ID
8952
Descrizione
S1007 Registration Worksheet Form - Step 2 Tamoxifen Citrate, Letrozole, Anastrozole, or Exemestane With or Without Chemotherapy in Treating Patients With Invasive RxPONDER Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=90C7517A-4524-82BC-E040-BB89AD432492
collegamento
Keywords
versioni (2)
- 27/08/12 27/08/12 -
- 09/01/15 09/01/15 - Martin Dugas
Caricato su
9 gennaio 2015
DOI
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Licenza
Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT01272037 Registration - S1007 Registration Worksheet Form - Step 2 - 3139539v1.0
INSTRUCTIONS: All of the information on this Registration Worksheet and the Protocol Eligibility Section must be answered appropriately for a patient to be considered eligible for registration. This Registration Worksheet must be entirely filled out and referred to during the registration. Do NOT submit this worksheet as part of the patient data
- StudyEvent: S1007 Registration Worksheet Form - Step 2
Descrizione
Swog Patient Id
Descrizione
Unnamed2
Descrizione
RegistrarSouthwestOncologyGroupIdentifierNumber
Tipo di dati
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
- NCI Thesaurus Property-2
- C25699
- UMLS 2011AA Property-2
- C1519429
- NCI Thesaurus ObjectClass
- C25357
- UMLS 2011AA ObjectClass
- C0557514
Descrizione
SouthwestOncologyGroupInvestigatorIdentifierNumber
Tipo di dati
float
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
- NCI Thesaurus ObjectClass
- C25699
- UMLS 2011AA ObjectClass
- C1519429
- NCI Thesaurus ObjectClass-2
- C17089
- UMLS 2011AA ObjectClass-2
- C0035173
Descrizione
SouthwestOncologyGroupTreatingInstitutionIdentifierNumber
Tipo di dati
float
Alias
- NCI Thesaurus ObjectClass
- C25699
- UMLS 2011AA ObjectClass
- C1519429
- NCI Thesaurus ObjectClass-2
- C25705
- UMLS 2011AA ObjectClass-2
- C1522326
- NCI Thesaurus ObjectClass-3
- C41206
- UMLS 2011AA ObjectClass-3
- C1272753
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
Descrizione
Unnamed5
Descrizione
Treatment Begin Date
Tipo di dati
date
Alias
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus ObjectClass-2
- C25631
- NCI Thesaurus Property
- C25431
- UMLS CUI-1
- C3173309
- NCI Thesaurus Property-2
- C25275
- NCI Thesaurus ValueDomain
- C25164
- NCI Thesaurus ValueDomain-2
- C25431
Descrizione
Stratification Questions
Descrizione
ClinicalStudyRecurrenceScoreStratificationCode
Tipo di dati
float
Alias
- NCI Thesaurus ObjectClass
- C15206
- UMLS 2011AA ObjectClass
- C0008972
- NCI Thesaurus Property
- C3352
- UMLS 2011AA Property
- C0034897
- NCI Thesaurus Property-2
- C25689
- UMLS 2011AA Property-2
- C1514983
- NCI Thesaurus Property-3
- C25338
- UMLS 2011AA Property-3
- C0449820
- NCI Thesaurus ValueDomain
- C25162
- UMLS 2011AA ValueDomain
- C0805701
Descrizione
ClinicalStudyMenopauseStatusStratificationCode
Tipo di dati
float
Alias
- NCI Thesaurus ObjectClass
- C15206
- UMLS 2011AA ObjectClass
- C0008972
- NCI Thesaurus Property
- C3231
- UMLS 2011AA Property
- C0025320
- NCI Thesaurus Property-2
- C25688
- UMLS 2011AA Property-2
- C0449438
- NCI Thesaurus Property-3
- C25689
- UMLS 2011AA Property-3
- C1514983
- NCI Thesaurus ValueDomain
- C25162
- UMLS 2011AA ValueDomain
- C0805701
Descrizione
ClinicalStudyNodalDissectionStratificationCode
Tipo di dati
float
Alias
- NCI Thesaurus ObjectClass
- C15206
- UMLS 2011AA ObjectClass
- C0008972
- NCI Thesaurus Property
- C15227
- UMLS 2011AA Property
- C0012737
- NCI Thesaurus Property-2
- C25323
- UMLS 2011AA Property-2
- C0443268
- NCI Thesaurus Property-3
- C25689
- UMLS 2011AA Property-3
- C1514983
- NCI Thesaurus ValueDomain
- C25162
- UMLS 2011AA ValueDomain
- C0805701
Descrizione
Unnamed4
Descrizione
PatientQualityofLifeConsentInd-2
Tipo di dati
boolean
Alias
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
- NCI Thesaurus Property
- C17047
- UMLS 2011AA Property
- C0518214
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property-2
- C25460
- UMLS 2011AA Property-2
- C1511481
Descrizione
SouthwestOncologyGroupPatientResearchConsentInd-2
Tipo di dati
boolean
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus ObjectClass-2
- C25699
- UMLS 2011AA ObjectClass-2
- C1519429
- NCI Thesaurus Property
- C15319
- NCI Thesaurus Property-2
- C25460
- UMLS 2011AA Property
- C1511481
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Descrizione
PersonSpecimenMalignantNeoplasmResearchConsentInd-2
Tipo di dati
boolean
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C15319
- NCI Thesaurus Property-2
- C9305
- UMLS 2011AA Property
- C0006826
- NCI Thesaurus Property-3
- C19157
- UMLS 2011AA Property-2
- C0370003
- NCI Thesaurus Property-4
- C25460
- UMLS 2011AA Property-3
- C1511481
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Descrizione
PatientOtherDiseaseorDisorderClinicalStudyConsentInd-2
