ID
9082
Description
Gynecologic Oncology Group Smoking History Questionnaire (Form SHQ) Radiation Therapy With or Without Chemotherapy in Patients With Stage I or Stage II Cervical Cancer Who Previously Underwent Surgery Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=572CCDFB-3AD6-1370-E044-0003BA3F9857
Link
Keywords
Versions (3)
- 8/27/12 8/27/12 -
- 8/11/14 8/11/14 - Martin Dugas
- 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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Cervical Cancer NCT01101451 Quality of Life - Gynecologic Oncology Group Smoking History Questionnaire (Form SHQ) - 2785914v1.0
No Instruction available.
- StudyEvent: Gynecologic Oncology Group Smoking History Questionnaire (Form SHQ)
Description
Smoking History Questionnaire
Description
Personal Smoking Section
Description
Smoking history
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25180
- UMLS CUI-1
- C1519384
- NCI Thesaurus Property
- C20989
- NCI Thesaurus ObjectClass
- C29719
Description
SmokingCessationNicotinePatchNicotineGumUseInd-2
Data type
boolean
Alias
- NCI Thesaurus ObjectClass
- C17427
- UMLS 2011AA ObjectClass
- C0085134
- NCI Thesaurus Property
- C25340
- UMLS 2011AA Property
- C0457083
- NCI Thesaurus Property-2
- C17955
- UMLS 2011AA Property-2
- C0358855
- NCI Thesaurus Property-3
- C15663
- UMLS 2011AA Property-3
- C0068722
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Description
PatientInitialCigaretteSmokingAgeYearCount
Data type
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
Description
CigaretteAverageDailyUseCount
Data type
float
Alias
- NCI Thesaurus ObjectClass
- C1802
- UMLS 2011AA ObjectClass
- C0677453
- NCI Thesaurus Property
- C25473
- UMLS 2011AA Property
- C0332173
- NCI Thesaurus Property-2
- C37917
- UMLS 2011AA Property-2
- C1510992
- NCI Thesaurus Property-3
- C25340
- UMLS 2011AA Property-3
- C0457083
- NCI Thesaurus ValueDomain
- C25463
- UMLS 2011AA ValueDomain
- C0750480
Description
PersonCigaretteWeekCurrentUseSmokingHistoryInd-2
Data type
boolean
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C25471
- UMLS 2011AA Property
- C0521116
- NCI Thesaurus Property-2
- C1802
- UMLS 2011AA Property-2
- C0677453
- NCI Thesaurus Property-3
- C29844
- UMLS 2011AA Property-3
- C0439230
- NCI Thesaurus Property-4
- C29719
- UMLS 2011AA Property-4
- C1519384
- NCI Thesaurus Property-5
- C25340
- UMLS 2011AA Property-5
- C0457083
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Description
PersonCigaretteSmokingCessationAgeYearCount
Data type
float
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C1802
- UMLS 2011AA Property
- C0677453
- NCI Thesaurus Property-2
- C17427
- UMLS 2011AA Property-2
- C0085134
- NCI Thesaurus Property-3
- C25150
- UMLS 2011AA Property-3
- C0001779
- NCI Thesaurus ValueDomain
- C29848
- UMLS 2011AA ValueDomain
- C0439234
- NCI Thesaurus ValueDomain-2
- C25463
- UMLS 2011AA ValueDomain-2
- C0750480
Description
Household Smoking Section
Description
PersonHouseholdYearPassiveSmokeExposureInd-2
Data type
boolean
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C29848
- UMLS 2011AA Property
- C0439234
- NCI Thesaurus Property-2
- C41194
- UMLS 2011AA Property-2
- C0020052
- NCI Thesaurus Property-3
- C17140
- UMLS 2011AA Property-3
- C0037370
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Description
PersonHouseholdYearPassiveSmokeExposureYearCount
Data type
float
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C29848
- UMLS 2011AA Property
- C0439234
- NCI Thesaurus Property-2
- C41194
- UMLS 2011AA Property-2
- C0020052
- NCI Thesaurus Property-3
- C17140
- UMLS 2011AA Property-3
- C0037370
- NCI Thesaurus ValueDomain
- C29848
- UMLS 2011AA ValueDomain
- C0439234
- NCI Thesaurus ValueDomain-2
- C25463
- UMLS 2011AA ValueDomain-2
