ID
9200
Description
CALGB: 10201 PERIPHERAL BLOOD AND BONE MARROW REPORT FORM Daunorubicin and Cytarabine With or Without Oblimersen in Treating Older Patients With Previously Untreated Acute Myeloid Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AD85FF2B-39F3-35D3-E034-0003BA12F5E7
Link
Keywords
Versions (2)
- 9/19/12 9/19/12 -
- 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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Leukemia NCT00085124 Lab - CALGB: 10201 PERIPHERAL BLOOD AND BONE MARROW REPORT FORM - 2031273v3.0
Instructions: Complete and submit thie form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice. Print text in capital letters. Avoid contact with the edges of the boxes. Cirlce amended items and check "Amended data" box to teh right. If submitting by mail, retain a copy for your records and send the original form for mazimum clarity in transmission and fax to 919-416-4990. If submistting electronically, click the Send button when you have completed the PDF version of the form.
Description
Bone Marrow
Description
Bone Marrow Differential
Description
BoneMarrow,Promyelocytes,CellPercentage
Data type
float
Description
BoneMarrow,Blasts,CellPercentage
Data type
float
Description
BoneMarrow,Lymphocytes,CellPercentage
Data type
float
Description
MarrowMonocytes(%)
Data type
text
Description
MarrowMonoblasts(%)
Data type
text
Description
BoneMarrow,Eosinophils,CellPercentage
Data type
float
Description
BoneMarrow,Basophils,CellPercentage
Data type
float
Description
LaboratoryProcedureErythroidCellBoneMarrowResultPercentageValue
Data type
float
Alias
- NCI Thesaurus ObjectClass
- C25294
- UMLS 2011AA ObjectClass
- C0022885
- NCI Thesaurus Property
- C12431
- UMLS 2011AA Property
- C0005953
- NCI Thesaurus Property-2
- C20200
- UMLS 2011AA Property-2
- C1274040
- NCI Thesaurus Property-3
- C12508
- UMLS 2011AA Property-3
- C0007634
- NCI Thesaurus Property-4
- C13805
- UMLS 2011AA Property-4
- C1516960
- NCI Thesaurus ValueDomain
- C25613
- UMLS 2011AA ValueDomain
- C0439165
- NCI Thesaurus ValueDomain-2
- C25712
- UMLS 2011AA ValueDomain-2
- C1522609
Description
MarrowPlasmaCells(%)
Data type
text
Description
MegakaryocyteStatus
Data type
text
Description
%Marrowneutrophils
Data type
text
Description
%MarrowMetamyeocytesandMarrowMyelocytes
Data type
text
Description
Peripheral Blood Differential
Description
Lab,Hematology,SampleCollectionDate
Data type
date
Description
Lab,Hematology,Hemoglobin
Data type
float
Description
Lab,Hematology,Platelets
Data type
float
Description
Lab,Hematology,WBC
Data type
float
Description
Lab,Hematology,Neutrophils,CellPercentage
Data type
float
Description
PeripheralMetamyelocytesandMyelocytes(%)
Data type
text
Description
Lab,Hematology,Promyelocytes,CellPercentage
Data type
float
Description
Lab,Hematology,Blasts,CellPercentage
Data type
float
Description
Lab,Hematology,Lymphocytes,CellPercentage
Data type
float
Description
Lab,Hematology,Monocytes,CellPercentage
Data type
float
Description
PeripheralMonoblasts(%)
Data type
text
Description
Lab,Hematology,Eosinophils,CellPercentage
Data type
float
Description
Lab,Hematology,Basophils,CellPercentage
Data type
float
Description
Degree Of Dyspoiesis Present
Description
MyelopoiesisPresentRate
Data type
text
Alias
- NCI Thesaurus Property
- C25626
- UMLS 2011AA Property
- C0150312
- NCI Thesaurus ObjectClass
- C21143
- UMLS 2011AA ObjectClass
- C0525006
- NCI Thesaurus ValueDomain
- C25636
- UMLS 2011AA ValueDomain
- C1521828
Description
Erythropoiesis
Data type
text
Description
Megakaryopoiesis
Data type
text
Description
CompletedBy
Data type
text
Description
DateCompleted
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Description
Ccrr Module For Calgb: 10201 Peripheral Blood And Bone Marrow Report Form
Similar models
Instructions: Complete and submit thie form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice. Print text in capital letters. Avoid contact with the edges of the boxes. Cirlce amended items and check "Amended data" box to teh right. If submitting by mail, retain a copy for your records and send the original form for mazimum clarity in transmission and fax to 919-416-4990. If submistting electronically, click the Send button when you have completed the PDF version of the form.
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
C1705108 (UMLS 2011AA)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C0022885 (UMLS 2011AA ObjectClass)
C12431 (NCI Thesaurus Property)
C0005953 (UMLS 2011AA Property)
C20200 (NCI Thesaurus Property-2)
C1274040 (UMLS 2011AA Property-2)
C12508 (NCI Thesaurus Property-3)
C0007634 (UMLS 2011AA Property-3)
C13805 (NCI Thesaurus Property-4)
C1516960 (UMLS 2011AA Property-4)
C25613 (NCI Thesaurus ValueDomain)
C0439165 (UMLS 2011AA ValueDomain)
C25712 (NCI Thesaurus ValueDomain-2)
C1522609 (UMLS 2011AA ValueDomain-2)
C0549184 (UMLS 2011AA)
C0205307 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C0150312 (UMLS 2011AA Property)
C21143 (NCI Thesaurus ObjectClass)
C0525006 (UMLS 2011AA ObjectClass)
C25636 (NCI Thesaurus ValueDomain)
C1521828 (UMLS 2011AA ValueDomain)
C1706089 (UMLS 2011AA)
C1706089 (UMLS 2011AA)
C1706089 (UMLS 2011AA)
C0011008 (UMLS 2011AA ValueDomain)