ID

8763

Beschrijving

E1505 TEST Registration Worksheet (step 1) Chemotherapy With or Without Bevacizumab in Treating Patients With Stage IB, Stage II, or Stage IIIA Non-Small Lung Cancer That Was Removed By Surgery Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=71F8ECE9-1DD6-C56F-E040-BB89AD4342B9

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=71F8ECE9-1DD6-C56F-E040-BB89AD4342B9

Trefwoorden

Lungentumoren

D016430

Behandlungsbedürftigkeit, Begutachtung

19-09-12 19-09-12 -
09-01-15 09-01-15 - Martin Dugas
17-09-21 17-09-21 -

Geüploaded op

9 januari 2015

DOI

Voor een aanvraag inloggen.

Licentie

Creative Commons BY-NC 3.0 Legacy

Model Commentaren :

Hier kunt u commentaar leveren op het model. U kunt de tekstballonnen bij de itemgroepen en items gebruiken om er specifiek commentaar op te geven.

Terug naar het model Commentaren

Itemgroep Commentaren voor :

Item Commentaren voor :

U moet ingelogd zijn om formulieren te downloaden. AUB inloggen of schrijf u gratis in.

Lung Cancer NCT00324805 Eligibility - E1505 TEST Registration Worksheet (step 1) - 2935543v1.0

model
Details

No Instruction available.

1 Formulieren

StudyEvent: E1505 TEST Registration Worksheet (step 1)
1. No Instruction available.

Name

Type

Description | Question | Decode (Coded Value)

Datatype

Alias

Eligibility

Item Group

Eligibility

Patient Initials First

Item

First initial

text

C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C0205435 (UMLS CUI-2)
C25536 (NCI Thesaurus Property)
C25509 (NCI Thesaurus Property-2)

Patient Initials Last

Item

Last initial

text

C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1517741 (UMLS CUI-2)
C25536 (NCI Thesaurus Property)
C25551 (NCI Thesaurus Property-2)

EligibilityDeterminationChecklistCompleteEligibilityInd-2

Item

Has the eligibility checklist been completed

boolean

C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C25250 (NCI Thesaurus Property)
C0205197 (UMLS 2011AA Property)
C25171 (NCI Thesaurus ObjectClass)
C0013893 (UMLS 2011AA ObjectClass)
C49073 (NCI Thesaurus Property-2)
C1707357 (UMLS 2011AA Property-2)

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)

Consent signed

Item

Has written informed consent been obtained

boolean

C38147 (NCI Thesaurus ValueDomain)
C0742766 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25678 (NCI Thesaurus Property)
C25460 (NCI Thesaurus Property-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)

HealthInsurancePortabilityandAccountabilityActAuthorizationIndicator

Item

Has HIPAA authorization been obtained

text

C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C62504 (NCI Thesaurus ObjectClass)
C0600593 (UMLS 2011AA ObjectClass)
C41192 (NCI Thesaurus Property)
C1524004 (UMLS 2011AA Property)

CL.4

Code List

Has HIPAA authorization been obtained

CL Item

No: C49487 (No)

C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)

CL Item

Yes: C49488 (Yes)

C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)

CL Item

Exempt - Non-usa Participant (Exempt - non-USA participant)

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)

ChemotherapyRegimenType

Item

Planned Chemotherapy Regimen

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C15632 (NCI Thesaurus ObjectClass)
C0392920 (UMLS 2011AA ObjectClass)
C15697 (NCI Thesaurus Property)
C0040808 (UMLS 2011AA Property)

CL.5

Code List

Planned Chemotherapy Regimen

CL Item

Cisplatin And Vinorelbine (Cisplatin and Vinorelbine)

CL Item

Cisplatin And Docetaxel (Cisplatin and Docetaxel)

CL Item

Cisplatin And Gemcitabine (Cisplatin and Gemcitabine)

CL Item

Cisplatin And Pemetrexed (Cisplatin and pemetrexed)

PatientLungStageGroupingClinicalTrialEligibilityCriteriaType

Item

What is the patient's stage of disease

text

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C12468 (NCI Thesaurus Property)
C0024109 (UMLS 2011AA Property)
C16112 (NCI Thesaurus Property-2)
C1516637 (UMLS 2011AA Property-2)
C38027 (NCI Thesaurus Property-3)
C1519504 (UMLS 2011AA Property-3)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)

CL.6

Code List

What is the patient's stage of disease

CL Item

Stage Ib >/= 4 Cm (Stage IB >/= 4 cm)

CL Item

Stage Ii Lung Cancer (Stage II)

CL Item

Stage Iiia-n2 Lung Cancer (Stage IIIA-N2)

CL Item

Stage Iiia-t3n1 Lung Cancer (Stage IIIA-T3N1)

Histologic Type

Item

Histology

text

C3262 (NCI Thesaurus ObjectClass)
C0449574 (UMLS CUI-1)
C12468 (NCI Thesaurus ObjectClass-2)
C25526 (NCI Thesaurus Property)
C25161 (NCI Thesaurus Property-2)
C25372 (NCI Thesaurus ValueDomain)
C25526 (NCI Thesaurus ValueDomain-2)