- C0750480
Description
PersonCurrentHouseholdCigarettePassiveSmokeExposureInd-2
Data type
boolean
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C25471
- UMLS 2011AA Property
- C0521116
- NCI Thesaurus Property-2
- C1802
- UMLS 2011AA Property-2
- C0677453
- NCI Thesaurus Property-3
- C41194
- UMLS 2011AA Property-3
- C0020052
- NCI Thesaurus Property-4
- C17140
- UMLS 2011AA Property-4
- C0037370
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Description
PersonCurrentHouseholdCigarettePassiveSmokeExposureDayCount
Data type
float
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C25471
- UMLS 2011AA Property
- C0521116
- NCI Thesaurus Property-2
- C1802
- UMLS 2011AA Property-2
- C0677453
- NCI Thesaurus Property-3
- C41194
- UMLS 2011AA Property-3
- C0020052
- NCI Thesaurus Property-4
- C17140
- UMLS 2011AA Property-4
- C0037370
- NCI Thesaurus ValueDomain
- C25301
- UMLS 2011AA ValueDomain
- C0439228
- NCI Thesaurus ValueDomain-2
- C25463
- UMLS 2011AA ValueDomain-2
- C0750480
Description
Second Hand Smoking Section
Description
PersonCurrentExternalHouseholdCigarettePassiveSmokeExposureInd-2
Data type
boolean
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C25471
- UMLS 2011AA Property
- C0521116
- NCI Thesaurus Property-2
- C1802
- UMLS 2011AA Property-2
- C0677453
- NCI Thesaurus Property-3
- C44280
- UMLS 2011AA Property-3
- C0205101
- NCI Thesaurus Property-4
- C41194
- UMLS 2011AA Property-4
- C0020052
- NCI Thesaurus Property-5
- C17140
- UMLS 2011AA Property-5
- C0037370
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Description
PersonCurrentExternalHouseholdCigaretteHourWeekPassiveSmokeExposureCount
Data type
float
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C25471
- UMLS 2011AA Property
- C0521116
- NCI Thesaurus Property-2
- C1802
- UMLS 2011AA Property-2
- C0677453
- NCI Thesaurus Property-3
- C44280
- UMLS 2011AA Property-3
- C0205101
- NCI Thesaurus Property-4
- C25529
- UMLS 2011AA Property-4
- C0439227
- NCI Thesaurus Property-5
- C29844
- UMLS 2011AA Property-5
- C0439230
- NCI Thesaurus Property-6
- C41194
- UMLS 2011AA Property-6
- C0020052
- NCI Thesaurus Property-7
- C17140
- UMLS 2011AA Property-7
- C0037370
- NCI Thesaurus ValueDomain
- C25463
- UMLS 2011AA ValueDomain
- C0750480
Description
Comments
Similar models
No Instruction available.
- StudyEvent: Gynecologic Oncology Group Smoking History Questionnaire (Form SHQ)
C1549507 (UMLS CUI-1)
C25250 (NCI Thesaurus Property)
C25604 (NCI Thesaurus Property-2)
C25164 (NCI Thesaurus ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
C0680532 (UMLS CUI-1)
C25250 (NCI Thesaurus Property)
C0011008 (UMLS CUI-2)
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C1547383 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C1301584 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25364 (NCI Thesaurus Property)
C25551 (NCI Thesaurus Property-2)
C1443235 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25364 (NCI Thesaurus Property)
C25509 (NCI Thesaurus Property-2)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1512288 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25521 (NCI Thesaurus Property-2)
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C25657 (NCI Thesaurus ObjectClass-2)
C1301584 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25551 (NCI Thesaurus Property-2)
C25191 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C17934 (NCI Thesaurus ObjectClass)
C0453996 (UMLS 2011AA ObjectClass)
C18772 (NCI Thesaurus Property)
C0262926 (UMLS 2011AA Property)
C1519384 (UMLS CUI-1)
C20989 (NCI Thesaurus Property)
C29719 (NCI Thesaurus ObjectClass)
C1298908 (UMLS 2011AA)
C0085134 (UMLS 2011AA ObjectClass)
C25340 (NCI Thesaurus Property)
C0457083 (UMLS 2011AA Property)
C17955 (NCI Thesaurus Property-2)
