ID
8697
Beschreibung
NSABP Protocol B-43 - Protocol Entry Form Worksheet Radiation Therapy With or Without Trastuzumab in Treating Women With Ductal Carcinoma In Situ Who Have Undergone Lumpectomy Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=39C95E6B-CA7A-3A5C-E044-0003BA3F9857
Link
Stichworte
Versionen (2)
- 27.08.12 27.08.12 -
- 09.01.15 09.01.15 - Martin Dugas
Hochgeladen am
9. Januar 2015
DOI
Für eine Beantragung loggen Sie sich ein.
Lizenz
Creative Commons BY-NC 3.0 Legacy
Modell Kommentare :
Hier können Sie das Modell kommentieren. Über die Sprechblasen an den Itemgruppen und Items können Sie diese spezifisch kommentieren.
Itemgroup Kommentare für :
Item Kommentare für :
Um Formulare herunterzuladen müssen Sie angemeldet sein. Bitte loggen Sie sich ein oder registrieren Sie sich kostenlos.
Breast Cancer NCT00769379 Registration - NSABP Protocol B-43 - Protocol Entry Form Worksheet - 2679593v1.0
Submit every 6 months from date of randomization for the first 5 years; yearly thereafter, and when a protocol event occurs. Fax Form F to 412-622-2111
- StudyEvent: NSABP Protocol B-43 - Protocol Entry Form Worksheet
Beschreibung
Race
Beschreibung
Racial Group
Datentyp
text
Alias
- NCI Thesaurus ValueDomain
- C25372
- UMLS CUI-1
- C0034510
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C17049
Beschreibung
Person Completing Form, Last Name
Beschreibung
PatientPaymentType
Datentyp
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
Beschreibung
Ethnic Group
Datentyp
text
Alias
- NCI Thesaurus ValueDomain
- C25372
- UMLS CUI-1
- C0015031
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C16564
Beschreibung
PatientAddressCountryCode
Datentyp
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
Beschreibung
Country of current residence
Datentyp
text
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS CUI-1
- C3258975
- NCI Thesaurus ValueDomain
- C25464
- NCI Thesaurus Property
- C25407
- NCI Thesaurus ValueDomain-2
- C42614
Beschreibung
PatientAddressPostalCode
Datentyp
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
Beschreibung
Receptor Status
Beschreibung
ERLevelTumorStatus
Datentyp
text
Alias
- NCI Thesaurus ValueDomain
- C3262
- UMLS 2011AA ValueDomain
- C0027651
- NCI Thesaurus ObjectClass
- C17069
- UMLS 2011AA ObjectClass
- C0034804
- NCI Thesaurus ValueDomain-2
- C25688
- UMLS 2011AA ValueDomain-2
- C0449438
- NCI Thesaurus Property
- C25554
- UMLS 2011AA Property
- C0441889
Beschreibung
PgRStatusType
Datentyp
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus ObjectClass
- C17075
- UMLS 2011AA ObjectClass
- C0034833
- NCI Metathesaurus Property
- C0678257
Beschreibung
Treatment
Beschreibung
BreastNeoplasmNuclearGradeCategory
Datentyp
text
Alias
- NCI Thesaurus ObjectClass
- C3262
- UMLS 2011AA ObjectClass
- C0027651
- NCI Thesaurus ObjectClass-2
- C12971
- UMLS 2011AA ObjectClass-2
- C0006141
- NCI Thesaurus Property
- C13361
- UMLS 2011AA Property
- C0521447
- NCI Thesaurus Property-2
- C48309
- UMLS 2011AA Property-2
- C0441800
- NCI Thesaurus ValueDomain
- C25372
- UMLS 2011AA ValueDomain
- C0683312
Beschreibung
HormoneTherapyPlanAdministrationInd-2
Datentyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
- NCI Thesaurus ObjectClass
- C15445
- UMLS 2011AA ObjectClass
- C0279025
- NCI Thesaurus Property
- C25619
- UMLS 2011AA Property
- C1301732
- NCI Thesaurus Property-2
- C25409
- UMLS 2011AA Property-2
- C1533734
Beschreibung
Patient Characteristics
