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

Lien

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B122D931-FF39-4DDE-E034-0003BA12F5E7

Mots-clés

  1. 19/09/2012 19/09/2012 -
  2. 09/01/2015 09/01/2015 - Martin Dugas
Téléchargé le

9 janvier 2015

DOI

Pour une demande vous connecter.

Licence

Creative Commons BY-NC 3.0 Legacy

Modèle Commentaires :

Ici, vous pouvez faire des commentaires sur le modèle. À partir des bulles de texte, vous pouvez laisser des commentaires spécifiques sur les groupes Item et les Item.

Groupe Item commentaires pour :

Item commentaires pour :

Vous devez être connecté pour pouvoir télécharger des formulaires. Veuillez vous connecter ou s’inscrire gratuitement.

Melanoma (Skin) null Follow-Up - Recurrence Information (RI) - 2074747v3.0

NOTE: Submit reports to document the above indicated recurrence. Use appropriate Shuttle CRFs.

Ccrr Module For Recurrence Information (ri)
Description

Ccrr Module For Recurrence Information (ri)

Patient ID (Pt. ID issued during registration or previously issued patient ID)
Description

Pt.ID

Type de données

text

Institution ID:
Description

InstitutionNo.

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
Patient Initials: (F ML)
Description

Patient Initials

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986440
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25536
Institution:
Description

InstitutionName

Type de données

text

Date of Assessment: (Year Month Day)
Description

AssessmentDate

Type de données

date

Has the patient had an initial recurrence of this cancer that has not been previously reported?
Description

Hasthepatienthadaninitialrecurrenceofthiscancerthathasnotbeenpreviouslyreported?

Type de données

text

Date of Recurrence: (Year Month Day)
Description

PriorRecentRecurrenceDate

Type de données

date

Alias
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus Property
C25279
UMLS 2011AA Property
C0332162
Completed by:
Description

CompletedBy

Type de données

text

Date: (Year Month Day)
Description

FormCompletionDate,Original

Type de données

date

Notice of Initial Recurrence
Description

NoticeofInitialRecurrence

Type de données

text

Similar models

NOTE: Submit reports to document the above indicated recurrence. Use appropriate Shuttle CRFs.

Name
Type
Description | Question | Decode (Coded Value)
Type de données
Alias
Item Group
Ccrr Module For Recurrence Information (ri)
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)
Patient Initials
Item
Patient Initials: (F ML)
text
C25191 (NCI Thesaurus ValueDomain)
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)
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)
CompletedBy
Item
Completed by:
text
FormCompletionDate,Original
Item
Date: (Year Month Day)
date
NoticeofInitialRecurrence
Item
Notice of Initial Recurrence
text

Utilisez ce formulaire pour les retours, les questions et les améliorations suggérées.

Les champs marqués d’un * sont obligatoires.

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial