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ID

9052

Descrição

Hormone Receptor Form (Form 24-F) Brain Function in Premenopausal Women Receiving Tamoxifen With or Without Ovarian Function Suppression for Early-Stage Breast Cancer on Clinical Trial IBCSG-2402 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B0EA32D1-99C1-62FB-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B0EA32D1-99C1-62FB-E034-0003BA12F5E7

Palavras-chave

  1. 27/08/2012 27/08/2012 -
  2. 09/01/2015 09/01/2015 - Martin Dugas
Transferido a

9 de janeiro de 2015

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Licença

Creative Commons BY-NC 3.0 Legacy

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    Breast Cancer NCT00659373 Pathology - Hormone Receptor Form (Form 24-F) - 2073222v3.0

    HORMONE RECEPTOR FORM (Form 24-F) Instructions: This form is to be completed and submitted after hormone receptor analysis is performed, within one done at first recurrence. Mark your selection with an ?X? in the appropriate box(es). Use minus one (-1) to indicate that an answer is unknown, unobtainable or not done.

    Ccrr Module For Hormone Receptor Form (form 24-f)
    Descrição

    Ccrr Module For Hormone Receptor Form (form 24-f)

    Patient ID No. (Study No.)
    Descrição

    PatientStudyID,CoordinatingGroup

    Tipo de dados

    text

    Patient Initials (f m fl sl)
    Descrição

    Patient Initials

    Tipo de dados

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2986440
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25536
    Patient's Date of Birth (day)
    Descrição

    PatientBirthDate

    Tipo de dados

    date

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25275
    UMLS 2011AA Property
    C2745955
    Participating Center/Affiliate
    Descrição

    ParticipatingCenter/Affiliate

    Tipo de dados

    text

    Center Code
    Descrição

    ParticipatingGroupCode

    Tipo de dados

    text

    Alias
    NCI Thesaurus ValueDomain
    C25162
    UMLS 2011AA ValueDomain
    C0805701
    This form is being completed for
    Descrição

    BreastSideAssessmentSite

    Tipo de dados

    text

    Alias
    NCI Thesaurus ValueDomain
    C13717
    UMLS 2011AA ValueDomain
    C1515974
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus ObjectClass
    C12971
    UMLS 2011AA ObjectClass
    C0006141
    NCI Thesaurus Property-2
    C25306
    UMLS 2011AA Property-2
    C0441987
    Specimen ID Number
    Descrição

    SpecimenID

    Tipo de dados

    float

    Date Specimen Collected (D M Y)
    Descrição

    SpecimenCollectionDate

    Tipo de dados

    date

    ER % Positive (Results of immunohistochemical IHC: Percent of positive cells use 0-100)
    Descrição

    EstrogenReceptorPositivePercentage

    Tipo de dados

    float

    Unidades de medida
    • %
    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS 2011AA ValueDomain
    C0237753
    %
    PR % Positive (Results of immunohistochemical IHC: Percent of positive cells use 0-100)
    Descrição

    ProgesteroneReceptorPositivePercentage

    Tipo de dados

    float

    Unidades de medida
    • %
    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS 2011AA ValueDomain
    C0237753
    NCI Thesaurus ObjectClass
    C17075
    UMLS 2011AA ObjectClass
    C0034833
    NCI Thesaurus Property
    C25554
    UMLS 2011AA Property
    C0441889
    %
    ER status (select one)
    Descrição

    ERStatus

    Tipo de dados

    text

    PgR status (select one)
    Descrição

    PgRStatus

    Tipo de dados

    text

    Investigator Signature
    Descrição

    Investigator Signature

    Tipo de dados

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704
    UMLS CUI-1
    C2346576
    NCI Thesaurus Property
    C25678
    NCI Thesaurus ObjectClass
    C17089
    Date
    Descrição

    Investigator Signature Date

    Tipo de dados

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS CUI-1
    C2346576
    NCI Thesaurus Property
    C25678
    UMLS CUI-2
    C0011008
    NCI Thesaurus ValueDomain-2
    C25367
    NCI Thesaurus ObjectClass
    C17089

    Similar models

    HORMONE RECEPTOR FORM (Form 24-F) Instructions: This form is to be completed and submitted after hormone receptor analysis is performed, within one done at first recurrence. Mark your selection with an ?X? in the appropriate box(es). Use minus one (-1) to indicate that an answer is unknown, unobtainable or not done.