Beschreibung
Patient Height
Datentyp
float
Maßeinheiten
- cm
Alias
- NCI Thesaurus ValueDomain
- C25209
- UMLS CUI-1
- C0489786
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25347
Beschreibung
Patient Weight
Datentyp
float
Maßeinheiten
- Kg
Alias
- NCI Thesaurus ValueDomain
- C25209
- UMLS CUI-1
- C0005910
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25208
Beschreibung
Unnamed4
Beschreibung
InformedConsentFormSignedDate
Datentyp
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
Beschreibung
Permission to contact Patient
Datentyp
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
Beschreibung
PatientPHIConsentIndicator
Datentyp
text
Alias
- NCI Thesaurus ValueDomain
- C25180
- UMLS 2011AA ValueDomain
- C1522602
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C25460
- UMLS 2011AA Property
- C1511481
Beschreibung
Eligibility for trial
Datentyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS CUI-1
- C1302261
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25171
Beschreibung
SpecimenNationalSurgicalAdjuvantBreastandBowelProjectCentralLaboratoryIdentifierNumber
Datentyp
text
Alias
- NCI Thesaurus ObjectClass
- C19157
- UMLS 2011AA ObjectClass
- C0370003
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
- NCI Thesaurus Property-2
- C15818
- UMLS 2011AA Property-2
- C1513905
- NCI Thesaurus Property-3
- C64207
- UMLS 2011AA Property-3
- C1880016
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
Beschreibung
Determination Of Pre-entry Menopausal Status
Beschreibung
BilateralOophorectomyPerformedInd-2
Datentyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
- NCI Thesaurus ObjectClass
- C13332
- UMLS 2011AA ObjectClass
- C0238767
- NCI Thesaurus Property
- C38000
- UMLS 2011AA Property
- C0884358
- NCI Thesaurus ObjectClass-2
- C15291
- UMLS 2011AA ObjectClass-2
- C0029936
Beschreibung
MensesEndOccurrenceInd-3
Datentyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
- NCI Thesaurus Property
- C25275
- UMLS 2011AA Property
- C2745955
- NCI Thesaurus ObjectClass
- C3232
- UMLS 2011AA ObjectClass
- C0025344
- NCI Thesaurus Property-2
- C25496
- UMLS 2011AA Property-2
- C2746065
Beschreibung
HysterectomyAdvancedReproductionAgePerformedInd-2
Datentyp
boolean
Alias
- NCI Thesaurus ObjectClass
- C15256
- UMLS 2011AA ObjectClass
- C0020699
- NCI Thesaurus Property
- C38000
- UMLS 2011AA Property
- C0884358
- NCI Thesaurus Property-2
- C25411
- UMLS 2011AA Property-2
- C0205179
- NCI Thesaurus Property-3
- C25150
- UMLS 2011AA Property-3
- C0001779
- NCI Thesaurus Property-4
- C17087
- UMLS 2011AA Property-4
- C0035150
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Beschreibung
HysterectomyFluorescenceinsituHybridizationPerformedInd-2
Datentyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
- NCI Thesaurus Property
- C17563
- UMLS 2011AA Property
- C0162789
- NCI Thesaurus Property-2
- C38000
- UMLS 2011AA Property-2
- C0884358
- NCI Thesaurus ObjectClass
- C15256
- UMLS 2011AA ObjectClass
- C0020699
Beschreibung
PatientPostMenopauseIndicator
Datentyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C25180
- UMLS 2011AA ValueDomain
- C1522602
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C15421
- UMLS 2011AA Property
- C0232970
Beschreibung
LastMenstrualCycleOnsetDate
Datentyp
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ObjectClass
- C25551
- UMLS 2011AA ObjectClass
- C1517741
- NCI Metathesaurus ObjectClass
- C0025329
- NCI Thesaurus Property
