ID

9035

Description

E2410 Registration Worksheet (Step 2) Chemotherapy Based on PET Scan in Treating Patients With Stage I or Stage II Hodgkin Lymphoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B0DB2488-DEEB-F2F5-E040-BB89AD430E38

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B0DB2488-DEEB-F2F5-E040-BB89AD430E38

Keywords

Versions (2)
  1. 9/19/12 9/19/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
Uploaded on

January 9, 2015

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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Lymphoma NCT01390584 Eligibility - E2410 Registration Worksheet (Step 2) - 3299717v1.0

English

No Instruction available.

1 forms  
  1. StudyEvent: E2410 Registration Worksheet (Step 2)
    1. No Instruction available.
Eligibility
Description

Eligibility

Has the eligibility checklist been completed
Description

EligibilityDeterminationChecklistCompleteEligibilityInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus Property
C25250
UMLS 2011AA Property
C0205197
NCI Thesaurus ObjectClass
C25171
UMLS 2011AA ObjectClass
C0013893
NCI Thesaurus Property-2
C49073
UMLS 2011AA Property-2
C1707357
In the opinion of the investigator, is the patient eligible?
Description

Eligibility for trial

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS CUI-1
C1302261
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25171
Indicate the PET-CT scan result that was determined centrally and reported to you
Description

PositronEmissionTomographyComputedTomographyDiagnosticImagingClinicalTrialEligibilityCriteriaStatus

Data type

text

Alias
NCI Thesaurus ObjectClass
C17007
UMLS 2011AA ObjectClass
C0032743
NCI Thesaurus ObjectClass-2
C16502
UMLS 2011AA ObjectClass-2
C0011923
NCI Thesaurus ObjectClass-3
C17204
UMLS 2011AA ObjectClass-3
C0040405
NCI Thesaurus Property
C16112
UMLS 2011AA Property
C1516637
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
Radiation Oncology Facility (Enter response)
Description

RadiationOncologyHealthcareFacilityRadiationTherapyPerformedText

Data type

text

Alias
NCI Thesaurus ObjectClass
C21541
UMLS 2011AA ObjectClass
C0018704
NCI Thesaurus ObjectClass-2
C17760
UMLS 2011AA ObjectClass-2
C0243005
NCI Thesaurus Property
C15313
UMLS 2011AA Property
C1522449
NCI Thesaurus Property-2
C38000
UMLS 2011AA Property-2
C0884358
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
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Similar models

No Instruction available.

1 forms
  1. StudyEvent: E2410 Registration Worksheet (Step 2)
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Eligibility
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)
Item
Indicate the PET-CT scan result that was determined centrally and reported to you
text
C17007 (NCI Thesaurus ObjectClass)
C0032743 (UMLS 2011AA ObjectClass)
C16502 (NCI Thesaurus ObjectClass-2)
C0011923 (UMLS 2011AA ObjectClass-2)
C17204 (NCI Thesaurus ObjectClass-3)
C0040405 (UMLS 2011AA ObjectClass-3)
C16112 (NCI Thesaurus Property)
C1516637 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.3
Code List
Indicate the PET-CT scan result that was determined centrally and reported to you
CL Item
Positron Emission Tomography Negative Finding (PET Negative)
C17007 (NCI Thesaurus)
C0032743 (UMLS 2011AA)
C38757 (NCI Thesaurus-3)
C1513916 (UMLS 2011AA-4)
CL Item
Positron Emission Tomography Positive (PET Positive)
C17007 (NCI Thesaurus)
C0032743 (UMLS 2011AA)
C0205159 (NCI Metathesaurus)
RadiationOncologyHealthcareFacilityRadiationTherapyPerformedText
Item
Radiation Oncology Facility (Enter response)
text
C21541 (NCI Thesaurus ObjectClass)
C0018704 (UMLS 2011AA ObjectClass)
C17760 (NCI Thesaurus ObjectClass-2)
C0243005 (UMLS 2011AA ObjectClass-2)
C15313 (NCI Thesaurus Property)
C1522449 (UMLS 2011AA Property)
C38000 (NCI Thesaurus Property-2)
C0884358 (UMLS 2011AA Property-2)
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
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