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8913

Description

RTOG 0724 Phase III Cervix Chemo RT (+)/(-) Adjuvant Chemotherapy: Demographic Data Form (A5) Chemotherapy and Pelvic Radiation Therapy With or Without Additional Chemotherapy in Treating Patients With High-Risk Early-Stage Cervical Cancer After Radical Hysterectomy Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=5CFDEE98-0794-2FA7-E044-0003BA3F9857

Lien

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=5CFDEE98-0794-2FA7-E044-0003BA3F9857

Mots-clés

  1. 27/08/2012 27/08/2012 -
  2. 11/08/2014 11/08/2014 - Martin Dugas
  3. 11/08/2014 11/08/2014 - Martin Dugas
  4. 09/01/2015 09/01/2015 - Martin Dugas
  5. 09/01/2015 09/01/2015 - Martin Dugas
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9 janvier 2015

DOI

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Licence

Creative Commons BY-NC 3.0 Legacy

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    Cervical Cancer NCT00980954 Demographic - RTOG 0724 Phase III Cervix Chemo RT (+)/(-) Adjuvant Chemotherapy: Demographic Data Form (A5) - 2806724v1.0

    Version 2.2

    1. StudyEvent: RTOG 0724 Phase III Cervix Chemo RT (+)/(-) Adjuvant Chemotherapy: Demographic Data Form (A5)
      1. Version 2.2
    Header
    Description

    Header

    RTOG Study No.
    Description

    Protocol ID RTOG

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C3274381
    NCI Thesaurus ObjectClass
    C25320
    UMLS CUI-2
    C1514695
    NCI Thesaurus Property
    C19778
    NCI Thesaurus Property-2
    C25364
    Case #
    Description

    RadiationTherapyOncologyGroupPatientCaseIdentifierNumber

    Type de données

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus ObjectClass-2
    C19778
    UMLS 2011AA ObjectClass-2
    C1514695
    NCI Thesaurus Property
    C25364
    UMLS 2011AA Property
    C0600091
    NCI Thesaurus Property-2
    C49152
    UMLS 2011AA Property-2
    C1706256
    NCI Thesaurus ValueDomain
    C25337
    UMLS 2011AA ValueDomain
    C0237753
    Institution Name
    Description

    Institution Name

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C1301943
    NCI Thesaurus ObjectClass
    C21541
    NCI Thesaurus ValueDomain-2
    C21541
    NCI Thesaurus Property
    C25364
    Institution No.
    Description

    Institution Number

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C1301943
    NCI Thesaurus ObjectClass
    C21541
    UMLS CUI-2
    C0805701
    NCI Thesaurus Property
    C25364
    Patient Initials
    Description

    Patient Initials

    Type de données

    text

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

    Trial subject ID RTOG

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2348585
    NCI Thesaurus ObjectClass
    C16960
    UMLS CUI-2
    C1514695
    NCI Thesaurus Property
    C19778
    NCI Thesaurus Property-2
    C25364
    Unnamed2
    Description

    Unnamed2

    Date Completed (mm-dd-yyyy)
    Description

    FormCompletionDate

    Type de données

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ObjectClass
    C40988
    UMLS 2011AA ObjectClass
    C1516308
    NCI Thesaurus Property
    C25250
    UMLS 2011AA Property
    C0205197
    Amended Data
    Description

    Data amended

    Type de données

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS CUI-1
    C0680532
    NCI Thesaurus ObjectClass
    C25474
    NCI Thesaurus Property
    C25416
    Who completed this form (Check one box)
    Description

    ResponsiblePersonDescriptionType

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    NCI Thesaurus ObjectClass
    C25190
    UMLS 2011AA ObjectClass
    C0027361
    NCI Thesaurus ObjectClass-2
    C25657
    UMLS 2011AA ObjectClass-2
    C1273518
    NCI Thesaurus Property
    C25365
    UMLS 2011AA Property
    C0678257
    Patient Race Category (Check all that apply)
    Description

    Racial Group

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25372
    UMLS CUI-1
    C0034510
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C17049
    Patient Ethnic Group Cateogy (If you consider yourself multiracial, check all additional categories that apply in this question Do not include what you reported in 2A.)
    Description

    Ethnic Group

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25372
    UMLS CUI-1
    C0015031
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C16564
    Highest school grade completed (Check one box)
    Description

    PersonHighestEducationType

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    NCI Thesaurus ObjectClass
    C25190
    UMLS 2011AA ObjectClass
    C0027361
    NCI Thesaurus Property
    C16529
    UMLS 2011AA Property
    C0013622
    NCI Thesaurus Property-2
    C25525
    UMLS 2011AA Property-2
    C1522410
    Other, specify
    Description

