ID

9215

Beschrijving

Recurrence Information (RI) Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B122D931-FF39-4DDE-E034-0003BA12F5E7

Link

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

Trefwoorden

  1. 19-09-12 19-09-12 -
  2. 09-01-15 09-01-15 - Martin Dugas
Geüploaded op

9 januari 2015

DOI

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Licentie

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.

Ccrr Module For Recurrence Information (ri)
Beschrijving

Ccrr Module For Recurrence Information (ri)

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

Pt.ID

Datatype

text

Institution ID:
Beschrijving

InstitutionNo.

Datatype

text

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

Patient Initials

Datatype

text

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

InstitutionName

Datatype

text

Date of Assessment: (Year Month Day)
Beschrijving

AssessmentDate

Datatype

date

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

Hasthepatienthadaninitialrecurrenceofthiscancerthathasnotbeenpreviouslyreported?

Datatype

text

Date of Recurrence: (Year Month Day)
Beschrijving

PriorRecentRecurrenceDate

Datatype

date

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

CompletedBy

Datatype

text

Date: (Year Month Day)
Beschrijving

FormCompletionDate,Original

Datatype

date

Notice of Initial Recurrence
Beschrijving

NoticeofInitialRecurrence

Datatype

text

Similar models

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

Name
Type
Description | Question | Decode (Coded Value)
Datatype
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

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