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ID

9219

Beskrivning

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

Länk

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

Nyckelord

  1. 2012-09-19 2012-09-19 -
  2. 2015-01-09 2015-01-09 - Martin Dugas
Uppladdad den

9 januari 2015

DOI

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Licens

Creative Commons BY-NC 3.0 Legacy

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    Melanoma (Skin) null Follow-Up - Termination of Patient Follow-up (TPFU) - 2074808v3.0

    No Instruction available.

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

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

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

    Pt.ID

    Datatyp

    text

    Institution ID:
    Beskrivning

    InstitutionNo.

    Datatyp

    text

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

    Patient Initials

    Datatyp

    text

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

    InstitutionName

    Datatyp

    text

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

    PatientEndFollow-upDate

    Datatyp

    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
    Beskrivning

    Follow-UpPatientCompleteStudyInd-2

    Datatyp

    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:)
    Beskrivning

    Off-TreatmentACOSOGReason

    Datatyp

    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)
    Beskrivning

    Adverseevent,

    Datatyp

    text

    Patient declared ineligible (specify)
    Beskrivning

    Patientdeclaredineligible

    Datatyp

    text

    Other, (specify)
    Beskrivning

    Other,

    Datatyp

    text

    Early follow-up termination authorization number:
    Beskrivning

    Off-TreatmentACOSOGDescriptionNumber

    Datatyp

    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:
    Beskrivning

    CompletedBy

    Datatyp

    text

    Date:
    Beskrivning

    FormCompletionDate,Original

    Datatyp

    date

    Year Month Day
    Beskrivning

    YearMonthDay

    Datatyp

    text

    Similar models

    No Instruction available.

    1. StudyEvent: Termination of Patient Follow-up (TPFU)
      1. No Instruction available.
    Name
    Typ
    Description | Question | Decode (Coded Value)
    Datatyp
    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)
    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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