    PersonHighestEducationSpecify

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    UMLS 2011AA ValueDomain
    C1521902
    NCI Thesaurus ObjectClass
    C25190
    UMLS 2011AA ObjectClass
    C0027361
    NCI Thesaurus Property
    C16529
    UMLS 2011AA Property
    C0013622
    NCI Thesaurus Property-2
    C25525
    UMLS 2011AA Property-2
    C1522410
    Religion during childhood (Check one box)
    Description

    PersonPediatricReligionName

    Type de données

    text

    Alias
    NCI Thesaurus ObjectClass
    C25190
    UMLS 2011AA ObjectClass
    C0027361
    NCI Thesaurus Property
    C39299
    UMLS 2011AA Property
    C0231335
    NCI Thesaurus ValueDomain
    C42614
    UMLS 2011AA ValueDomain
    C0027365
    NCI Thesaurus Property-2
    C17085
    UMLS 2011AA Property-2
    C0035039
    Other, specify
    Description

    PersonPediatricReligionSpecify

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    UMLS 2011AA ValueDomain
    C1521902
    NCI Thesaurus ObjectClass
    C25190
    UMLS 2011AA ObjectClass
    C0027361
    NCI Thesaurus Property
    C39299
    UMLS 2011AA Property
    C0231335
    NCI Thesaurus Property-2
    C17085
    UMLS 2011AA Property-2
    C0035039
    Marital status (Check one box)
    Description

    MaritalStatusDescriptionType

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    NCI Thesaurus ObjectClass
    C25188
    UMLS 2011AA ObjectClass
    C0024819
    NCI Thesaurus Property
    C25365
    UMLS 2011AA Property
    C0678257
    Where were you born (Check one box)
    Description

    PatientBirthCountryType

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25464
    UMLS 2011AA Property
    C0454664
    NCI Thesaurus Property-2
    C25155
    UMLS 2011AA Property-2
    C0005615
    USA, specify the 2 letter State code, eg NY (eg NY)
    Description

    PatientBirthStateSpecify

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    UMLS 2011AA ValueDomain
    C1521902
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C30010
    UMLS 2011AA Property
    C1301808
    NCI Thesaurus Property-2
    C25155
    UMLS 2011AA Property-2
    C0005615
    Other country, specify
    Description

    PatientBirthCountrySpecify

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    UMLS 2011AA ValueDomain
    C1521902
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25464
    UMLS 2011AA Property
    C0454664
    NCI Thesaurus Property-2
    C25155
    UMLS 2011AA Property-2
    C0005615
    Where did you live the longest (Check one box)
    Description

    PatientLongestDurationResidenceType

    Type de données

    text

    Alias
    NCI Metathesaurus ObjectClass
    C0030705
    NCI Thesaurus Property
    C25558
    UMLS 2011AA Property
    C1522425
    NCI Thesaurus Property-2
    C25330
    UMLS 2011AA Property-2
    C0449238
    NCI Thesaurus Property-3
    C25273
    UMLS 2011AA Property-3
    C0237096
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    USA, specify the 2 letter State code (eg NY)
    Description

    PatientStateLongestDurationResidenceCode

    Type de données

    text

    Alias
    NCI Metathesaurus ObjectClass
    C0030705
    NCI Thesaurus Property
    C25558
    UMLS 2011AA Property
    C1522425
    NCI Thesaurus Property-2
    C30010
    UMLS 2011AA Property-2
    C1301808
    NCI Thesaurus Property-3
    C25330
    UMLS 2011AA Property-3
    C0449238
    NCI Thesaurus Property-4
    C25273
    UMLS 2011AA Property-4
    C0237096
    NCI Thesaurus ValueDomain
    C25162
    UMLS 2011AA ValueDomain
    C0805701
    NCI Thesaurus ValueDomain-2
    C30010
    UMLS 2011AA ValueDomain-2
    C1301808
    Other country, specify
    Description

    PatientCountryLongestDurationResidenceName

    Type de données

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25558
    UMLS 2011AA Property
    C1522425
    NCI Thesaurus Property-2
    C25464
    UMLS 2011AA Property-2
    C0454664
    NCI Thesaurus Property-3
    C25330
    UMLS 2011AA Property-3
    C0449238
    NCI Thesaurus Property-4
    C25273
    UMLS 2011AA Property-4
    C0237096
    NCI Thesaurus ValueDomain
    C25464
    UMLS 2011AA ValueDomain
    C0454664
    NCI Thesaurus ValueDomain-2
    C42614
    UMLS 2011AA ValueDomain-2
    C0027365
    Cigarette History
    Description

    Cigarette History

    Smoked at least 100 cigarette during lifetime (5 packs)
    Description

    Smoking history

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180
    UMLS CUI-1
    C1519384
    NCI Thesaurus Property
    C20989
    NCI Thesaurus ObjectClass
    C29719
    Age began smoking cigarettes
    Description

