ID
8895
Description
CALGB 140503 INTRA-OPERATIVE REGISTRATION/RANDOMIZATION WORKSHEET Comparison of Different Types of Surgery in Treating Patients With Stage IA Non-Small Cell Lung Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=6E4AB7DA-A794-776C-E040-BB89AD430B3B
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Versions (5)
- 19/09/2012 19/09/2012 -
- 09/01/2015 09/01/2015 - Martin Dugas
- 09/01/2015 09/01/2015 - Martin Dugas
- 29/07/2015 29/07/2015 - Martin Dugas
- 20/09/2021 20/09/2021 -
Téléchargé le
9 janvier 2015
DOI
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Creative Commons BY-NC 3.0 Legacy
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Lung Cancer NCT00499330 Registration - CALGB 140503 INTRA-OPERATIVE REGISTRATION/RANDOMIZATION WORKSHEET - 2916823v1.0
A Phase III Randomized Trial of Lobectomy versus Sublobar Resection for Small ( <= 2 cm) Peripheral NSCLC. CALGB INSTRUCTIONS: To perform the intra-operative registration/randomization select the "Register a Patient" link in the CALGB Web-based Patient Registration System CTSU INSTRUCTIONS: On day of surgery fax worksheet, with as much as data completed as possible. During surgery call the CTSU cell phone (301-704-2376) to complete the randomization.
- StudyEvent: CALGB 140503 INTRA-OPERATIVE REGISTRATION/RANDOMIZATION WORKSHEET
Description
Patient Demographics/pre-treatment Characteristics
Description
Patient Initials
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS CUI-1
- C2986440
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25536
Description
Birth Date
Type de données
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C0421451
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus ValueDomain-2
- C25367
- NCI Thesaurus Property
- C25155
Description
PatientPersonSocialSecurityNumber
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C25686
- UMLS 2011AA Property
- C1301821
Description
Medical Record Number
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS CUI-1
- C1301894
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25261
- NCI Thesaurus Property-2
- C25198
Description
Gender
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25372
- UMLS CUI-1
- C0079399
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C17357
Description
Patient Demographics/pre-treatment Characteristics2
Description
ECOG Performance Status
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25664
- UMLS CUI-1
- C1520224
- NCI Thesaurus Property
- C25367
- NCI Thesaurus ValueDomain-2
- C25491
- NCI Thesaurus ObjectClass
- C20641
Description
Patient Height
Type de données
float
Unités de mesure
- cm
Alias
- NCI Thesaurus ValueDomain
- C25209
- UMLS CUI-1
- C0489786
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25347
Description
Patient Weight
Type de données
float
Unités de mesure
- Kg
Alias
- NCI Thesaurus ValueDomain
- C25209
- UMLS CUI-1
- C0005910
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25208
Description
PatientPaymentType
Type de données
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
Description
Patient Demographics/pre-treatment Characteristics3
Description
Certification Of Eligibility
Description
Eligibility for trial
Type de données
boolean
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS CUI-1
- C1302261
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25171
Description
Protocol Design
Description
AmericanCollegeofSurgeonsOncologyGroupPatientMalignantNeoplasmSizeEligibilityDeterminationType
Type de données
text
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus ObjectClass-2
- C19712
- UMLS 2011AA ObjectClass-2
- C1515944
- NCI Thesaurus Property
- C9305
- UMLS 2011AA Property
- C0006826
- NCI Thesaurus Property-2
- C25171
- UMLS 2011AA Property-2
- C0013893
- NCI Thesaurus Property-3
- C25681
- UMLS 2011AA Property-3
- C0456389
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
Description
Histologic Type
Type de données
text
Alias
- NCI Thesaurus ObjectClass
- C3262
- UMLS CUI-1
- C0449574
- NCI Thesaurus ObjectClass-2
- C12468
- NCI Thesaurus Property
- C25526
- NCI Thesaurus Property-2
- C25161
- NCI Thesaurus ValueDomain
- C25372
- NCI Thesaurus ValueDomain-2
- C25526
Description
CigaretteSmokingStatusTextType
Type de données
text
Alias
- NCI Thesaurus ObjectClass
- C1802
- UMLS 2011AA ObjectClass
- C0677453
- NCI Metathesaurus ObjectClass
- C0037369
- NCI Metathesaurus Property
- C0449438
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus ValueDomain-2
- C25704
- UMLS 2011AA ValueDomain-2
- C1527021
Description
Protocol Treatment Arm
Type de données
text
Alias
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus ObjectClass-2
- C42651
- UMLS CUI-1
- C1522541
- NCI Thesaurus Property
- C32141
- NCI Thesaurus Property-2
- C25426
- NCI Thesaurus ValueDomain
- C25284
Description
Study Companion 580602 (mandatory)
Description
Eligibility for trial
Type de données
boolean
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS CUI-1
- C1302261
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25171
Description
Notes:
Description
ClinicalResearchAssociateResponsiblePersonName
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS 2011AA ValueDomain
- C1547383
- NCI Thesaurus ObjectClass
- C25657
- UMLS 2011AA ObjectClass
- C1273518
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
- NCI Thesaurus ObjectClass-2
- C25465
- UMLS 2011AA ObjectClass-2
- C1516627
Description
ClinicalResearchAssociatePersonEmailAddressText
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus ObjectClass-2
- C25465
- UMLS 2011AA ObjectClass-2
- C1516627
- NCI Thesaurus Property
- C42775
- UMLS 2011AA Property
- C1705961
Description
ClinicalResearchAssociatePersonTelephoneNumber
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C25395
- UMLS 2011AA Property
- C0039457
- NCI Thesaurus ObjectClass-2
- C25465
- UMLS 2011AA ObjectClass-2
- C1516627
Similar models
A Phase III Randomized Trial of Lobectomy versus Sublobar Resection for Small ( <= 2 cm) Peripheral NSCLC. CALGB INSTRUCTIONS: To perform the intra-operative registration/randomization select the "Register a Patient" link in the CALGB Web-based Patient Registration System CTSU INSTRUCTIONS: On day of surgery fax worksheet, with as much as data completed as possible. During surgery call the CTSU cell phone (301-704-2376) to complete the randomization.