CL.7

Code List

Histology

CL Item

Squamous Cell Carcinoma (Squamous cell carcinoma)

C2929 (NCI Thesaurus)
C0007137 (UMLS 2011AA)

CL Item

Non-small Cell Lung Carcinoma (Other Non-Small Cell Lung Cancer)

C2926 (NCI Thesaurus)
C0007131 (UMLS 2011AA)

Gender

Item

Patient Gender

text

C25372 (NCI Thesaurus ValueDomain)
C0079399 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C17357 (NCI Thesaurus Property)

CL.8

Code List

Patient Gender

CL Item

Male (MALE)

C46109 (NCI Thesaurus)
C1706180 (UMLS 2011AA)

CL Item

Female (FEMALE)

C46110 (NCI Thesaurus)
C0015780 (UMLS 2011AA)

PrincipalInvestigatorName

Item

Principal Investigator

text

C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C19924 (NCI Thesaurus ObjectClass)
C1521895 (UMLS 2011AA ObjectClass)

PrincipalInvestigatorPersonTelephoneNumber

Item

Phone

text

C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25395 (NCI Thesaurus Property)
C0039457 (UMLS 2011AA Property)
C19924 (NCI Thesaurus ObjectClass-2)
C1521895 (UMLS 2011AA ObjectClass-2)

PrincipalInvestigatorPersonFaxNumber

Item

Fax Number

text

C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C19924 (NCI Thesaurus ObjectClass-2)
C1521895 (UMLS 2011AA ObjectClass-2)
C25210 (NCI Thesaurus Property)
C0085205 (UMLS 2011AA Property)

PrincipalInvestigatorPersonEmailAddressText

Item

Email address

text

C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C19924 (NCI Thesaurus ObjectClass-2)
C1521895 (UMLS 2011AA ObjectClass-2)
C42775 (NCI Thesaurus Property)
C1705961 (UMLS 2011AA Property)

ClinicalResearchAssociatePersonIdentifierName

Item

Senior Clinical Research Associate/Data Manager

text

C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25465 (NCI Thesaurus ObjectClass-2)
C1516627 (UMLS 2011AA ObjectClass-2)

ClinicalResearchAssociatePersonTelephoneNumber

Item

Phone

text

C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25395 (NCI Thesaurus Property)
C0039457 (UMLS 2011AA Property)
C25465 (NCI Thesaurus ObjectClass-2)
C1516627 (UMLS 2011AA ObjectClass-2)

ClinicalResearchAssociatePersonFaxNumber

Item

Fax Number

text

C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25465 (NCI Thesaurus ObjectClass-2)
C1516627 (UMLS 2011AA ObjectClass-2)
C25210 (NCI Thesaurus Property)
C0085205 (UMLS 2011AA Property)

ClinicalResearchAssociatePersonEmailAddressText

Item

Email address

text

C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25465 (NCI Thesaurus ObjectClass-2)
C1516627 (UMLS 2011AA ObjectClass-2)
C42775 (NCI Thesaurus Property)
C1705961 (UMLS 2011AA Property)

PersonBloodTissueDonorConsentIndicator

Item

I agree to donate additional blood for research.

boolean

C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25168 (NCI Thesaurus Property)
C0040288 (UMLS 2011AA Property)
C12434 (NCI Thesaurus Property-2)
C0229664 (UMLS 2011AA Property-2)
C25460 (NCI Thesaurus Property-3)
C1511481 (UMLS 2011AA Property-3)
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)

PersonSpecimenMalignantNeoplasmResearchConsentInd-2

Item

My specimens may be kept for use in research to learn about, prevent, treat, or cure cancer.

boolean

C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C15319 (NCI Thesaurus Property)
C9305 (NCI Thesaurus Property-2)
C0006826 (UMLS 2011AA Property)
C19157 (NCI Thesaurus Property-3)
C0370003 (UMLS 2011AA Property-2)
C25460 (NCI Thesaurus Property-4)
C1511481 (UMLS 2011AA Property-3)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)

SouthwestOncologyGroupPatientTissueSpecimenConsentInd-2

Item

My specimens may be kept for research about other health problems (for example: causes of diabetes, Alzheimer's disease, and heart disease) (for example: causes of diabetes, Alzheimer's disease, and heart disease)

boolean

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25699 (NCI Thesaurus ObjectClass-2)
C1519429 (UMLS 2011AA ObjectClass-2)
C12801 (NCI Thesaurus Property)
C0040300 (UMLS 2011AA Property)
C19157 (NCI Thesaurus Property-2)
C0370003 (UMLS 2011AA Property-2)
C25460 (NCI Thesaurus Property-3)
C1511481 (UMLS 2011AA Property-3)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)

Permission to contact Patient

Item

Someone may contact me in the future to ask me to allow other uses of my specimens.