    PatientInitialCigaretteSmokingAgeYearCount

    Type de données

    float

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25536
    UMLS 2011AA Property
    C1555582
    NCI Thesaurus Property-2
    C18270
    UMLS 2011AA Property-2
    C0700219
    NCI Thesaurus ValueDomain
    C29848
    UMLS 2011AA ValueDomain
    C0439234
    NCI Thesaurus ValueDomain-2
    C25463
    UMLS 2011AA ValueDomain-2
    C0750480
    Number of years smoked cigarettes
    Description

    CigarettesSmokingYearNumber

    Type de données

    float

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS 2011AA ValueDomain
    C0237753
    NCI Thesaurus ObjectClass
    C1802
    UMLS 2011AA ObjectClass
    C0677453
    NCI Thesaurus ValueDomain-2
    C29848
    UMLS 2011AA ValueDomain-2
    C0439234
    NCI Thesaurus Property
    C17934
    UMLS 2011AA Property
    C0453996
    Average number of cigarettes smoked per day
    Description

    Smoker amount smoked

    Type de données

    float

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C1608325
    NCI Thesaurus ObjectClass
    C17934
    NCI Thesaurus Property
    C25340
    If quit, age stopped smoking completely
    Description

    PatientSmokingCessationAgeYear

    Type de données

    float

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus ValueDomain
    C29848
    UMLS 2011AA ValueDomain
    C0439234
    NCI Thesaurus ValueDomain-2
    C25463
    UMLS 2011AA ValueDomain-2
    C0750480
    NCI Metathesaurus Property
    C0085134
    If you have had any of the illnesses listed below, please check yes for those that apply (check = Yes)
    Description

    OtherDiseaseDiagnosisType

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    NCI Thesaurus ObjectClass
    C17649
    UMLS 2011AA ObjectClass
    C0205394
    NCI Thesaurus ObjectClass-2
    C2991
    UMLS 2011AA ObjectClass-2
    C0012634
    NCI Thesaurus Property
    C15220
    UMLS 2011AA Property
    C0011900
    Specify other
    Description

    OtherDiseaseDiagnosisSpecify

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    UMLS 2011AA ValueDomain
    C1521902
    NCI Thesaurus ObjectClass
    C17649
    UMLS 2011AA ObjectClass
    C0205394
    NCI Thesaurus ObjectClass-2
    C2991
    UMLS 2011AA ObjectClass-2
    C0012634
    NCI Thesaurus Property
    C15220
    UMLS 2011AA Property
    C0011900
    Family History
    Description

    Family History

    How many brothers do you have (How many of the following family members do you have living and dead Include only those who are blood-related)
    Description

    BrotherPatientFamilyMembersAssessmentNumber

    Type de données

    float

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus ObjectClass-2
    C25289
    UMLS 2011AA ObjectClass-2
    C0337527
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Metathesaurus Property
    C0086282
    NCI Thesaurus ValueDomain
    C25337
    UMLS 2011AA ValueDomain
    C0237753
    How many sisters do you have
    Description

    SisterPatientFamilyMembersAssessmentNumber

    Type de données

    float

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus ObjectClass-2
    C25680
    UMLS 2011AA ObjectClass-2
    C0337514
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Metathesaurus Property
    C0086282
    NCI Thesaurus ValueDomain
    C25337
    UMLS 2011AA ValueDomain
    C0237753
    How many sons do you have
    Description

    SonPatientFamilyMembersAssessmentNumber

    Type de données

    float

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus ObjectClass-2
    C25205
    UMLS 2011AA ObjectClass-2
    C0037683
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Metathesaurus Property
    C0086282
    NCI Thesaurus ValueDomain
    C25337
    UMLS 2011AA ValueDomain
    C0237753
    How many daughters do you have
    Description

    DaughterPatientFamilyMembersAssessmentNumber

    Type de données

    float

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus ObjectClass-2
    C25165
    UMLS 2011AA ObjectClass-2
    C0011011
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Metathesaurus Property
    C0086282
    NCI Thesaurus ValueDomain
    C25337
    UMLS 2011AA ValueDomain
    C0237753
    Are you adopted (Check one)
    Description

    PatientAdoptedInd-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
    C25290
    UMLS 2011AA Property
    C0425382
    Blood relative with cancer (check = yes)
    Description

    RelativeFamilyCancerHistoryType

    Type de données

    text

    Alias
    NCI Thesaurus ObjectClass
    C25173
    UMLS 2011AA ObjectClass
    C0015576
    NCI Thesaurus ObjectClass-2
    C21480
    UMLS 2011AA ObjectClass-2
    C0080103
    NCI Thesaurus Property
    C9305
    UMLS 2011AA Property
    C0006826
    NCI Thesaurus Property-2
    C18772
    UMLS 2011AA Property-2
    C0262926
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    Age when first cancer diagnosed
    Description

