ID

9219

Descrição

Termination of Patient Follow-up (TPFU) Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B1243BAC-D9BC-4E9B-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B1243BAC-D9BC-4E9B-E034-0003BA12F5E7

Palavras-chave

Versões (2)
  1. 19/09/2012 19/09/2012 -
  2. 09/01/2015 09/01/2015 - Martin Dugas
Transferido a

9 de janeiro de 2015

DOI

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Licença

Creative Commons BY-NC 3.0 Legacy
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Melanoma (Skin) null Follow-Up - Termination of Patient Follow-up (TPFU) - 2074808v3.0

Inglês

No Instruction available.

1 Formulários  
  1. StudyEvent: Termination of Patient Follow-up (TPFU)
    1. No Instruction available.
Ccrr Module For Termination Of Patient Follow-up (tpfu)
Descrição

Ccrr Module For Termination Of Patient Follow-up (tpfu)

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

Pt.ID

Tipo de dados

text

Institution ID:
Descrição

InstitutionNo.

Tipo de dados

text

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

Patient Initials

Tipo de dados

text

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

InstitutionName

Tipo de dados

text

Date of Study Completion or Early Follow-up Terminiation (Year Month Day)
Descrição

PatientEndFollow-upDate

Tipo de dados

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C16033
UMLS 2011AA Property
C1522577
NCI Thesaurus Property-2
C25496
UMLS 2011AA Property-2
C2746065
Did the Patient complete the study per protocol
Descrição

Follow-UpPatientCompleteStudyInd-2

Tipo de dados

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C16033
UMLS 2011AA Property
C1522577
NCI Thesaurus Property-2
C25496
UMLS 2011AA Property-2
C2746065
Reason for early termination of patient follow-up (mark x only one:)
Descrição

Off-TreatmentACOSOGReason

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25638
UMLS 2011AA ValueDomain
C0392360
NCI Thesaurus Property
C19712
UMLS 2011AA Property
C1515944
NCI Thesaurus ObjectClass
C25601
UMLS 2011AA ObjectClass
C1518544
NCI Thesaurus Property-2
C25365
UMLS 2011AA Property-2
C0678257
Adverse event, (specify)
Descrição

Adverseevent,

Tipo de dados

text

Patient declared ineligible (specify)
Descrição

Patientdeclaredineligible

Tipo de dados

text

Other, (specify)
Descrição

Other,

Tipo de dados

text

Early follow-up termination authorization number:
Descrição

Off-TreatmentACOSOGDescriptionNumber

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus Property
C19712
UMLS 2011AA Property
C1515944
NCI Thesaurus ObjectClass
C25601
UMLS 2011AA ObjectClass
C1518544
NCI Thesaurus Property-2
C25365
UMLS 2011AA Property-2
C0678257
Completed by:
Descrição

CompletedBy

Tipo de dados

text

Date:
Descrição

FormCompletionDate,Original

Tipo de dados

date

Year Month Day
Descrição

YearMonthDay

Tipo de dados

text

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Similar models

No Instruction available.

1 Formulários
  1. StudyEvent: Termination of Patient Follow-up (TPFU)
    1. No Instruction available.
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de dados
Alias
Item Group
Ccrr Module For Termination Of Patient Follow-up (tpfu)
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)
CL.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
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