- C25279
- UMLS 2011AA Property
- C0332162
Beschreibung
Footer Module
Beschreibung
Person Completing Form
Datentyp
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS CUI-1
- C1550483
- NCI Thesaurus ObjectClass
- C25657
- NCI Thesaurus Property
- C25364
Beschreibung
Date Form Completed
Datentyp
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C1115437
- NCI Thesaurus ObjectClass
- C40988
- NCI Thesaurus Property
- C25250
- NCI Thesaurus ValueDomain-2
- C25367
Beschreibung
Patient ID NSABP
Datentyp
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS CUI-1
- C2348585
- NCI Thesaurus ObjectClass
- C16960
- UMLS CUI-2
- C1513905
- NCI Thesaurus Property
- C25364
- NCI Thesaurus Property-2
- C15818
Ähnliche Modelle
Submit every 6 months from date of randomization for the first 5 years; yearly thereafter, and when a protocol event occurs. Fax Form F to 412-622-2111
- StudyEvent: NSABP Protocol B-43 - Protocol Entry Form Worksheet
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1517741 (UMLS CUI-2)
C25536 (NCI Thesaurus Property)
C25551 (NCI Thesaurus Property-2)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C0205435 (UMLS CUI-2)
C25536 (NCI Thesaurus Property)
C25509 (NCI Thesaurus Property-2)
C1547383 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25536 (NCI Thesaurus Property)
C1555582 (UMLS 2011AA Property)
C25569 (NCI Thesaurus Property-2)
C0444598 (UMLS 2011AA Property-2)
C1527021 (UMLS 2011AA ValueDomain)
C15207 (NCI Thesaurus ObjectClass)
C37901 (NCI Thesaurus Property)
C0205145 (UMLS 2011AA Property)
C42614 (NCI Thesaurus ValueDomain-2)
C0027365 (UMLS 2011AA ValueDomain-2)
C0421451 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25367 (NCI Thesaurus ValueDomain-2)
C25155 (NCI Thesaurus Property)
C1547383 (UMLS 2011AA ValueDomain)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25741 (NCI Thesaurus ObjectClass)
C0031831 (UMLS 2011AA ObjectClass)
C25705 (NCI Thesaurus ObjectClass-2)
C1522326 (UMLS 2011AA ObjectClass-2)
C1301821 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25686 (NCI Thesaurus Property)
C0034510 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C17049 (NCI Thesaurus Property)
C1515945 (UMLS 2011AA)
C0078988 (UMLS 2011AA)
C0085756 (UMLS 2011AA)
C1513907 (UMLS 2011AA)
C1706613 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C0007457 (UMLS 2011AA)
C0332307 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25371 (NCI Thesaurus Property)
C0680264 (UMLS 2011AA Property)
C0018717 (UMLS 2011AA)
C0205394 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C0015031 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C16564 (NCI Thesaurus Property)
C0086409 (UMLS 2011AA)
C1518424 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C0805701 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25407 (NCI Thesaurus Property)
C1442065 (UMLS 2011AA Property)
C0034044 (UMLS 2011AA)
C0006823 (UMLS 2011AA)
C3258975 (UMLS CUI-1)
C25464 (NCI Thesaurus ValueDomain)
C25407 (NCI Thesaurus Property)
C42614 (NCI Thesaurus ValueDomain-2)
C0805701 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25407 (NCI Thesaurus Property)
C1442065 (UMLS 2011AA Property)
C0027651 (UMLS 2011AA ValueDomain)
C17069 (NCI Thesaurus ObjectClass)
C0034804 (UMLS 2011AA ObjectClass)
C25688 (NCI Thesaurus ValueDomain-2)
C0449438 (UMLS 2011AA ValueDomain-2)
C25554 (NCI Thesaurus Property)
C0441889 (UMLS 2011AA Property)
C0205160 (UMLS 2011AA)