    PersonFirstCancerDiagnosisAgeYearCount

    Type de données

    float

    Alias
    NCI Thesaurus ObjectClass
    C25190
    UMLS 2011AA ObjectClass
    C0027361
    NCI Thesaurus Property
    C9305
    UMLS 2011AA Property
    C0006826
    NCI Thesaurus Property-2
    C25509
    UMLS 2011AA Property-2
    C1279901
    NCI Thesaurus Property-3
    C15220
    UMLS 2011AA Property-3
    C0011900
    NCI Thesaurus Property-4
    C25150
    UMLS 2011AA Property-4
    C0001779
    NCI Thesaurus ValueDomain
    C29848
    UMLS 2011AA ValueDomain
    C0439234
    NCI Thesaurus ValueDomain-2
    C25463
    UMLS 2011AA ValueDomain-2
    C0750480
    Type of Cancer (check = yes)
    Description

    CancerSiteType

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    NCI Thesaurus Property
    C25341
    UMLS 2011AA Property
    C0450429
    NCI Thesaurus ObjectClass
    C9305
    UMLS 2011AA ObjectClass
    C0006826
    Specify
    Description

    CancerSiteSpecify

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    UMLS 2011AA ValueDomain
    C1521902
    NCI Thesaurus Property
    C25341
    UMLS 2011AA Property
    C0450429
    NCI Thesaurus ObjectClass
    C9305
    UMLS 2011AA ObjectClass
    C0006826
    Have you ever heard of Cancer Prevention Trials (Check one box)
    Description

    CancerPreventionTrialKnowledgeDocumentedInd-2

    Type de données

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    NCI Thesaurus ObjectClass
    C15790
    UMLS 2011AA ObjectClass
    C1516220
    NCI Thesaurus Property
    C25356
    UMLS 2011AA Property
    C1301725
    NCI Metathesaurus Property
    C0376554
    How likely would you be to volunteer to participate in Cancer Prevention Trials (The numbers below allow you to rate your answer between 1 - never and 10 - extremely likely. Circle the number below that best describes your choice.)
    Description

    CancerPreventionTrialParticipationScale

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25664
    UMLS 2011AA ValueDomain
    C0349674
    NCI Thesaurus Property
    C25608
    UMLS 2011AA Property
    C0679823
    NCI Thesaurus ObjectClass
    C15790
    UMLS 2011AA ObjectClass
    C1516220