Tipo di dati
boolean
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C17649
- UMLS 2011AA Property
- C0205394
- NCI Thesaurus Property-2
- C2991
- UMLS 2011AA Property-2
- C0012634
- NCI Thesaurus Property-3
- C15206
- UMLS 2011AA Property-3
- C0008972
- NCI Thesaurus Property-4
- C25460
- UMLS 2011AA Property-4
- C1511481
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Descrizione
Permission to contact Patient
Tipo di dati
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
Descrizione
Unnamed 7
Descrizione
SouthwestOncologyGroupPatientRegistrationEligibilityDeterminationInd-2
Tipo di dati
boolean
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus ObjectClass-2
- C25699
- UMLS 2011AA ObjectClass-2
- C1519429
- NCI Thesaurus Property
- C25646
- UMLS 2011AA Property
- C1514821
- NCI Thesaurus Property-2
- C25171
- UMLS 2011AA Property-2
- C0013893
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Similar models
INSTRUCTIONS: All of the information on this Registration Worksheet and the Protocol Eligibility Section must be answered appropriately for a patient to be considered eligible for registration. This Registration Worksheet must be entirely filled out and referred to during the registration. Do NOT submit this worksheet as part of the patient data
- StudyEvent: S1007 Registration Worksheet Form - Step 2
C0011008 (UMLS 2011AA ValueDomain)
C25320 (NCI Thesaurus ObjectClass)
C1507394 (UMLS 2011AA ObjectClass)
C64382 (NCI Thesaurus Property)
C1879547 (UMLS 2011AA Property)
C41200 (NCI Thesaurus Property-2)
C0680532 (UMLS 2011AA Property-2)
C0011008 (UMLS 2011AA ValueDomain)
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
C25551 (NCI Thesaurus ValueDomain-2)
C1517741 (UMLS 2011AA ValueDomain-2)
C1514821 (UMLS CUI-1)
C25646 (NCI Thesaurus ObjectClass)
C0237753 (UMLS CUI-2)
C16154 (NCI Thesaurus Property)
C16154 (NCI Thesaurus ValueDomain-2)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1519429 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25699 (NCI Thesaurus Property-2)
C0237753 (UMLS 2011AA ValueDomain)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25699 (NCI Thesaurus Property-2)
C1519429 (UMLS 2011AA Property-2)
C25357 (NCI Thesaurus ObjectClass)
C0557514 (UMLS 2011AA ObjectClass)
C0237753 (UMLS 2011AA ValueDomain)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25699 (NCI Thesaurus ObjectClass)
C1519429 (UMLS 2011AA ObjectClass)
C17089 (NCI Thesaurus ObjectClass-2)
C0035173 (UMLS 2011AA ObjectClass-2)
C1519429 (UMLS 2011AA ObjectClass)
C25705 (NCI Thesaurus ObjectClass-2)
C1522326 (UMLS 2011AA ObjectClass-2)
C41206 (NCI Thesaurus ObjectClass-3)
C1272753 (UMLS 2011AA ObjectClass-3)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (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)
C0008972 (UMLS 2011AA ObjectClass)
C3352 (NCI Thesaurus Property)
C0034897 (UMLS 2011AA Property)
C25689 (NCI Thesaurus Property-2)
C1514983 (UMLS 2011AA Property-2)
C25338 (NCI Thesaurus Property-3)
C0449820 (UMLS 2011AA Property-3)
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
C0008972 (UMLS 2011AA ObjectClass)
C3231 (NCI Thesaurus Property)
C0025320 (UMLS 2011AA Property)
C25688 (NCI Thesaurus Property-2)
C0449438 (UMLS 2011AA Property-2)
C25689 (NCI Thesaurus Property-3)
C1514983 (UMLS 2011AA Property-3)
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
C0008972 (UMLS 2011AA ObjectClass)
C15227 (NCI Thesaurus Property)
C0012737 (UMLS 2011AA Property)
C25323 (NCI Thesaurus Property-2)
C0443268 (UMLS 2011AA Property-2)
C25689 (NCI Thesaurus Property-3)
C1514983 (UMLS 2011AA Property-3)
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus Property)
C0518214 (UMLS 2011AA Property)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25460 (NCI Thesaurus Property-2)
C1511481 (UMLS 2011AA Property-2)
C0030705 (UMLS 2011AA ObjectClass)
C25699 (NCI Thesaurus ObjectClass-2)
C1519429 (UMLS 2011AA ObjectClass-2)
C15319 (NCI Thesaurus Property)
C25460 (NCI Thesaurus Property-2)
C1511481 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
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)
C0030705 (UMLS 2011AA ObjectClass)
C17649 (NCI Thesaurus Property)
C0205394 (UMLS 2011AA Property)
C2991 (NCI Thesaurus Property-2)
C0012634 (UMLS 2011AA Property-2)
C15206 (NCI Thesaurus Property-3)
C0008972 (UMLS 2011AA Property-3)
C25460 (NCI Thesaurus Property-4)
C1511481 (UMLS 2011AA Property-4)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
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)
C0030705 (UMLS 2011AA ObjectClass)
C25699 (NCI Thesaurus ObjectClass-2)
C1519429 (UMLS 2011AA ObjectClass-2)
C25646 (NCI Thesaurus Property)
C1514821 (UMLS 2011AA Property)
C25171 (NCI Thesaurus Property-2)
C0013893 (UMLS 2011AA Property-2)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)