ID
9124
Description
NSABP Protocol B-43 Worksheet for Menopausal Status Form Radiation Therapy With or Without Trastuzumab in Treating Women With Ductal Carcinoma In Situ Who Have Undergone Lumpectomy Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=39688272-F98B-5199-E044-0003BA3F9857
Link
Keywords
Versions (2)
- 8/27/12 8/27/12 -
- 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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Breast Cancer NCT00769379 Follow-Up - NSABP Protocol B-43 Worksheet for Menopausal Status Form - 2677537v1.0
No Instruction available.
- StudyEvent: NSABP Protocol B-43 Worksheet for Menopausal Status Form
Description
Menopausal Assessment
Description
Assessment Date
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C2985720
- NCI Thesaurus ObjectClass
- C25367
- NCI Thesaurus ValueDomain-2
- C25367
- NCI Thesaurus Property
- C38000
Description
LastMenstrualCycleOnsetDate
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ObjectClass
- C25551
- UMLS 2011AA ObjectClass
- C1517741
- NCI Metathesaurus ObjectClass
- C0025329
- NCI Thesaurus Property
- C25279
- UMLS 2011AA Property
- C0332162
Description
MenstrualPeriod12MonthsIndicator
Data type
boolean
Alias
- NCI Thesaurus ValueDomain
- C25180
- UMLS 2011AA ValueDomain
- C1522602
- NCI Metathesaurus ObjectClass
- C0025329
- NCI Metathesaurus Property
- C0814444
Description
HysterectomyPostClinicalStudyEnrollmentPerformedInd-2
Data type
boolean
Alias
- NCI Thesaurus ObjectClass
- C15256
- UMLS 2011AA ObjectClass
- C0020699
- NCI Thesaurus Property
- C38000
- UMLS 2011AA Property
- C0884358
- NCI Thesaurus Property-2
- C38008
- UMLS 2011AA Property-2
- C0687676
- NCI Thesaurus Property-3
- C15206
- UMLS 2011AA Property-3
- C0008972
- NCI Thesaurus Property-4
- C37948
- UMLS 2011AA Property-4
- C1516879
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Description
HysterectomyPerformedDate
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus Property
- C38000
- UMLS 2011AA Property
- C0884358
- NCI Thesaurus ObjectClass
- C15256
- UMLS 2011AA ObjectClass
- C0020699
Description
OvaryPresentInd-2
Data type
boolean
Alias
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
- NCI Thesaurus Property
- C25626
- UMLS 2011AA Property
- C0150312
- NCI Thesaurus ObjectClass
- C12404
- UMLS 2011AA ObjectClass
- C0029939
Description
OophorectomySecondOvaryPerformedDate
Data type
date
Alias
- NCI Thesaurus ObjectClass
- C15291
- UMLS 2011AA ObjectClass
- C0029936
- NCI Thesaurus Property
- C12404
- UMLS 2011AA Property
- C0029939
- NCI Thesaurus Property-2
- C38000
- UMLS 2011AA Property-2
- C0884358
- NCI Thesaurus Property-3
- C25666
- UMLS 2011AA Property-3
- C0205436
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Description
TamoxifenAgentPostClinicalStudyEnrollmentAdministeredInd-2
Data type
boolean
Alias
- NCI Thesaurus ObjectClass
- C855
- UMLS 2011AA ObjectClass
- C0039286
- NCI Thesaurus ObjectClass-2
- C1708
- UMLS 2011AA ObjectClass-2
- C0450442
- NCI Thesaurus Property
- C38008
- UMLS 2011AA Property
- C0687676
- NCI Thesaurus Property-2
- C15206
- UMLS 2011AA Property-2
- C0008972
- NCI Thesaurus Property-3
- C25382
- UMLS 2011AA Property-3
- C1521801
- NCI Thesaurus Property-4
- C37948
- UMLS 2011AA Property-4
- C1516879
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Description
TamoxifenTreatmentBeginDate
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ObjectClass
- C855
- UMLS 2011AA ObjectClass
- C0039286
- NCI Thesaurus Property
- C15368
Description
TamoxifenAgentPostClinicalStudyEnrollmentAdministeredMostRecentDate
Data type
date
Alias
- NCI Thesaurus ObjectClass
- C855
- UMLS 2011AA ObjectClass
- C0039286
- NCI Thesaurus ObjectClass-2
- C1708
- UMLS 2011AA ObjectClass-2
- C0450442
- NCI Thesaurus Property
- C38008
- UMLS 2011AA Property
- C0687676
- NCI Thesaurus Property-2
- C15206
- UMLS 2011AA Property-2
- C0008972
- NCI Thesaurus Property-3
- C25382
- UMLS 2011AA Property-3
- C1521801
- NCI Thesaurus Property-4
- C37948
- UMLS 2011AA Property-4
- C1516879
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ValueDomain-2
- C25577
- UMLS 2011AA ValueDomain-2
- C1513491
Description