    Similar models

    Version 2.2

    1. StudyEvent: RTOG 0724 Phase III Cervix Chemo RT (+)/(-) Adjuvant Chemotherapy: Demographic Data Form (A5)
      1. Version 2.2
    Name
    Type
    Description | Question | Decode (Coded Value)
    Type de données
    Alias
    Item Group
    Header
    Protocol ID RTOG
    Item
    RTOG Study No.
    text
    C25337 (NCI Thesaurus ValueDomain)
    C3274381 (UMLS CUI-1)
    C25320 (NCI Thesaurus ObjectClass)
    C1514695 (UMLS CUI-2)
    C19778 (NCI Thesaurus Property)
    C25364 (NCI Thesaurus Property-2)
    RadiationTherapyOncologyGroupPatientCaseIdentifierNumber
    Item
    Case #
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C19778 (NCI Thesaurus ObjectClass-2)
    C1514695 (UMLS 2011AA ObjectClass-2)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    C49152 (NCI Thesaurus Property-2)
    C1706256 (UMLS 2011AA Property-2)
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    Institution Name
    Item
    Institution Name
    text
    C25191 (NCI Thesaurus ValueDomain)
    C1301943 (UMLS CUI-1)
    C21541 (NCI Thesaurus ObjectClass)
    C21541 (NCI Thesaurus ValueDomain-2)
    C25364 (NCI Thesaurus Property)
    Institution Number
    Item
    Institution No.
    text
    C25337 (NCI Thesaurus ValueDomain)
    C1301943 (UMLS CUI-1)
    C21541 (NCI Thesaurus ObjectClass)
    C0805701 (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)
    Trial subject ID RTOG
    Item
    RTOG Patient ID
    text
    C25337 (NCI Thesaurus ValueDomain)
    C2348585 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C1514695 (UMLS CUI-2)
    C19778 (NCI Thesaurus Property)
    C25364 (NCI Thesaurus Property-2)
    Item Group
    Unnamed2
    FormCompletionDate
    Item
    Date Completed (mm-dd-yyyy)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C40988 (NCI Thesaurus ObjectClass)
    C1516308 (UMLS 2011AA ObjectClass)
    C25250 (NCI Thesaurus Property)
    C0205197 (UMLS 2011AA Property)
    Data amended
    Item
    Amended Data
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C0680532 (UMLS CUI-1)
    C25474 (NCI Thesaurus ObjectClass)
    C25416 (NCI Thesaurus Property)
    Item
    Who completed this form (Check one box)
    text
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    C25190 (NCI Thesaurus ObjectClass)
    C0027361 (UMLS 2011AA ObjectClass)
    C25657 (NCI Thesaurus ObjectClass-2)
    C1273518 (UMLS 2011AA ObjectClass-2)
    C25365 (NCI Thesaurus Property)
    C0678257 (UMLS 2011AA Property)
    Code List
    Who completed this form (Check one box)
    CL Item
    Self (Self)
    C25200 (NCI Thesaurus)
    C0036588 (UMLS 2011AA)
    CL Item
    Staff (Staff)
    CL Item
    Other Person (Other person)
    CL Item
    Not Applicable, No Items Completed (Not applicable, no items completed)
    Item
    Patient Race Category (Check all that apply)
    text
    C25372 (NCI Thesaurus ValueDomain)
    C0034510 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C17049 (NCI Thesaurus Property)
    Code List
    Patient Race Category (Check all that apply)
    CL Item
    Not Provided Or Available (Not Reported)
    C43234 (NCI Thesaurus)
    C1706613 (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
    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
    Could Not Be Determined Or Unsure (Unknown)
    C17998 (NCI Thesaurus)
    C0439673 (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 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)
    Item
    Patient Ethnic Group Cateogy (If you consider yourself multiracial, check all additional categories that apply in this question Do not include what you reported in 2A.)
    text
    C25372 (NCI Thesaurus ValueDomain)
    C0015031 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C16564 (NCI Thesaurus Property)
    Code List
    Patient Ethnic Group Cateogy (If you consider yourself multiracial, check all additional categories that apply in this question Do not include what you reported in 2A.)
    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)
    Item
    Highest school grade completed (Check one box)
    text
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    C25190 (NCI Thesaurus ObjectClass)
    C0027361 (UMLS 2011AA ObjectClass)
    C16529 (NCI Thesaurus Property)
    C0013622 (UMLS 2011AA Property)
    C25525 (NCI Thesaurus Property-2)
    C1522410 (UMLS 2011AA Property-2)
    Code List
    Highest school grade completed (Check one box)
    CL Item
    8th Or Less (8th or less)
    CL Item
    9 - 11th Grade (9 - 11th Grade)
    CL Item
    High School Graduate / Ged (High school graduate/GED)
    CL Item
    Vocational / Technical School (Vocational/technical school)
    CL Item
    Associate Degree / Some College (Associate degree/some college)
    CL Item
    Bachelor's Degree (Bachelor's degree)
    C39327 (NCI Thesaurus)
    C1511035 (UMLS 2011AA)
    CL Item
    Advanced Degree (Advanced degree)
    CL Item
    Other (Other)
    C17649 (NCI Thesaurus)
