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
PatientEndFollow-upDate
Item
Date of Study Completion or Early Follow-up Terminiation (Year Month Day)
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C16033 (NCI Thesaurus Property)
C1522577 (UMLS 2011AA Property)
C25496 (NCI Thesaurus Property-2)
C2746065 (UMLS 2011AA Property-2)
Follow-UpPatientCompleteStudyInd-2
Item
Did the Patient complete the study per protocol
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C16033 (NCI Thesaurus Property)
C1522577 (UMLS 2011AA Property)
C25496 (NCI Thesaurus Property-2)
C2746065 (UMLS 2011AA Property-2)
Item
Reason for early termination of patient follow-up (mark x only one:)
text
C25638 (NCI Thesaurus ValueDomain)
C0392360 (UMLS 2011AA ValueDomain)
C19712 (NCI Thesaurus Property)
C1515944 (UMLS 2011AA Property)
C25601 (NCI Thesaurus ObjectClass)
C1518544 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property-2)
C0678257 (UMLS 2011AA Property-2)
Code List
Reason for early termination of patient follow-up (mark x only one:)
CL Item
Adverse Event (Adverse event, specify)
C41331 (NCI Thesaurus)
C0877248 (UMLS 2011AA)
CL Item
Patient Follow-up Terminated For Other Complicating Disease. (Patient follow-up terminated for other complicating disease.)
CL Item
Patient Withdrew Consent. (Patient withdrew consent.)
CL Item
Patient Declared Ineligible (Patient declared ineligible, specify)
CL Item
Death (Death)
C28554 (NCI Thesaurus)
C0011065 (UMLS 2011AA)
CL Item
Other (Other, specify)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
Adverseevent,
Item
Adverse event, (specify)
text
Patientdeclaredineligible
Item
Patient declared ineligible (specify)
text
Other,
Item
Other, (specify)
text
Off-TreatmentACOSOGDescriptionNumber
Item
Early follow-up termination authorization number:
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C19712 (NCI Thesaurus Property)
C1515944 (UMLS 2011AA Property)
C25601 (NCI Thesaurus ObjectClass)
C1518544 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property-2)
C0678257 (UMLS 2011AA Property-2)
CompletedBy
Item
Completed by:
text
FormCompletionDate,Original
Item
Date:
date
YearMonthDay
Item
Year Month Day
text