Information:
Error:
ID
9215
Description
Recurrence Information (RI) Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B122D931-FF39-4DDE-E034-0003BA12F5E7
Link
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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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Melanoma (Skin) null Follow-Up - Recurrence Information (RI) - 2074747v3.0
NOTE: Submit reports to document the above indicated recurrence. Use appropriate Shuttle CRFs.
- StudyEvent: Recurrence Information (RI)
Similar models
NOTE: Submit reports to document the above indicated recurrence. Use appropriate Shuttle CRFs.
- StudyEvent: Recurrence Information (RI)
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Pt.ID
Item
Patient ID (Pt. ID issued during registration or previously issued patient ID)
text
InstitutionNo.
Item
Institution ID:
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
Patient Initials
Item
Patient Initials: (F ML)
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
InstitutionName
Item
Institution:
text
AssessmentDate
Item
Date of Assessment: (Year Month Day)
date
Item
Has the patient had an initial recurrence of this cancer that has not been previously reported?
text
Code List
Has the patient had an initial recurrence of this cancer that has not been previously reported?
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
CL Item
Notice Of Initial Recurrence (Notice of Initial Recurrence)
CL Item
Type Of Recurrence(s): (Type of Recurrence(s):)
CL Item
Local: (Local:)
CL Item
Intransit: (Intransit:)
CL Item
Regional/nodal (Regional/Nodal)
CL Item
Distant: (Distant:)
PriorRecentRecurrenceDate
Item
Date of Recurrence: (Year Month Day)
date
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C25279 (NCI Thesaurus Property)
C0332162 (UMLS 2011AA Property)
C0012634 (UMLS 2011AA ObjectClass)
C25279 (NCI Thesaurus Property)
C0332162 (UMLS 2011AA Property)
CompletedBy
Item
Completed by:
text
FormCompletionDate,Original
Item
Date: (Year Month Day)
date
NoticeofInitialRecurrence
Item
Notice of Initial Recurrence
text