    C0205394 (UMLS 2011AA)
    CL Item
    I Prefer Not To Answer (I prefer not to answer)
    PersonHighestEducationSpecify
    Item
    Other, specify
    text
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    C25190 (NCI Thesaurus ObjectClass)
    C0027361 (UMLS 2011AA ObjectClass)
    C16529 (NCI Thesaurus Property)
    C0013622 (UMLS 2011AA Property)
    C25525 (NCI Thesaurus Property-2)
    C1522410 (UMLS 2011AA Property-2)
    Item
    Religion during childhood (Check one box)
    text
    C25190 (NCI Thesaurus ObjectClass)
    C0027361 (UMLS 2011AA ObjectClass)
    C39299 (NCI Thesaurus Property)
    C0231335 (UMLS 2011AA Property)
    C42614 (NCI Thesaurus ValueDomain)
    C0027365 (UMLS 2011AA ValueDomain)
    C17085 (NCI Thesaurus Property-2)
    C0035039 (UMLS 2011AA Property-2)
    Code List
    Religion during childhood (Check one box)
    CL Item
    Protestant (Protestant)
    CL Item
    Catholic (Catholic)
    CL Item
    Jewish (Jewish)
    C0178443 (NCI Metathesaurus)
    CL Item
    Morman/latter Day Saints (Morman/Latter Day Saints)
    CL Item
    Muslim / Islam (Muslim/Islam)
    CL Item
    None (None)
    C41132 (NCI Thesaurus)
    C0549184 (UMLS 2011AA)
    CL Item
    Other (Other)
    C17649 (NCI Thesaurus)
    C0205394 (UMLS 2011AA)
    CL Item
    I Prefer Not To Answer (I prefer not to answer)
    PersonPediatricReligionSpecify
    Item
    Other, specify
    text
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    C25190 (NCI Thesaurus ObjectClass)
    C0027361 (UMLS 2011AA ObjectClass)
    C39299 (NCI Thesaurus Property)
    C0231335 (UMLS 2011AA Property)
    C17085 (NCI Thesaurus Property-2)
    C0035039 (UMLS 2011AA Property-2)
    Item
    Marital status (Check one box)
    text
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    C25188 (NCI Thesaurus ObjectClass)
    C0024819 (UMLS 2011AA ObjectClass)
    C25365 (NCI Thesaurus Property)
    C0678257 (UMLS 2011AA Property)
    Code List
    Marital status (Check one box)
    CL Item
    Married (Married)
    C0555047 (NCI Metathesaurus)
    CL Item
    Widowed (Widowed)
    C51775 (NCI Thesaurus)
    C0206275 (UMLS 2011AA)
    CL Item
    Never Married (Never married)
    C51774 (NCI Thesaurus)
    C0027952 (UMLS 2011AA)
    CL Item
    Divorced (Divorced)
    C0086170 (NCI Metathesaurus)
    CL Item
    Domestic Partnership (Domestic Partnership)
    C53262 (NCI Thesaurus)
    C1549111 (UMLS 2011AA)
    CL Item
    Separated (Separated)
    CL Item
    I Prefer Not To Answer (I prefer not to answer)
    Item
    Where were you born (Check one box)
    text
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25464 (NCI Thesaurus Property)
    C0454664 (UMLS 2011AA Property)
    C25155 (NCI Thesaurus Property-2)
    C0005615 (UMLS 2011AA Property-2)
    Code List
    Where were you born (Check one box)
    CL Item
    Usa (USA)
    CL Item
    Other Country (Other country)
    PatientBirthStateSpecify
    Item
    USA, specify the 2 letter State code, eg NY (eg NY)
    text
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C30010 (NCI Thesaurus Property)
    C1301808 (UMLS 2011AA Property)
    C25155 (NCI Thesaurus Property-2)
    C0005615 (UMLS 2011AA Property-2)
    PatientBirthCountrySpecify
    Item
    Other country, specify
    text
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25464 (NCI Thesaurus Property)
    C0454664 (UMLS 2011AA Property)
    C25155 (NCI Thesaurus Property-2)
    C0005615 (UMLS 2011AA Property-2)
    Item
    Where did you live the longest (Check one box)
    text
    C0030705 (NCI Metathesaurus ObjectClass)
    C25558 (NCI Thesaurus Property)
    C1522425 (UMLS 2011AA Property)
    C25330 (NCI Thesaurus Property-2)
    C0449238 (UMLS 2011AA Property-2)
    C25273 (NCI Thesaurus Property-3)
    C0237096 (UMLS 2011AA Property-3)
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    Code List
    Where did you live the longest (Check one box)
    CL Item
    Usa (USA)
    CL Item
    Other Country (Other country)
    PatientStateLongestDurationResidenceCode
    Item
    USA, specify the 2 letter State code (eg NY)
    text
    C0030705 (NCI Metathesaurus ObjectClass)
    C25558 (NCI Thesaurus Property)
    C1522425 (UMLS 2011AA Property)
    C30010 (NCI Thesaurus Property-2)
    C1301808 (UMLS 2011AA Property-2)
    C25330 (NCI Thesaurus Property-3)
    C0449238 (UMLS 2011AA Property-3)
    C25273 (NCI Thesaurus Property-4)
    C0237096 (UMLS 2011AA Property-4)
    C25162 (NCI Thesaurus ValueDomain)
    C0805701 (UMLS 2011AA ValueDomain)
    C30010 (NCI Thesaurus ValueDomain-2)
    C1301808 (UMLS 2011AA ValueDomain-2)
    PatientCountryLongestDurationResidenceName
    Item
    Other country, specify
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25558 (NCI Thesaurus Property)
    C1522425 (UMLS 2011AA Property)
    C25464 (NCI Thesaurus Property-2)
    C0454664 (UMLS 2011AA Property-2)
    C25330 (NCI Thesaurus Property-3)
    C0449238 (UMLS 2011AA Property-3)
