPersonalMedicalHistoryInd-3
Item
Myocardial infarction or cerebrovascular accident
boolean
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C27996 (NCI Thesaurus Property)
C0027051 (UMLS 2011AA Property)
C3390 (NCI Thesaurus Property-2)
C0038454 (UMLS 2011AA Property-2)
C18772 (NCI Thesaurus Property-3)
C0262926 (UMLS 2011AA Property-3)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
Current Smoker
Item
Have you smoked during the past year
boolean
C38148 (NCI Thesaurus ValueDomain)
C3241966 (UMLS CUI-1)
C25471 (NCI Thesaurus Property)
C17934 (NCI Thesaurus ObjectClass)
C0449865 (NCI Metathesaurus Property)
CigaretteAverageDailyPackUseCount
Item
If you smoke, how many packs of cigarettes do you average per day
float
C1802 (NCI Thesaurus ObjectClass)
C0677453 (UMLS 2011AA ObjectClass)
C25473 (NCI Thesaurus Property)
C0332173 (UMLS 2011AA Property)
C62653 (NCI Thesaurus Property-2)
C2825051 (UMLS 2011AA Property-2)
C37917 (NCI Thesaurus Property-3)
C1510992 (UMLS 2011AA Property-3)
C25340 (NCI Thesaurus Property-4)
C0457083 (UMLS 2011AA Property-4)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
CigarAverageDailyUseCount
Item
How many cigars/pipes do you average per day
float
C1813 (NCI Thesaurus ObjectClass)
C0182504 (UMLS 2011AA ObjectClass)
C25473 (NCI Thesaurus Property)
C0332173 (UMLS 2011AA Property)
C37917 (NCI Thesaurus Property-2)
C1510992 (UMLS 2011AA Property-2)
C25340 (NCI Thesaurus Property-3)
C0457083 (UMLS 2011AA Property-3)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
Smoking Duration
Item
How many years have you smoked
float
C25463 (NCI Thesaurus ValueDomain)
C3694955 (UMLS CUI-1)
C17934 (NCI Thesaurus ObjectClass)
C25330 (NCI Thesaurus Property)
Item
Do you currently take medication for diabetes
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C2985 (NCI Thesaurus Property)
C0011849 (UMLS 2011AA Property)
C49236 (NCI Thesaurus Property-2)
C0087111 (UMLS 2011AA Property-2)
C18772 (NCI Thesaurus Property-3)
C0262926 (UMLS 2011AA Property-3)
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
CL.5
Code List
Do you currently take medication for diabetes
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes - Insulin (Yes - Insulin)
CL Item
Yes - Oral Hypoglycemics (Yes - Oral hypoglycemics)
Item Group
Ovarian: Findings From Primary Surgery
DiseasesandDisordersPatientSelf-ReportAutoimmuneDiseaseDiagnosisInd-3
Item
Have you ever been diagnosed with an autoimmune disease
boolean
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
C2889 (NCI Thesaurus Property-2)
C0004364 (UMLS 2011AA Property-2)
C21089 (NCI Thesaurus Property-3)
C0681906 (UMLS 2011AA Property-3)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
Item Group
Ovarian: Post-operative Findings Following Primary Surgery
PatientUlcerationPersonalMedicalHistoryInd-3
Item
Have you ever had peptic ulcer disease, documented by endoscopy
boolean
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C18772 (NCI Thesaurus Property)
C0262926 (UMLS 2011AA Property)
C25757 (NCI Thesaurus Property-2)
C0041582 (UMLS 2011AA Property-2)
TumorIntestinalObstructionInd-3
Item
Have you ever had an intestinal obstruction, documented radiographically
boolean
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C25266 (NCI Thesaurus Property)
C0021853 (UMLS 2011AA Property)
C3284 (NCI Thesaurus Property-2)
C0028778 (UMLS 2011AA Property-2)
Item
Have you ever had inflammatory bowel disease
text
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C3138 (NCI Thesaurus Property)
C0021390 (UMLS 2011AA Property)
C18772 (NCI Thesaurus Property-2)
C0262926 (UMLS 2011AA Property-2)
CL.9
Code List
Have you ever had inflammatory bowel disease
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes - Crohn's Disease (Yes - Crohn's disease)
CL Item
Yes - Ulcerative Colitis (Yes - Ulcerative colitis)
PatientInflammatoryBowelDiseaseTreatmentPersonalMedicalHistoryInd-2
Item
If you have had inflammatory bowel disease, did you require medication and/or surgery
boolean
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus Property)
C3138 (NCI Thesaurus Property-2)
C0021390 (UMLS 2011AA Property)