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)

SpecimenSubmissionContactPersonIdentifierName

Item

Name of the contact person responsible for sample submission

text

C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C25461 (NCI Thesaurus ObjectClass-2)
C0337611 (UMLS 2011AA ObjectClass-2)
C25694 (NCI Thesaurus ObjectClass-3)
C1515022 (UMLS 2011AA ObjectClass-3)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)

SpecimenSubmissionContactPersonTelephoneNumber

Item

Phone

text

C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C25461 (NCI Thesaurus ObjectClass-2)
C0337611 (UMLS 2011AA ObjectClass-2)
C25694 (NCI Thesaurus ObjectClass-3)
C1515022 (UMLS 2011AA ObjectClass-3)
C40978 (NCI Thesaurus Property)
C1515258 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25395 (NCI Thesaurus ValueDomain-2)
C0039457 (UMLS 2011AA ValueDomain-2)

SpecimenSubmissionContactPersonFaxNumber

Item

FAX

text

C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C25461 (NCI Thesaurus ObjectClass-2)
C0337611 (UMLS 2011AA ObjectClass-2)
C25694 (NCI Thesaurus ObjectClass-3)
C1515022 (UMLS 2011AA ObjectClass-3)
C42879 (NCI Thesaurus Property)
C1549619 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25395 (NCI Thesaurus ValueDomain-2)
C0039457 (UMLS 2011AA ValueDomain-2)

SpecimenSubmissionContactPersonE-mailAddressText

Item

text

C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C25461 (NCI Thesaurus ObjectClass-2)
C0337611 (UMLS 2011AA ObjectClass-2)
C25694 (NCI Thesaurus ObjectClass-3)
C1515022 (UMLS 2011AA ObjectClass-3)
C42775 (NCI Thesaurus Property)
C1705961 (UMLS 2011AA Property)
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)

Race

Item Group

Race

Racial Group

Item

Patient's Race

text

C25372 (NCI Thesaurus ValueDomain)
C0034510 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C17049 (NCI Thesaurus Property)

CL.13

Code List

Patient's Race

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 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 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

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

Not Provided Or Available (Not Reported)

C43234 (NCI Thesaurus)
C1706613 (UMLS 2011AA)

CL Item

Could Not Be Determined Or Unsure (Unknown)

C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)

Patient Demographics / Pre-Treatment Characteristics

Item Group

Patient Demographics / Pre-treatment Characteristics

PatientSexCode

Item

Patient's Sex

text

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C28421 (NCI Thesaurus Property)
C1522384 (UMLS 2011AA Property)
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ValueDomain-2)
C0030705 (UMLS 2011AA ValueDomain-2)
C28421 (NCI Thesaurus ValueDomain-3)
C1522384 (UMLS 2011AA ValueDomain-3)

CL.14

Code List

Patient's Sex

CL Item

Male (M)

C20197 (NCI Thesaurus)
C0024554 (UMLS 2011AA)

CL Item

Female (F)

C16576 (NCI Thesaurus)
C0015780 (UMLS 2011AA)

Birth Date

Item

Birthdate (mm/yy)

date

C25164 (NCI Thesaurus ValueDomain)
C0421451 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25155 (NCI Thesaurus Property)

AddressPostalCodeIdentifier

Item

ZIP Code

text

C25407 (NCI Thesaurus ObjectClass)
C1442065 (UMLS 2011AA ObjectClass)
C25621 (NCI Thesaurus Property)
C1514254 (UMLS 2011AA Property)
C25364 (NCI Thesaurus ValueDomain)
C0600091 (UMLS 2011AA ValueDomain)
C25407 (NCI Thesaurus ValueDomain-2)
C1442065 (UMLS 2011AA ValueDomain-2)
C25621 (NCI Thesaurus ValueDomain-3)
C1514254 (UMLS 2011AA ValueDomain-3)

Ethnic Group

Item

Patient Ethnicity

text

C25372 (NCI Thesaurus ValueDomain)
C0015031 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C16564 (NCI Thesaurus Property)

CL.15

Code List

Patient Ethnicity

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

Not Provided Or Available (Not reported)

C43234 (NCI Thesaurus)
C1706613 (UMLS 2011AA)

CL Item

Could Not Be Determined Or Unsure (Unknown)

C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)

Medical Record Number

Item

Patient Hospital No.

text

C25337 (NCI Thesaurus ValueDomain)
C1301894 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25261 (NCI Thesaurus Property)
C25198 (NCI Thesaurus Property-2)

Social Security Number

Item

Patient Social Security Number

text

C25337 (NCI Thesaurus ValueDomain)
C1301821 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25686 (NCI Thesaurus Property)

PatientInternationalPaymentType

Item

Method of payment (check one)

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)
C25541 (NCI Thesaurus Property-2)
C1512888 (UMLS 2011AA Property-2)

CL.16

Code List

Method of payment (check one)

CL Item

Private Insurance (Private Insurance)

CL Item

Medicare (Medicare)

C16665 (NCI Thesaurus)
C0018717 (UMLS 2011AA)

CL Item

Medicare And Private Insurance (Medicare and Private Insurance)