    C25273 (NCI Thesaurus Property-4)
    C0237096 (UMLS 2011AA Property-4)
    C25464 (NCI Thesaurus ValueDomain)
    C0454664 (UMLS 2011AA ValueDomain)
    C42614 (NCI Thesaurus ValueDomain-2)
    C0027365 (UMLS 2011AA ValueDomain-2)
    Item Group
    Cigarette History
    Item
    Smoked at least 100 cigarette during lifetime (5 packs)
    text
    C25180 (NCI Thesaurus ValueDomain)
    C1519384 (UMLS CUI-1)
    C20989 (NCI Thesaurus Property)
    C29719 (NCI Thesaurus ObjectClass)
    Code List
    Smoked at least 100 cigarette during lifetime (5 packs)
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes, But Quit (Yes, but quit)
    CL Item
    Yes, Currently Smoke (Yes, currently smoke)
    PatientInitialCigaretteSmokingAgeYearCount
    Item
    Age began smoking cigarettes
    float
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25536 (NCI Thesaurus Property)
    C1555582 (UMLS 2011AA Property)
    C18270 (NCI Thesaurus Property-2)
    C0700219 (UMLS 2011AA Property-2)
    C29848 (NCI Thesaurus ValueDomain)
    C0439234 (UMLS 2011AA ValueDomain)
    C25463 (NCI Thesaurus ValueDomain-2)
    C0750480 (UMLS 2011AA ValueDomain-2)
    CigarettesSmokingYearNumber
    Item
    Number of years smoked cigarettes
    float
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    C1802 (NCI Thesaurus ObjectClass)
    C0677453 (UMLS 2011AA ObjectClass)
    C29848 (NCI Thesaurus ValueDomain-2)
    C0439234 (UMLS 2011AA ValueDomain-2)
    C17934 (NCI Thesaurus Property)
    C0453996 (UMLS 2011AA Property)
    Smoker amount smoked
    Item
    Average number of cigarettes smoked per day
    float
    C25337 (NCI Thesaurus ValueDomain)
    C1608325 (UMLS CUI-1)
    C17934 (NCI Thesaurus ObjectClass)
    C25340 (NCI Thesaurus Property)
    PatientSmokingCessationAgeYear
    Item
    If quit, age stopped smoking completely
    float
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C29848 (NCI Thesaurus ValueDomain)
    C0439234 (UMLS 2011AA ValueDomain)
    C25463 (NCI Thesaurus ValueDomain-2)
    C0750480 (UMLS 2011AA ValueDomain-2)
    C0085134 (NCI Metathesaurus Property)
    Item
    If you have had any of the illnesses listed below, please check yes for those that apply (check = Yes)
    text
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    C17649 (NCI Thesaurus ObjectClass)
    C0205394 (UMLS 2011AA ObjectClass)
    C2991 (NCI Thesaurus ObjectClass-2)
    C0012634 (UMLS 2011AA ObjectClass-2)
    C15220 (NCI Thesaurus Property)
    C0011900 (UMLS 2011AA Property)
    Code List
    If you have had any of the illnesses listed below, please check yes for those that apply (check = Yes)
    CL Item
    Heart Problems (Heart problems)
    CL Item
    Lung Problems (Lung problems)
    CL Item
    High Blood Pressure (High blood pressure)
    CL Item
    Bleeding Problems (Bleeding problems)
    CL Item
    Circulation Problems (Circulation problems)
    CL Item
    Liver Problems (Liver problems)
    CL Item
    Diabetes Or Sugar In Urine (Diabetes or sugar in urine)
    CL Item
    Kidney/urine Problems (Kidney/urine problems)
    CL Item
    Stroke (Stroke)
    CL Item
    Thyroid Problems (Thyroid problems)
    CL Item
    Seizure (Seizure)
    C2962 (NCI Thesaurus)
    C0036572 (UMLS 2011AA)
    CL Item
    Hiv/aids (HIV/AIDS)
    CL Item
    Frequent Infections (Frequent infections)
    CL Item
    Psychological Problems (Psychological problems)
    CL Item
    Other (Other)
    C17649 (NCI Thesaurus)
    C0205394 (UMLS 2011AA)
    OtherDiseaseDiagnosisSpecify
    Item
    Specify other
    text
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    C17649 (NCI Thesaurus ObjectClass)
    C0205394 (UMLS 2011AA ObjectClass)
    C2991 (NCI Thesaurus ObjectClass-2)
    C0012634 (UMLS 2011AA ObjectClass-2)
    C15220 (NCI Thesaurus Property)
    C0011900 (UMLS 2011AA Property)
    Item Group
    Family History
    BrotherPatientFamilyMembersAssessmentNumber
    Item
    How many brothers do you have (How many of the following family members do you have living and dead Include only those who are blood-related)
    float
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25289 (NCI Thesaurus ObjectClass-2)
    C0337527 (UMLS 2011AA ObjectClass-2)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C0086282 (NCI Metathesaurus Property)
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    SisterPatientFamilyMembersAssessmentNumber
    Item
    How many sisters do you have
    float
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25680 (NCI Thesaurus ObjectClass-2)
    C0337514 (UMLS 2011AA ObjectClass-2)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C0086282 (NCI Metathesaurus Property)
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    SonPatientFamilyMembersAssessmentNumber
    Item
    How many sons do you have
    float
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25205 (NCI Thesaurus ObjectClass-2)
    C0037683 (UMLS 2011AA ObjectClass-2)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C0086282 (NCI Metathesaurus Property)
