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
Lien
Mots-clés
Versions (4)
- 19/09/2012 19/09/2012 -
- 11/08/2014 11/08/2014 - Martin Dugas
- 11/08/2014 11/08/2014 - Martin Dugas
- 09/01/2015 09/01/2015 - Martin Dugas
Téléchargé le
9 janvier 2015
DOI
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Licence
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
No Instruction available.
- StudyEvent: GOG-0262: Medical History Form (Form MEDH)
Description
Ovarian: Disease Description
Description
PersonHypertensionTherapeuticProcedurePersonalMedicalHistoryIndicator
Type de données
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
Description
HistoryofPeripheralVascularDiseasePresentInd-3
Type de données
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
Description
PatientCerebrovascularAccidentMyocardialInfarctionPersonalMedicalHistoryInd-3
Type de données
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
Description
Current Smoker
Type de données
boolean
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS CUI-1
- C3241966
- NCI Thesaurus Property
- C25471
- NCI Thesaurus ObjectClass
- C17934
- NCI Metathesaurus Property
- C0449865
Description
CigaretteAverageDailyPackUseCount
Type de données
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
Description
CigarAverageDailyUseCount
Type de données
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
Description
Smoking Duration
Type de données
float
Alias
- NCI Thesaurus ValueDomain
- C25463
- UMLS CUI-1
- C3694955
- NCI Thesaurus ObjectClass
- C17934
- NCI Thesaurus Property
- C25330
Description
PersonDiabetesMellitusTherapeuticProcedurePersonalMedicalHistoryIndicator
Type de données
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
Description
Ovarian: Findings From Primary Surgery
Description
DiseasesandDisordersPatientSelf-ReportAutoimmuneDiseaseDiagnosisInd-3
Type de données
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
Description
Ovarian: Post-operative Findings Following Primary Surgery
Description
PatientUlcerationPersonalMedicalHistoryInd-3
Type de données
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
Description
TumorIntestinalObstructionInd-3
Type de données
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
Description
PatientInflammatoryBowelDiseasePersonalMedicalHistoryIndicator
Type de données
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
Description
PatientInflammatoryBowelDiseaseTreatmentPersonalMedicalHistoryInd-2
Type de données
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
Description
PatientDiverticulitisTreatmentPersonalMedicalHistoryInd-2
Type de données
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
Description
PatientC.DifficileColitisPersonalMedicalHistoryInd-2
Type de données
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
Description
PatientSmallIntestineExcisionAnastomosisPersonalMedicalHistoryInd-2
Type de données
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
Description
PatientSmallBowelExcisionAnastomosisDebulkingPersonalMedicalHistoryInd-2
Type de données
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
Description
PatientLargeIntestineExcisionAnastomosisPersonalMedicalHistoryInd-2
Type de données
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
Description
PatientLargeIntestineExcisionAnastomosisDebulkingPersonalMedicalHistoryInd-2
Type de données
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
Description
Footer Module
Description
PatientCorticosteroidUsePersonalMedicalHistoryInd-2
Type de données
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
Description
PatientNonsteroidalAntiinflammatoryDrugRegularUsePersonalMedicalHistoryInd-2
Type de données
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
Description
Comments
Similar models
No Instruction available.
- StudyEvent: GOG-0262: Medical History Form (Form MEDH)
C1549507 (UMLS CUI-1)
C25250 (NCI Thesaurus Property)
C25604 (NCI Thesaurus Property-2)
C25164 (NCI Thesaurus ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
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)
C0680532 (UMLS CUI-1)
C25190 (NCI Thesaurus ObjectClass)
C1547383 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25462 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
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)
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)
C1298908 (UMLS 2011AA)
C1512699 (UMLS 2011AA ValueDomain)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C66923 (NCI Thesaurus ObjectClass)
C1881056 (UMLS 2011AA 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)
C3241966 (UMLS CUI-1)
C25471 (NCI Thesaurus Property)
C17934 (NCI Thesaurus ObjectClass)
C0449865 (NCI Metathesaurus Property)
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)
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)
C3694955 (UMLS CUI-1)
C17934 (NCI Thesaurus ObjectClass)
C25330 (NCI Thesaurus Property)
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)
C1298908 (UMLS 2011AA)
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)
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)
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)
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)
C1298908 (UMLS 2011AA)
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)
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)
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)
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)
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)
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)
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)
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)
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)
C0947611 (UMLS CUI-1)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)