CL Item

Medicaid (Medicaid)

C0025071 (NCI Metathesaurus)

CL Item

Medicaid And Medicare (Medicaid and Medicare)

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)

AttendingPhysicianIdentifierIndividualsName

Item

Attending Physician

text

C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
CL317115 (NCI Metathesaurus ObjectClass)

InstitutionContactPersonName

Item

Institution contact

text

C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C21541 (NCI Thesaurus ObjectClass)
C0018704 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25461 (NCI Thesaurus ObjectClass-2)
C0337611 (UMLS 2011AA ObjectClass-2)

Protocol Registrar

Item

Registrar

text

C25191 (NCI Thesaurus ValueDomain)
C1507394 (UMLS CUI-1)
C25364 (NCI Thesaurus Property)
C0557514 (UMLS CUI-2)
C25357 (NCI Thesaurus ObjectClass)

PatientAddressCountryCode

Item

Country of residence

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)

CL.17

Code List

Country of residence

CL Item

Ascension Island (AC)

CL Item

Andorra (AD)

C16289 (NCI Thesaurus)
C0002838 (UMLS 2011AA)

CL Item

United Arab Emirates (AE)

C17232 (NCI Thesaurus)
C0041698 (UMLS 2011AA)

CL Item

Afghanistan (AF)

C16267 (NCI Thesaurus)
C0001732 (UMLS 2011AA)

CL Item

Antigua And Barbuda (AG)

C16303 (NCI Thesaurus)
C0003354 (UMLS 2011AA)

CL Item

Anguilla (AI)

C20133 (NCI Thesaurus)
C0003353 (UMLS 2011AA)

CL Item

Albania (AL)

CL Item

Armenia (AM)

C16306 (NCI Thesaurus)
C0003798 (UMLS 2011AA)

CL Item

Netherland Antilles (AN)

CL Item

Angola (AO)

C16292 (NCI Thesaurus)
C0003023 (UMLS 2011AA)

CL Item

Antarctica (AQ)

C18007 (NCI Thesaurus)
C0454691 (UMLS 2011AA)

CL Item

Argentina (AR)

C16305 (NCI Thesaurus)
C0003761 (UMLS 2011AA)

CL Item

American Samoa (AS)

C17739 (NCI Thesaurus)
C0242536 (UMLS 2011AA)

CL Item

Austria (AT)

C16312 (NCI Thesaurus)
C0004348 (UMLS 2011AA)

CL Item

Australia (AU)

C16311 (NCI Thesaurus)
C0004340 (UMLS 2011AA)

CL Item

Aruba (AW)

C17884 (NCI Thesaurus)
C0282379 (UMLS 2011AA)

CL Item

Azerbaidjan (AZ)

CL Item

Bosnia-herzegovina (BA)

C16361 (NCI Thesaurus)
C0006036 (UMLS 2011AA)

CL Item

Barbados (BB)

C16324 (NCI Thesaurus)
C0004739 (UMLS 2011AA)

CL Item

Bangladesh (BD)

C16323 (NCI Thesaurus)
C0004732 (UMLS 2011AA)

CL Item

Belgium (BE)

C16329 (NCI Thesaurus)
C0004950 (UMLS 2011AA)

CL Item

Burkina Faso (BF)

C16369 (NCI Thesaurus)
C0006409 (UMLS 2011AA)

CL Item

Bulgaria (BG)

C16368 (NCI Thesaurus)
C0006368 (UMLS 2011AA)

CL Item

Bahrain (BH)

C16322 (NCI Thesaurus)
C0004684 (UMLS 2011AA)

CL Item

Burundi (BI)

C16371 (NCI Thesaurus)
C0006448 (UMLS 2011AA)

CL Item

Benin (BJ)

CL Item

Bermuda (BM)

C16334 (NCI Thesaurus)
C0005126 (UMLS 2011AA)

CL Item

Brunei Darussalam (BN)

C16367 (NCI Thesaurus)
C0006320 (UMLS 2011AA)

CL Item

Bolivia (BO)

C16359 (NCI Thesaurus)
C0005918 (UMLS 2011AA)

CL Item

Brazil (BR)

C16364 (NCI Thesaurus)
C0006137 (UMLS 2011AA)

CL Item

Bahamas (BS)

C16321 (NCI Thesaurus)
C0004683 (UMLS 2011AA)

CL Item

Bhutan (BT)

C16336 (NCI Thesaurus)
C0005341 (UMLS 2011AA)

CL Item

Bouvet Island (BV)

C20104 (NCI Thesaurus)
C1511278 (UMLS 2011AA)

CL Item

Botswana (BW)

C16363 (NCI Thesaurus)
C0006041 (UMLS 2011AA)

CL Item

Belarus (BY)

C16372 (NCI Thesaurus)
C0006539 (UMLS 2011AA)

CL Item

Belize (BZ)

C16331 (NCI Thesaurus)
C0004952 (UMLS 2011AA)

CL Item

Canada (CA)