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    DaughterPatientFamilyMembersAssessmentNumber
    Item
    How many daughters do you have
    float
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25165 (NCI Thesaurus ObjectClass-2)
    C0011011 (UMLS 2011AA ObjectClass-2)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C0086282 (NCI Metathesaurus Property)
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    PatientAdoptedInd-3
    Item
    Are you adopted (Check one)
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C1512699 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25290 (NCI Thesaurus Property)
    C0425382 (UMLS 2011AA Property)
    Item
    Blood relative with cancer (check = yes)
    text
    C25173 (NCI Thesaurus ObjectClass)
    C0015576 (UMLS 2011AA ObjectClass)
    C21480 (NCI Thesaurus ObjectClass-2)
    C0080103 (UMLS 2011AA ObjectClass-2)
    C9305 (NCI Thesaurus Property)
    C0006826 (UMLS 2011AA Property)
    C18772 (NCI Thesaurus Property-2)
    C0262926 (UMLS 2011AA Property-2)
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    Code List
    Blood relative with cancer (check = yes)
    CL Item
    Father (Father)
    C25174 (NCI Thesaurus)
    C0015671 (UMLS 2011AA)
    CL Item
    Mother (Mother)
    C25189 (NCI Thesaurus)
    C0026591 (UMLS 2011AA)
    CL Item
    Brother #1 (Brother #1)
    CL Item
    Brother #2 (Brother #2)
    CL Item
    Brother #3 (Brother #3)
    CL Item
    Brother #4 (Brother #4)
    CL Item
    Sister #1 (Sister #1)
    CL Item
    Sister #2 (Sister #2)
    CL Item
    Sister #3 (Sister #3)
    CL Item
    Sister #4 (Sister #4)
    CL Item
    Child #1 (Child #1)
    CL Item
    Child #2 (Child #2)
    CL Item
    Child #3 (Child #3)
    CL Item
    Child #4 (Child #4)
    PersonFirstCancerDiagnosisAgeYearCount
    Item
    Age when first cancer diagnosed
    float
    C25190 (NCI Thesaurus ObjectClass)
    C0027361 (UMLS 2011AA ObjectClass)
    C9305 (NCI Thesaurus Property)
    C0006826 (UMLS 2011AA Property)
    C25509 (NCI Thesaurus Property-2)
    C1279901 (UMLS 2011AA Property-2)
    C15220 (NCI Thesaurus Property-3)
    C0011900 (UMLS 2011AA Property-3)
    C25150 (NCI Thesaurus Property-4)
    C0001779 (UMLS 2011AA Property-4)
    C29848 (NCI Thesaurus ValueDomain)
    C0439234 (UMLS 2011AA ValueDomain)
    C25463 (NCI Thesaurus ValueDomain-2)
    C0750480 (UMLS 2011AA ValueDomain-2)
    Item
    Type of Cancer (check = yes)
    text
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    C25341 (NCI Thesaurus Property)
    C0450429 (UMLS 2011AA Property)
    C9305 (NCI Thesaurus ObjectClass)
    C0006826 (UMLS 2011AA ObjectClass)
    Code List
    Type of Cancer (check = yes)
    CL Item
    Lung (Lung)
    C12468 (NCI Thesaurus)
    C0024109 (UMLS 2011AA)
    CL Item
    Breast (Breast)
    C12971 (NCI Thesaurus)
    C0006141 (UMLS 2011AA)
    CL Item
    Colon (Colon)
    C12382 (NCI Thesaurus)
    C0009368 (UMLS 2011AA)
    CL Item
    Prostate (Prostate)
    C12410 (NCI Thesaurus)
    C0033572 (UMLS 2011AA)
    CL Item
    Head & Neck (Head & Neck)
    CL Item
    Non Melanoma Skin (Non Melanoma Skin)
    CL Item
    Other (Other)
    C17649 (NCI Thesaurus)
    C0205394 (UMLS 2011AA)
    CancerSiteSpecify
    Item
    Specify
    text
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    C25341 (NCI Thesaurus Property)
    C0450429 (UMLS 2011AA Property)
    C9305 (NCI Thesaurus ObjectClass)
    C0006826 (UMLS 2011AA ObjectClass)
    CancerPreventionTrialKnowledgeDocumentedInd-2
    Item
    Have you ever heard of Cancer Prevention Trials (Check one box)
    boolean
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    C15790 (NCI Thesaurus ObjectClass)
    C1516220 (UMLS 2011AA ObjectClass)
    C25356 (NCI Thesaurus Property)
    C1301725 (UMLS 2011AA Property)
    C0376554 (NCI Metathesaurus Property)
    Item
    How likely would you be to volunteer to participate in Cancer Prevention Trials (The numbers below allow you to rate your answer between 1 - never and 10 - extremely likely. Circle the number below that best describes your choice.)
    text
    C25664 (NCI Thesaurus ValueDomain)
    C0349674 (UMLS 2011AA ValueDomain)
    C25608 (NCI Thesaurus Property)
    C0679823 (UMLS 2011AA Property)
    C15790 (NCI Thesaurus ObjectClass)
    C1516220 (UMLS 2011AA ObjectClass)
    Code List
    How likely would you be to volunteer to participate in Cancer Prevention Trials (The numbers below allow you to rate your answer between 1 - never and 10 - extremely likely. Circle the number below that best describes your choice.)
    CL Item
    1 (1)
    CL Item
    2 (2)
    C66833 (NCI Thesaurus)
    C0205448 (UMLS 2011AA)
    CL Item
    3 (3)
    CL Item
    4 (4)
    CL Item
    5 (5)
    CL Item
    6 (6)
    CL Item
    7 (7)
    CL Item
    8 (8)
    CL Item
    9 (9)
    CL Item
    10 (10)

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