C18772 (NCI Thesaurus Property-3)
C0262926 (UMLS 2011AA Property-2)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
PatientDiverticulitisTreatmentPersonalMedicalHistoryInd-2
Item
Have you ever had diverticulitis that required hospitalization or outpatient antibiotics and dietary modification
boolean
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus Property)
C18772 (NCI Thesaurus Property-2)
C0262926 (UMLS 2011AA Property)
C26752 (NCI Thesaurus Property-3)
C0012813 (UMLS 2011AA Property-2)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
PatientC.DifficileColitisPersonalMedicalHistoryInd-2
Item
Have you ever had C. difficile colitis
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C18772 (NCI Thesaurus Property)
C0262926 (UMLS 2011AA Property)
C35286 (NCI Thesaurus Property-2)
C0238106 (UMLS 2011AA Property-2)
PatientSmallIntestineExcisionAnastomosisPersonalMedicalHistoryInd-2
Item
Have you ever had small bowel resection with anastomosis
boolean
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C12386 (NCI Thesaurus Property)
C0021852 (UMLS 2011AA Property)
C15609 (NCI Thesaurus Property-2)
C0677554 (UMLS 2011AA Property-2)
C15232 (NCI Thesaurus Property-3)
C0728940 (UMLS 2011AA Property-3)
C18772 (NCI Thesaurus Property-4)
C0262926 (UMLS 2011AA Property-4)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
PatientSmallBowelExcisionAnastomosisDebulkingPersonalMedicalHistoryInd-2
Item
At primary debulking surgery
boolean
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C12386 (NCI Thesaurus Property)
C0021852 (UMLS 2011AA Property)
C15609 (NCI Thesaurus Property-2)
C0677554 (UMLS 2011AA Property-2)
C15232 (NCI Thesaurus Property-3)
C0728940 (UMLS 2011AA Property-3)
C18772 (NCI Thesaurus Property-4)
C0262926 (UMLS 2011AA Property-4)
C15749 (NCI Thesaurus Property-5)
C0439805 (UMLS 2011AA Property-5)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
PatientLargeIntestineExcisionAnastomosisPersonalMedicalHistoryInd-2
Item
Have you ever had large bowel resection with anastomosis
boolean
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C15609 (NCI Thesaurus Property)
C0677554 (UMLS 2011AA Property)
C12379 (NCI Thesaurus Property-2)
C0021851 (UMLS 2011AA Property-2)
C15232 (NCI Thesaurus Property-3)
C0728940 (UMLS 2011AA Property-3)
C18772 (NCI Thesaurus Property-4)
C0262926 (UMLS 2011AA Property-4)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
PatientLargeIntestineExcisionAnastomosisDebulkingPersonalMedicalHistoryInd-2
Item
At primary debulking surgery
boolean
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C15609 (NCI Thesaurus Property)
C0677554 (UMLS 2011AA Property)
C12379 (NCI Thesaurus Property-2)
C0021851 (UMLS 2011AA Property-2)
C15232 (NCI Thesaurus Property-3)
C0728940 (UMLS 2011AA Property-3)
C18772 (NCI Thesaurus Property-4)
C0262926 (UMLS 2011AA Property-4)
C15749 (NCI Thesaurus Property-5)
C0439805 (UMLS 2011AA Property-5)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
Item Group
Footer Module
PatientCorticosteroidUsePersonalMedicalHistoryInd-2
Item
Do you use corticosteroids for a chronic condition
boolean
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C2322 (NCI Thesaurus Property)
C0001617 (UMLS 2011AA Property)
C18772 (NCI Thesaurus Property-2)
C0262926 (UMLS 2011AA Property-2)
C25340 (NCI Thesaurus Property-3)
C0457083 (UMLS 2011AA Property-3)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
PatientNonsteroidalAntiinflammatoryDrugRegularUsePersonalMedicalHistoryInd-2
Item
Do you use NSAID chronically
boolean
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C18772 (NCI Thesaurus Property)
C0262926 (UMLS 2011AA Property)
C257 (NCI Thesaurus Property-2)
C0003211 (UMLS 2011AA Property-2)
C25340 (NCI Thesaurus Property-3)
C0457083 (UMLS 2011AA Property-3)
C25647 (NCI Thesaurus Property-4)
C0205272 (UMLS 2011AA Property-4)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
Item Group
Comments
Research Comments
Item
COMMENTS
text
C25704 (NCI Thesaurus ValueDomain)
C0947611 (UMLS CUI-1)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
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