C0358855 (UMLS 2011AA Property-2)
C15663 (NCI Thesaurus Property-3)
C0068722 (UMLS 2011AA Property-3)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
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)
C0677453 (UMLS 2011AA ObjectClass)
C25473 (NCI Thesaurus Property)
C0332173 (UMLS 2011AA Property)
C37917 (NCI Thesaurus Property-2)
C1510992 (UMLS 2011AA Property-2)
C25340 (NCI Thesaurus Property-3)
C0457083 (UMLS 2011AA Property-3)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C0027361 (UMLS 2011AA ObjectClass)
C25471 (NCI Thesaurus Property)
C0521116 (UMLS 2011AA Property)
C1802 (NCI Thesaurus Property-2)
C0677453 (UMLS 2011AA Property-2)
C29844 (NCI Thesaurus Property-3)
C0439230 (UMLS 2011AA Property-3)
C29719 (NCI Thesaurus Property-4)
C1519384 (UMLS 2011AA Property-4)
C25340 (NCI Thesaurus Property-5)
C0457083 (UMLS 2011AA Property-5)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C0027361 (UMLS 2011AA ObjectClass)
C1802 (NCI Thesaurus Property)
C0677453 (UMLS 2011AA Property)
C17427 (NCI Thesaurus Property-2)
C0085134 (UMLS 2011AA Property-2)
C25150 (NCI Thesaurus Property-3)
C0001779 (UMLS 2011AA Property-3)
C29848 (NCI Thesaurus ValueDomain)
C0439234 (UMLS 2011AA ValueDomain)
C25463 (NCI Thesaurus ValueDomain-2)
C0750480 (UMLS 2011AA ValueDomain-2)
C0027361 (UMLS 2011AA ObjectClass)
C29848 (NCI Thesaurus Property)
C0439234 (UMLS 2011AA Property)
C41194 (NCI Thesaurus Property-2)
C0020052 (UMLS 2011AA Property-2)
C17140 (NCI Thesaurus Property-3)
C0037370 (UMLS 2011AA Property-3)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C0027361 (UMLS 2011AA ObjectClass)
C29848 (NCI Thesaurus Property)
C0439234 (UMLS 2011AA Property)
C41194 (NCI Thesaurus Property-2)
C0020052 (UMLS 2011AA Property-2)
C17140 (NCI Thesaurus Property-3)
C0037370 (UMLS 2011AA Property-3)
C29848 (NCI Thesaurus ValueDomain)
C0439234 (UMLS 2011AA ValueDomain)
C25463 (NCI Thesaurus ValueDomain-2)
C0750480 (UMLS 2011AA ValueDomain-2)
C0027361 (UMLS 2011AA ObjectClass)
C25471 (NCI Thesaurus Property)
C0521116 (UMLS 2011AA Property)
C1802 (NCI Thesaurus Property-2)
C0677453 (UMLS 2011AA Property-2)
C41194 (NCI Thesaurus Property-3)
C0020052 (UMLS 2011AA Property-3)
C17140 (NCI Thesaurus Property-4)
C0037370 (UMLS 2011AA Property-4)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C0027361 (UMLS 2011AA ObjectClass)
C25471 (NCI Thesaurus Property)
C0521116 (UMLS 2011AA Property)
C1802 (NCI Thesaurus Property-2)
C0677453 (UMLS 2011AA Property-2)
C41194 (NCI Thesaurus Property-3)
C0020052 (UMLS 2011AA Property-3)
C17140 (NCI Thesaurus Property-4)
C0037370 (UMLS 2011AA Property-4)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25463 (NCI Thesaurus ValueDomain-2)
C0750480 (UMLS 2011AA ValueDomain-2)
C0027361 (UMLS 2011AA ObjectClass)
C25471 (NCI Thesaurus Property)
C0521116 (UMLS 2011AA Property)
C1802 (NCI Thesaurus Property-2)
C0677453 (UMLS 2011AA Property-2)
C44280 (NCI Thesaurus Property-3)
C0205101 (UMLS 2011AA Property-3)
C41194 (NCI Thesaurus Property-4)
C0020052 (UMLS 2011AA Property-4)
C17140 (NCI Thesaurus Property-5)
C0037370 (UMLS 2011AA Property-5)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C0027361 (UMLS 2011AA ObjectClass)
C25471 (NCI Thesaurus Property)
C0521116 (UMLS 2011AA Property)
C1802 (NCI Thesaurus Property-2)
C0677453 (UMLS 2011AA Property-2)
C44280 (NCI Thesaurus Property-3)
C0205101 (UMLS 2011AA Property-3)
C25529 (NCI Thesaurus Property-4)
C0439227 (UMLS 2011AA Property-4)
C29844 (NCI Thesaurus Property-5)
C0439230 (UMLS 2011AA Property-5)
C41194 (NCI Thesaurus Property-6)
C0020052 (UMLS 2011AA Property-6)
C17140 (NCI Thesaurus Property-7)
C0037370 (UMLS 2011AA Property-7)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C0947611 (UMLS CUI-1)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)