C16380 (NCI Thesaurus)
C0006823 (UMLS 2011AA)

CL Item

Cocos Isl. (CC)

CL Item

Rep. Dem. Congo (CD)

CL Item

Central African Rep. (CF)

CL Item

Congo (CG)

C16467 (NCI Thesaurus)
C0009738 (UMLS 2011AA)

CL Item

Switzerland (CH)

C17181 (NCI Thesaurus)
C0039021 (UMLS 2011AA)

CL Item

Ivory Coast (CI)

CL Item

Cook Islands (CK)

C16469 (NCI Thesaurus)
C0009956 (UMLS 2011AA)

CL Item

Chile (CL)

CL Item

Cameroon (CM)

C16379 (NCI Thesaurus)
C0006802 (UMLS 2011AA)

CL Item

China (CN)

C16428 (NCI Thesaurus)
C0008115 (UMLS 2011AA)

CL Item

Colombia (CO)

C16449 (NCI Thesaurus)
C0009367 (UMLS 2011AA)

CL Item

Costa Rica (CR)

C16470 (NCI Thesaurus)
C0010182 (UMLS 2011AA)

CL Item

Cuba (CU)

C16477 (NCI Thesaurus)
C0010435 (UMLS 2011AA)

CL Item

Cape Verde (CV)

C16382 (NCI Thesaurus)
C0006893 (UMLS 2011AA)

CL Item

Christmas Island (CX)

C44482 (NCI Thesaurus)
C0006888 (UMLS 2011AA)

CL Item

Cyprus (CY)

C16480 (NCI Thesaurus)
C0010622 (UMLS 2011AA)

CL Item

Czech Republic (CZ)

C17668 (NCI Thesaurus)
C0206578 (UMLS 2011AA)

CL Item

Germany (DE)

CL Item

Djibouti (DJ)

CL Item

Denmark (DK)

CL Item

Dominica (DM)

CL Item

Dominican Republic (DO)

CL Item

Algeria (DZ)

CL Item

Ecuador (EC)

CL Item

Estonia (EE)

CL Item

Egypt (EG)

CL Item

Western Sahara (EH)

CL Item

Eritrea (ER)

CL Item

Spain (ES)

CL Item

Ethiopia (ET)

CL Item

Finland (FI)

CL Item

Fiji (FJ)

CL Item

Falkland Isl. (FK)

CL Item

Micronesia (FM)

CL Item

Faroe Islands (FO)

CL Item

France (FR)

CL Item

France (european Ter.) (FX)

CL Item

Gabon (GA)

CL Item

Great Britain (GB)

CL Item

Grenada (GD)

CL Item

Georgia (GE)

CL Item

Guiana (fr.) (GF)

CL Item

Guernsey (GG)

CL Item

Ghana (GH)

CL Item

Gibraltar (GI)

CL Item

Greenland (GL)

CL Item

Gambia (GM)

CL Item

Guinea (GN)

CL Item

Guadeloupe (fr.) (GP)

CL Item

Equatorial Guinea (GQ)

CL Item

Greece (GR)

CL Item

South Georgia And South Sandwich Islands (GS)

CL Item

Guatemala (GT)

CL Item

Guam (us) (GU)

CL Item

Guinea Bissau (GW)

CL Item

Guyana (GY)

CL Item

Hong Kong (HK)

CL Item

Heard & Mcdonald Isl. (HM)

CL Item

Honduras (HN)

C16694 (NCI Thesaurus)
C0019905 (UMLS 2011AA)

CL Item

Croatia (HR)

C16474 (NCI Thesaurus)
C0010343 (UMLS 2011AA)

CL Item

Haiti (HT)

C16660 (NCI Thesaurus)
C0018510 (UMLS 2011AA)

CL Item

Hungary (HU)

C16699 (NCI Thesaurus)
C0020174 (UMLS 2011AA)

CL Item

Indonesia (ID)

C16728 (NCI Thesaurus)
C0021247 (UMLS 2011AA)

CL Item

Ireland (IE)

C16757 (NCI Thesaurus)
C0022067 (UMLS 2011AA)

CL Item

Israel (IL)

C16760 (NCI Thesaurus)
C0022271 (UMLS 2011AA)

CL Item

Isle Of Man (IM)

C0022132 (NCI Metathesaurus)

CL Item

India (IN)

C16727 (NCI Thesaurus)
C0021201 (UMLS 2011AA)

CL Item

British Indian O. Ter. (IO)

CL Item

Iraq (IQ)

C16756 (NCI Thesaurus)
C0022066 (UMLS 2011AA)

CL Item

Iran (IR)

C16755 (NCI Thesaurus)
C0022065 (UMLS 2011AA)

CL Item

Iceland (IS)

C16704 (NCI Thesaurus)
C0020750 (UMLS 2011AA)

CL Item

Italy (IT)

C16761 (NCI Thesaurus)
C0022277 (UMLS 2011AA)

CL Item

Jersey (JE)

CL Item

Jamaica (JM)

C16763 (NCI Thesaurus)
C0022337 (UMLS 2011AA)