AromataseInhibitorAgentPostClinicalStudyEnrollmentAdministeredInd-2
Data type
boolean
Alias
- NCI Thesaurus ObjectClass
- C1740
- UMLS 2011AA ObjectClass
- C0593802
- NCI Thesaurus ObjectClass-2
- C1708
- UMLS 2011AA ObjectClass-2
- C0450442
- NCI Thesaurus Property
- C38008
- UMLS 2011AA Property
- C0687676
- NCI Thesaurus Property-2
- C15206
- UMLS 2011AA Property-2
- C0008972
- NCI Thesaurus Property-3
- C25382
- UMLS 2011AA Property-3
- C1521801
- NCI Thesaurus Property-4
- C37948
- UMLS 2011AA Property-4
- C1516879
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Description
AromataseInhibitorHormoneTherapyAdministeredBeginDate
Data type
date
Alias
- NCI Thesaurus ObjectClass
- C15445
- UMLS 2011AA ObjectClass
- C0279025
- NCI Thesaurus ObjectClass-2
- C1740
- UMLS 2011AA ObjectClass-2
- C0593802
- NCI Thesaurus Property
- C25382
- UMLS 2011AA Property
- C1521801
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ValueDomain-2
- C25431
- UMLS 2011AA ValueDomain-2
- C0439659
Description
AromataseInhibitorAgentPostClinicalStudyEnrollmentAdministeredMostRecentDate
Data type
date
Alias
- NCI Thesaurus ObjectClass
- C1740
- UMLS 2011AA ObjectClass
- C0593802
- NCI Thesaurus ObjectClass-2
- C1708
- UMLS 2011AA ObjectClass-2
- C0450442
- NCI Thesaurus Property
- C38008
- UMLS 2011AA Property
- C0687676
- NCI Thesaurus Property-2
- C15206
- UMLS 2011AA Property-2
- C0008972
- NCI Thesaurus Property-3
- C25382
- UMLS 2011AA Property-3
- C1521801
- NCI Thesaurus Property-4
- C37948
- UMLS 2011AA Property-4
- C1516879
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ValueDomain-2
- C25577
- UMLS 2011AA ValueDomain-2
- C1513491
Description
HormoneTherapyLuteinizingHormone-releasingHormoneAgonistPostClinicalStudyEnrollmentAdministeredInd-2
Data type
boolean
Alias
- NCI Thesaurus ObjectClass
- C15445
- UMLS 2011AA ObjectClass
- C0279025
- NCI Thesaurus Property
- C38008
- UMLS 2011AA Property
- C0687676
- NCI Thesaurus Property-2
- C15206
- UMLS 2011AA Property-2
- C0008972
- NCI Thesaurus Property-3
- C25382
- UMLS 2011AA Property-3
- C1521801
- NCI Thesaurus Property-4
- C37948
- UMLS 2011AA Property-4
- C1516879
- NCI Thesaurus Property-5
- C1910
- UMLS 2011AA Property-5
- C1518041
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Description
HormoneTherapyLuteinizingHormone-releasingHormoneAgonistAdministrationBeginDate
Data type
date
Alias
- NCI Thesaurus ObjectClass
- C15445
- UMLS 2011AA ObjectClass
- C0279025
- NCI Thesaurus Property
- C25409
- UMLS 2011AA Property
- C1533734
- NCI Thesaurus Property-2
- C1910
- UMLS 2011AA Property-2
- C1518041
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ValueDomain-2
- C25431
- UMLS 2011AA ValueDomain-2
- C0439659
Description
GonadotrophinReleasingHormoneAgentPostClinicalStudyEnrollmentAdministeredMostRecentDate
Data type
date
Alias
- NCI Thesaurus ObjectClass
- C15445
- UMLS 2011AA ObjectClass
- C0279025
- NCI Thesaurus Property
- C38008
- UMLS 2011AA Property
- C0687676
- NCI Thesaurus Property-2
- C15206
- UMLS 2011AA Property-2
- C0008972
- NCI Thesaurus Property-3
- C25382
- UMLS 2011AA Property-3
- C1521801
- NCI Thesaurus Property-4
- C37948
- UMLS 2011AA Property-4
- C1516879
- NCI Thesaurus Property-5
- C1910
- UMLS 2011AA Property-5
- C1518041
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ValueDomain-2
- C25577
- UMLS 2011AA ValueDomain-2
- C1513491
Description
PersonPriorYearPregnancyInd-2
Data type
boolean
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C25629
- UMLS 2011AA Property
- C0332152
- NCI Thesaurus Property-2
- C29848
- UMLS 2011AA Property-2
- C0439234
- NCI Thesaurus Property-3
- C25742
- UMLS 2011AA Property-3
- C0032961
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Description
Comments
Description
Footer
Description
Person Completing Form
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS CUI-1
- C1550483
- NCI Thesaurus ObjectClass
- C25657
- NCI Thesaurus Property
- C25364
Description
Date Form Completed
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C1115437
- NCI Thesaurus ObjectClass
- C40988
- NCI Thesaurus Property
- C25250
- NCI Thesaurus ValueDomain-2
- C25367
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No Instruction available.