C1446409 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C0332307 (UMLS 2011AA ValueDomain)
C17075 (NCI Thesaurus ObjectClass)
C0034833 (UMLS 2011AA ObjectClass)
C0678257 (NCI Metathesaurus Property)
C0205160 (UMLS 2011AA)
C1446409 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C0027651 (UMLS 2011AA ObjectClass)
C12971 (NCI Thesaurus ObjectClass-2)
C0006141 (UMLS 2011AA ObjectClass-2)
C13361 (NCI Thesaurus Property)
C0521447 (UMLS 2011AA Property)
C48309 (NCI Thesaurus Property-2)
C0441800 (UMLS 2011AA Property-2)
C25372 (NCI Thesaurus ValueDomain)
C0683312 (UMLS 2011AA ValueDomain)
C0205250 (UMLS 2011AA)
C1512698 (UMLS 2011AA ValueDomain)
C15445 (NCI Thesaurus ObjectClass)
C0279025 (UMLS 2011AA ObjectClass)
C25619 (NCI Thesaurus Property)
C1301732 (UMLS 2011AA Property)
C25409 (NCI Thesaurus Property-2)
C1533734 (UMLS 2011AA Property-2)
C0489786 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25347 (NCI Thesaurus Property)
C0005910 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25208 (NCI Thesaurus Property)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
C16468 (NCI Thesaurus ObjectClass)
C0009797 (UMLS 2011AA ObjectClass)
C25679 (NCI Thesaurus Property)
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)
C1522602 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25460 (NCI Thesaurus Property)
C1511481 (UMLS 2011AA Property)
C1298908 (UMLS 2011AA)
C1272460 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C1302261 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25171 (NCI Thesaurus Property)
C0370003 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C15818 (NCI Thesaurus Property-2)
C1513905 (UMLS 2011AA Property-2)
C64207 (NCI Thesaurus Property-3)
C1880016 (UMLS 2011AA Property-3)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C13332 (NCI Thesaurus ObjectClass)
C0238767 (UMLS 2011AA ObjectClass)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C15291 (NCI Thesaurus ObjectClass-2)
C0029936 (UMLS 2011AA ObjectClass-2)
C1512699 (UMLS 2011AA ValueDomain)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
C3232 (NCI Thesaurus ObjectClass)
C0025344 (UMLS 2011AA ObjectClass)
C25496 (NCI Thesaurus Property-2)
C2746065 (UMLS 2011AA Property-2)
C0020699 (UMLS 2011AA ObjectClass)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C25411 (NCI Thesaurus Property-2)
C0205179 (UMLS 2011AA Property-2)
C25150 (NCI Thesaurus Property-3)
C0001779 (UMLS 2011AA Property-3)
C17087 (NCI Thesaurus Property-4)
C0035150 (UMLS 2011AA Property-4)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C17563 (NCI Thesaurus Property)
C0162789 (UMLS 2011AA Property)
C38000 (NCI Thesaurus Property-2)
C0884358 (UMLS 2011AA Property-2)
C15256 (NCI Thesaurus ObjectClass)
C0020699 (UMLS 2011AA ObjectClass)
C1522602 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C15421 (NCI Thesaurus Property)
C0232970 (UMLS 2011AA Property)
C0011008 (UMLS 2011AA ValueDomain)
C25551 (NCI Thesaurus ObjectClass)
C1517741 (UMLS 2011AA ObjectClass)
C0025329 (NCI Metathesaurus ObjectClass)
C25279 (NCI Thesaurus Property)
C0332162 (UMLS 2011AA Property)
C1550483 (UMLS CUI-1)
C25657 (NCI Thesaurus ObjectClass)
C25364 (NCI Thesaurus Property)
C1115437 (UMLS CUI-1)
C40988 (NCI Thesaurus ObjectClass)
C25250 (NCI Thesaurus Property)
C25367 (NCI Thesaurus ValueDomain-2)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1513905 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C15818 (NCI Thesaurus Property-2)
Keine Kommentare