CL Item

Jordan (JO)

C16765 (NCI Thesaurus)
C0022418 (UMLS 2011AA)

CL Item

Japan (JP)

C16764 (NCI Thesaurus)
C0022341 (UMLS 2011AA)

CL Item

Kenya (KE)

C16769 (NCI Thesaurus)
C0022558 (UMLS 2011AA)

CL Item

Kyrgyz Republic (KG)

CL Item

Cambodia (KH)

C16378 (NCI Thesaurus)
C0006797 (UMLS 2011AA)

CL Item

Kiribati (KI)

C16639 (NCI Thesaurus)
C0017550 (UMLS 2011AA)

CL Item

Comoros (KM)

C16458 (NCI Thesaurus)
C0009490 (UMLS 2011AA)

CL Item

St. Kitts Nevis Anguilla (KN)

CL Item

Korea (north) (KP)

CL Item

Korea (south) (KR)

CL Item

Kuwait (KW)

C16775 (NCI Thesaurus)
C0022804 (UMLS 2011AA)

CL Item

Cayman Islands (KY)

C16391 (NCI Thesaurus)
C0007481 (UMLS 2011AA)

CL Item

Kazakstan (KZ)

CL Item

Laos (LA)

CL Item

Lebanon (LB)

C16784 (NCI Thesaurus)
C0023190 (UMLS 2011AA)

CL Item

Saint Lucia (LC)

C17113 (NCI Thesaurus)
C0036056 (UMLS 2011AA)

CL Item

Liechtenstein (LI)

C16794 (NCI Thesaurus)
C0023668 (UMLS 2011AA)

CL Item

Sri Lanka (LK)

C17163 (NCI Thesaurus)
C0038088 (UMLS 2011AA)

CL Item

Liberia (LR)

C16791 (NCI Thesaurus)
C0023617 (UMLS 2011AA)

CL Item

Lesotho (LS)

CL Item

Lithuania (LT)

C16799 (NCI Thesaurus)
C0023879 (UMLS 2011AA)

CL Item

Luxembourg (LU)

C16803 (NCI Thesaurus)
C0024176 (UMLS 2011AA)

CL Item

Latvia (LV)

C16783 (NCI Thesaurus)
C0023128 (UMLS 2011AA)

CL Item

Libya (LY)

CL Item

Morocco (MA)

C16878 (NCI Thesaurus)
C0026544 (UMLS 2011AA)

CL Item

Monaco (MC)

C16874 (NCI Thesaurus)
C0026405 (UMLS 2011AA)

CL Item

Moldova (MD)

C16871 (NCI Thesaurus)
C0026374 (UMLS 2011AA)

CL Item

Madagascar (MG)

C16808 (NCI Thesaurus)
C0024443 (UMLS 2011AA)

CL Item

Marshall Islands (MH)

C16822 (NCI Thesaurus)
C0024851 (UMLS 2011AA)

CL Item

Macedonia (MK)

C0700290 (NCI Metathesaurus)

CL Item

Mali (ML)

C16816 (NCI Thesaurus)
C0024581 (UMLS 2011AA)

CL Item

Myanmar (MM)

C16370 (NCI Thesaurus)
C0006416 (UMLS 2011AA)

CL Item

Mongolia (MN)

C16875 (NCI Thesaurus)
C0026410 (UMLS 2011AA)

CL Item

Macau (MO)

C16807 (NCI Thesaurus)
C0024403 (UMLS 2011AA)

CL Item

Northern Mariana Isl. (MP)

CL Item

Martinique (fr.) (MQ)

CL Item

Mauritania (MR)

C16826 (NCI Thesaurus)
C0024943 (UMLS 2011AA)

CL Item

Montserrat (MS)

C16876 (NCI Thesaurus)
C0026514 (UMLS 2011AA)

CL Item

Malta (MT)

C16817 (NCI Thesaurus)
C0024653 (UMLS 2011AA)

CL Item

Mauritius (MU)

C16827 (NCI Thesaurus)
C0024944 (UMLS 2011AA)

CL Item

Maldives (MV)

C16815 (NCI Thesaurus)
C0024553 (UMLS 2011AA)

CL Item

Malawi (MW)

C16813 (NCI Thesaurus)
C0024548 (UMLS 2011AA)

CL Item

Mexico (MX)

C16850 (NCI Thesaurus)
C0025885 (UMLS 2011AA)

CL Item

Malaysia (MY)

C16814 (NCI Thesaurus)
C0024552 (UMLS 2011AA)

CL Item

Mozambique (MZ)

C16882 (NCI Thesaurus)
C0026655 (UMLS 2011AA)

CL Item

Namibia (NA)

C16891 (NCI Thesaurus)
C0027366 (UMLS 2011AA)

CL Item

New Caledonia (fr.) (NC)

CL Item

Niger (NE)

C16916 (NCI Thesaurus)
C0028074 (UMLS 2011AA)

CL Item

Norfolk Island (NF)