- StudyEvent: NSABP Protocol B-43 Worksheet for Menopausal Status Form
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1513905 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
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C0011008 (UMLS 2011AA ValueDomain)
C0039286 (UMLS 2011AA ObjectClass)
C1708 (NCI Thesaurus ObjectClass-2)
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C38008 (NCI Thesaurus Property)
C0687676 (UMLS 2011AA Property)
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C0008972 (UMLS 2011AA Property-2)
C25382 (NCI Thesaurus Property-3)
C1521801 (UMLS 2011AA Property-3)
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C1512698 (UMLS 2011AA ValueDomain)
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C0039286 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus Property)
C0039286 (UMLS 2011AA ObjectClass)
C1708 (NCI Thesaurus ObjectClass-2)
C0450442 (UMLS 2011AA ObjectClass-2)
C38008 (NCI Thesaurus Property)
C0687676 (UMLS 2011AA Property)
C15206 (NCI Thesaurus Property-2)
C0008972 (UMLS 2011AA Property-2)
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C0687676 (UMLS 2011AA Property)
C15206 (NCI Thesaurus Property-2)
C0008972 (UMLS 2011AA Property-2)
C25382 (NCI Thesaurus Property-3)
C1521801 (UMLS 2011AA Property-3)
C37948 (NCI Thesaurus Property-4)
C1516879 (UMLS 2011AA Property-4)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C0279025 (UMLS 2011AA ObjectClass)
C1740 (NCI Thesaurus ObjectClass-2)
C0593802 (UMLS 2011AA ObjectClass-2)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25431 (NCI Thesaurus ValueDomain-2)
C0439659 (UMLS 2011AA ValueDomain-2)
C0593802 (UMLS 2011AA ObjectClass)
C1708 (NCI Thesaurus ObjectClass-2)
C0450442 (UMLS 2011AA ObjectClass-2)
C38008 (NCI Thesaurus Property)
C0687676 (UMLS 2011AA Property)
C15206 (NCI Thesaurus Property-2)
C0008972 (UMLS 2011AA Property-2)
C25382 (NCI Thesaurus Property-3)
C1521801 (UMLS 2011AA Property-3)
C37948 (NCI Thesaurus Property-4)
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C0011008 (UMLS 2011AA ValueDomain)
C25577 (NCI Thesaurus ValueDomain-2)
C1513491 (UMLS 2011AA ValueDomain-2)
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C38008 (NCI Thesaurus Property)
C0687676 (UMLS 2011AA Property)
C15206 (NCI Thesaurus Property-2)
C0008972 (UMLS 2011AA Property-2)
C25382 (NCI Thesaurus Property-3)
C1521801 (UMLS 2011AA Property-3)
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C1910 (NCI Thesaurus Property-2)
C1518041 (UMLS 2011AA Property-2)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25431 (NCI Thesaurus ValueDomain-2)
C0439659 (UMLS 2011AA ValueDomain-2)
C0279025 (UMLS 2011AA ObjectClass)
C38008 (NCI Thesaurus Property)
C0687676 (UMLS 2011AA Property)
C15206 (NCI Thesaurus Property-2)
C0008972 (UMLS 2011AA Property-2)
C25382 (NCI Thesaurus Property-3)
C1521801 (UMLS 2011AA Property-3)
C37948 (NCI Thesaurus Property-4)
C1516879 (UMLS 2011AA Property-4)
C1910 (NCI Thesaurus Property-5)
C1518041 (UMLS 2011AA Property-5)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25577 (NCI Thesaurus ValueDomain-2)
C1513491 (UMLS 2011AA ValueDomain-2)
C0027361 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus Property)
C0332152 (UMLS 2011AA Property)
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