    Name
    Tipo
    Description | Question | Decode (Coded Value)
    Tipo de dados
    Alias
    Item Group
    Ccrr Module For Hormone Receptor Form (form 24-f)
    PatientStudyID,CoordinatingGroup
    Item
    Patient ID No. (Study No.)
    text
    Patient Initials
    Item
    Patient Initials (f m fl sl)
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2986440 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25536 (NCI Thesaurus Property)
    PatientBirthDate
    Item
    Patient's Date of Birth (day)
    date
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25275 (NCI Thesaurus Property)
    C2745955 (UMLS 2011AA Property)
    ParticipatingCenter/Affiliate
    Item
    Participating Center/Affiliate
    text
    ParticipatingGroupCode
    Item
    Center Code
    text
    C25162 (NCI Thesaurus ValueDomain)
    C0805701 (UMLS 2011AA ValueDomain)
    Item
    This form is being completed for
    text
    C13717 (NCI Thesaurus ValueDomain)
    C1515974 (UMLS 2011AA ValueDomain)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C12971 (NCI Thesaurus ObjectClass)
    C0006141 (UMLS 2011AA ObjectClass)
    C25306 (NCI Thesaurus Property-2)
    C0441987 (UMLS 2011AA Property-2)
    Code List
    This form is being completed for
    CL Item
    Left Breast/side (Left breast/side)
    CL Item
    Right Breast/side (Right breast/side)
    SpecimenID
    Item
    Specimen ID Number
    float
    SpecimenCollectionDate
    Item
    Date Specimen Collected (D M Y)
    date
    EstrogenReceptorPositivePercentage
    Item
    ER % Positive (Results of immunohistochemical IHC: Percent of positive cells use 0-100)
    float
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    ProgesteroneReceptorPositivePercentage
    Item
    PR % Positive (Results of immunohistochemical IHC: Percent of positive cells use 0-100)
    float
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    C17075 (NCI Thesaurus ObjectClass)
    C0034833 (UMLS 2011AA ObjectClass)
    C25554 (NCI Thesaurus Property)
    C0441889 (UMLS 2011AA Property)
    Item
    ER status (select one)
    text
    Code List
    ER status (select one)
    CL Item
    Negative (Negative)
    C25247 (NCI Thesaurus)
    C0205160 (UMLS 2011AA)
    CL Item
    Positive (Positive)
    C25246 (NCI Thesaurus)
    C1446409 (UMLS 2011AA)
    CL Item
    Unknown (Unknown)
    C17998 (NCI Thesaurus)
    C0439673 (UMLS 2011AA)
    Item
    PgR status (select one)
    text
    Code List
    PgR status (select one)
    CL Item
    Negative (Negative)
    C25247 (NCI Thesaurus)
    C0205160 (UMLS 2011AA)
    CL Item
    Positive (Positive)
    C25246 (NCI Thesaurus)
    C1446409 (UMLS 2011AA)
    CL Item
    Unknown (Unknown)
    C17998 (NCI Thesaurus)
    C0439673 (UMLS 2011AA)
    Investigator Signature
    Item
    Investigator Signature
    text
    C25704 (NCI Thesaurus ValueDomain)
    C2346576 (UMLS CUI-1)
    C25678 (NCI Thesaurus Property)
    C17089 (NCI Thesaurus ObjectClass)
    Investigator Signature Date
    Item
    Date
    date
    C25164 (NCI Thesaurus ValueDomain)
    C2346576 (UMLS CUI-1)
    C25678 (NCI Thesaurus Property)
    C0011008 (UMLS CUI-2)
    C25367 (NCI Thesaurus ValueDomain-2)
    C17089 (NCI Thesaurus ObjectClass)

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