- StudyEvent: CALGB 140503 INTRA-OPERATIVE REGISTRATION/RANDOMIZATION WORKSHEET
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
C16468 (NCI Thesaurus ObjectClass)
C0009797 (UMLS 2011AA ObjectClass)
C25679 (NCI Thesaurus Property)
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)
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)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
C25191 (NCI Thesaurus ValueDomain)
C21541 (NCI Thesaurus ValueDomain-2)
C0205549 (UMLS 2011AA ObjectClass)
C18843 (NCI Thesaurus ObjectClass-2)
C1704382 (UMLS 2011AA ObjectClass-2)
C25741 (NCI Thesaurus Property)
C0031831 (UMLS 2011AA Property)
C38000 (NCI Thesaurus Property-2)
C0884358 (UMLS 2011AA Property-2)
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C19202 (NCI Thesaurus ObjectClass)
C1513882 (UMLS 2011AA ObjectClass)
C19924 (NCI Thesaurus ObjectClass-2)
C1521895 (UMLS 2011AA ObjectClass-2)
C0805701 (UMLS 2011AA ValueDomain)
C21541 (NCI Thesaurus ObjectClass)
C0018704 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C19202 (NCI Thesaurus ObjectClass-2)
C1513882 (UMLS 2011AA ObjectClass-2)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
C0421451 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25367 (NCI Thesaurus ValueDomain-2)
C25155 (NCI Thesaurus Property)
C0237753 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25686 (NCI Thesaurus Property)
C1301821 (UMLS 2011AA Property)
C1301894 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25261 (NCI Thesaurus Property)
C25198 (NCI Thesaurus Property-2)
C0079399 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C17357 (NCI Thesaurus Property)
C1706180 (UMLS 2011AA)
C0015780 (UMLS 2011AA)
C1520224 (UMLS CUI-1)
C25367 (NCI Thesaurus Property)
C25491 (NCI Thesaurus ValueDomain-2)
C20641 (NCI Thesaurus ObjectClass)
C0489786 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25347 (NCI Thesaurus Property)
C0005910 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25208 (NCI Thesaurus Property)
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)
C1527021 (UMLS 2011AA ValueDomain)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
C1302261 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25171 (NCI Thesaurus Property)
C0030705 (UMLS 2011AA ObjectClass)
C19712 (NCI Thesaurus ObjectClass-2)
C1515944 (UMLS 2011AA ObjectClass-2)
C9305 (NCI Thesaurus Property)
C0006826 (UMLS 2011AA Property)
C25171 (NCI Thesaurus Property-2)
C0013893 (UMLS 2011AA Property-2)
C25681 (NCI Thesaurus Property-3)
C0456389 (UMLS 2011AA Property-3)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
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)
C0007137 (UMLS 2011AA)
C0001418 (UMLS 2011AA)
C0205394 (UMLS 2011AA)
C17649 (NCI Thesaurus-3)
C0205394 (UMLS 2011AA-4)
C0677453 (UMLS 2011AA ObjectClass)
C0037369 (NCI Metathesaurus ObjectClass)
C0449438 (NCI Metathesaurus Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25704 (NCI Thesaurus ValueDomain-2)
C1527021 (UMLS 2011AA ValueDomain-2)
C0337671 (UMLS 2011AA)
C0337664 (UMLS 2011AA)
C42651 (NCI Thesaurus ObjectClass-2)
C1522541 (UMLS CUI-1)
C32141 (NCI Thesaurus Property)
C25426 (NCI Thesaurus Property-2)
C25284 (NCI Thesaurus ValueDomain)
C1302261 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25171 (NCI Thesaurus Property)
C1547383 (UMLS 2011AA ValueDomain)
C25657 (NCI Thesaurus ObjectClass)
C1273518 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25465 (NCI Thesaurus ObjectClass-2)
C1516627 (UMLS 2011AA ObjectClass-2)
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)
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)