C16919 (NCI Thesaurus)
C0028366 (UMLS 2011AA)

CL Item

Nigeria (NG)

C16917 (NCI Thesaurus)
C0028075 (UMLS 2011AA)

CL Item

Nicaragua (NI)

C16915 (NCI Thesaurus)
C0028002 (UMLS 2011AA)

CL Item

Netherlands (NL)

C16903 (NCI Thesaurus)
C0027778 (UMLS 2011AA)

CL Item

Norway (NO)

C16920 (NCI Thesaurus)
C0028423 (UMLS 2011AA)

CL Item

Nepal (NP)

C16901 (NCI Thesaurus)
C0027689 (UMLS 2011AA)

CL Item

Nauru (NR)

C16896 (NCI Thesaurus)
C0027496 (UMLS 2011AA)

CL Item

Niue (NU)

C16918 (NCI Thesaurus)
C0028219 (UMLS 2011AA)

CL Item

New Zealand (NZ)

C16914 (NCI Thesaurus)
C0027978 (UMLS 2011AA)

CL Item

Oman (OM)

C16933 (NCI Thesaurus)
C0028971 (UMLS 2011AA)

CL Item

Other (Other)

CL Item

Panama (PA)

C16951 (NCI Thesaurus)
C0030266 (UMLS 2011AA)

CL Item

Peru (PE)

C16972 (NCI Thesaurus)
C0031238 (UMLS 2011AA)

CL Item

Polynesia (fr.) (PF)

CL Item

Papua New Guinea (PG)

C16952 (NCI Thesaurus)
C0030375 (UMLS 2011AA)

CL Item

Philippines (PH)

CL Item

Pakistan (PK)

C16949 (NCI Thesaurus)
C0030211 (UMLS 2011AA)

CL Item

Poland (PL)

C17002 (NCI Thesaurus)
C0032356 (UMLS 2011AA)

CL Item

St. Pierre & Miquelon (PM)

CL Item

Pitcairn (PN)

C16993 (NCI Thesaurus)
C0031995 (UMLS 2011AA)

CL Item

Puerto Rico (PR)

C17043 (NCI Thesaurus)
C0034044 (UMLS 2011AA)

CL Item

Portugal (PT)

C17006 (NCI Thesaurus)
C0032729 (UMLS 2011AA)

CL Item

Palau (PW)

C17733 (NCI Thesaurus)
C0242397 (UMLS 2011AA)

CL Item

Paraguay (PY)

C16953 (NCI Thesaurus)
C0030428 (UMLS 2011AA)

CL Item

Qatar (QA)

C17045 (NCI Thesaurus)
C0034366 (UMLS 2011AA)

CL Item

Reunion (fr.) (RE)

CL Item

Romania (RO)

C17108 (NCI Thesaurus)
C0035826 (UMLS 2011AA)

CL Item

Russian Federation (RU)

CL Item

Rwanda (RW)

C17112 (NCI Thesaurus)
C0035978 (UMLS 2011AA)

CL Item

Saudi Arabia (SA)

C17117 (NCI Thesaurus)
C0036243 (UMLS 2011AA)

CL Item

Solomon Islands (SB)

C17148 (NCI Thesaurus)
C0037623 (UMLS 2011AA)

CL Item

Seychelles (SC)

C17129 (NCI Thesaurus)
C0036919 (UMLS 2011AA)

CL Item

Sudan (SD)

C17170 (NCI Thesaurus)
C0038642 (UMLS 2011AA)

CL Item

Sweden (SE)

C17180 (NCI Thesaurus)
C0038995 (UMLS 2011AA)

CL Item

Singapore (SG)

C17134 (NCI Thesaurus)
C0037173 (UMLS 2011AA)

CL Item

St. Helena (SH)

CL Item

Slovenia (SI)

C17138 (NCI Thesaurus)
C0037334 (UMLS 2011AA)

CL Item

Svalbard & Jan Mayen Isl. (SJ)

CL Item

Slovakia (SK)

C17669 (NCI Thesaurus)
C0206579 (UMLS 2011AA)

CL Item

Sierra Leone (SL)

C17130 (NCI Thesaurus)
C0037063 (UMLS 2011AA)

CL Item

San Marino (SM)

C17115 (NCI Thesaurus)
C0036154 (UMLS 2011AA)

CL Item

Senegal (SN)

C17121 (NCI Thesaurus)
C0036644 (UMLS 2011AA)

CL Item

Somalia (SO)

C17149 (NCI Thesaurus)
C0037640 (UMLS 2011AA)

CL Item

Suriname (SR)

C17175 (NCI Thesaurus)
C0038944 (UMLS 2011AA)

CL Item

St. Tome And Principe (ST)

CL Item

Soviet Union (SU)

CL Item

El Salvador (SV)

C16532 (NCI Thesaurus)
C0013754 (UMLS 2011AA)

CL Item

Syria (SY)

C17182 (NCI Thesaurus)
C0039138 (UMLS 2011AA)

CL Item

Swaziland (SZ)

C17179 (NCI Thesaurus)
C0038983 (UMLS 2011AA)

CL Item

Turks & Caicos Islands (TC)

CL Item

Chad (TD)

C16412 (NCI Thesaurus)
C0007928 (UMLS 2011AA)

CL Item

French Southern Terr. (TF)

CL Item

Togo (TG)

C17202 (NCI Thesaurus)
C0040363 (UMLS 2011AA)

CL Item

Thailand (TH)

C17192 (NCI Thesaurus)
C0039725 (UMLS 2011AA)

CL Item

Tadjikistan (TJ)

CL Item

Tokelau (TK)

C17704 (NCI Thesaurus)
C0220928 (UMLS 2011AA)

CL Item

Turkmenistan (TM)

C17223 (NCI Thesaurus)
C0041403 (UMLS 2011AA)

CL Item

Tunisia (TN)

C17221 (NCI Thesaurus)
C0041388 (UMLS 2011AA)

CL Item

Tonga (TO)

CL Item

East Timor (TP)

C17200 (NCI Thesaurus)
C1452561 (UMLS 2011AA)

CL Item

Turkey (TR)

C17222 (NCI Thesaurus)
C0041400 (UMLS 2011AA)

CL Item

Trinidad & Tobago (TT)

CL Item

Tuvalu (TV)

C17225 (NCI Thesaurus)
C0041413 (UMLS 2011AA)

CL Item

Taiwan (TW)

C17184 (NCI Thesaurus)
C0039260 (UMLS 2011AA)

CL Item

Tanzania (TZ)

C17185 (NCI Thesaurus)
C0039298 (UMLS 2011AA)

CL Item

Ukraine (UA)

C17229 (NCI Thesaurus)
C0041580 (UMLS 2011AA)

CL Item

Uganda (UG)

C17228 (NCI Thesaurus)
C0041573 (UMLS 2011AA)

CL Item

United Kingdom (UK)

C17233 (NCI Thesaurus)
C0041700 (UMLS 2011AA)

CL Item

Us Minor Outlying Isl. (UM)

CL Item

Usa (US)

CL Item

Uruguay (UY)

C17244 (NCI Thesaurus)
C0042113 (UMLS 2011AA)

CL Item

Uzbekistan (UZ)

C17246 (NCI Thesaurus)
C0042177 (UMLS 2011AA)

CL Item

Vatican City State (VA)

CL Item

St. Vincent & Grenadines (VC)

CL Item

Venezuela (VE)

C17250 (NCI Thesaurus)
C0042469 (UMLS 2011AA)

CL Item

Virgin Islands (brit) (VG)

CL Item

Virgin Islands (us) (VI)

CL Item

Vietnam (VN)

C17252 (NCI Thesaurus)
C0042658 (UMLS 2011AA)

CL Item

Vanuatu (VU)

C17247 (NCI Thesaurus)
C0042321 (UMLS 2011AA)

CL Item

Wallis & Futuna Islands (WF)

CL Item

Western Samoa (WS)

CL Item

Yemen (YE)

C17264 (NCI Thesaurus)
C0043402 (UMLS 2011AA)

CL Item

Mayotte (YT)

C16828 (NCI Thesaurus)
C0024974 (UMLS 2011AA)

CL Item

Yugoslavia (YU)

CL Item

South Africa (ZA)

CL Item

Zambia (ZM)

C17267 (NCI Thesaurus)
C0043445 (UMLS 2011AA)

CL Item

Dem. Rep. Of Congo (ZR)

CL Item

Zimbabwe (ZW)

C17268 (NCI Thesaurus)
C0043476 (UMLS 2011AA)

Research Comments

Item

Comments

text

C25704 (NCI Thesaurus ValueDomain)
C0947611 (UMLS CUI-1)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)

Terug naar het begin van de pagina

ID

Beschrijving

Link

Trefwoorden

Versies (3)

Geüploaded op

DOI

Licentie

Model Commentaren :

Itemgroep Commentaren voor :

Item Commentaren voor :

Lung Cancer NCT00324805 Eligibility - E1505 TEST Registration Worksheet (step 1) - 2935543v1.0

No Instruction available.

Beschrijving

Beschrijving

Datatype

Alias

Beschrijving

Datatype

Alias

Beschrijving

Datatype

Alias

Beschrijving

Datatype

Alias

Beschrijving

Datatype

Alias

Beschrijving

Datatype

Alias

Beschrijving

Datatype

Alias

Beschrijving

Datatype

Alias

Beschrijving

Datatype

Alias

Beschrijving

Datatype

Alias

Beschrijving

Datatype

Alias

Beschrijving

Datatype

Alias

Beschrijving

Datatype

Alias

Beschrijving

Datatype

Alias

Beschrijving

Datatype

Alias

Beschrijving

Datatype

Alias

Beschrijving

Datatype

Alias

Beschrijving

Datatype

Alias

Beschrijving

Datatype

Alias

Beschrijving

Datatype

Alias

Beschrijving

Datatype

Alias

Beschrijving

Datatype

Alias