ID

9233

Descripción

Southwest Oncology Group Quality of Life Cover Sheet Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A4CF40B1-65D3-2947-E034-080020C9C0E0

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A4CF40B1-65D3-2947-E034-080020C9C0E0

Palabras clave

Versiones (3)
  1. 19/9/12 19/9/12 -
  2. 9/1/15 9/1/15 - Martin Dugas
  3. 3/7/15 3/7/15 -
Subido en

9 de enero de 2015

DOI

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Licencia

Creative Commons BY-NC 3.0 Legacy
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Lung Cancer null Quality of Life - Southwest Oncology Group Quality of Life Cover Sheet - 2037591v3.0

Inglés

No Instruction available.

1 formularios  
  1. StudyEvent: Southwest Oncology Group Quality of Life Cover Sheet
    1. No Instruction available.
Unnamed 1
Descripción

Unnamed 1

SWOG Patient ID
Descripción

SWOGPatientID

Tipo de datos

text

SWOG Study No.
Descripción

SWOGStudyNo.

Tipo de datos

text

Registration Step
Descripción

RegistrationStep

Tipo de datos

text

Assessment
Descripción

Assessment

Tipo de datos

text

Patient Initials (L, F M)
Descripción

Patient Initials

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986440
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25536
Institution/Affiliate
Descripción

MainMemberInstitution/Affiliate

Tipo de datos

text

Physician
Descripción

RegisteredInvestigator

Tipo de datos

text

Unnamed 2
Descripción

Unnamed 2

Amended Data
Descripción

AmendedDataInd

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C25474
UMLS 2011AA ObjectClass
C1511726
NCI Thesaurus Property
C25416
UMLS 2011AA Property
C1691222
Unnamed 3
Descripción

Unnamed 3

Was the Medical Conditions Questionnaire completed (Prestudy Only)?
Descripción

WastheMedicalConditionsQuestionnairecompleted(PrestudyOnly)?

Tipo de datos

boolean

Was the FACT-L TOI completed?
Descripción

WastheFACT-LTOIcompleted?

Tipo de datos

boolean

Date
Descripción

Date

Tipo de datos

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
Date
Descripción

Date

Tipo de datos

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
If completed, in general, did the patient require assistance?
Descripción

Ifcompleted,ingeneral,didthepatientrequireassistance?

Tipo de datos

boolean

If Yes, describe
Descripción

IfYes,describe

Tipo de datos

text

If completed, questionnaire(s) administered
Descripción

Ifcompleted,questionnaire(s)administered

Tipo de datos

text

Other (please specify)
Descripción

Other(pleasespecify)

Tipo de datos

text

If Not Completed, please give reason (select one)
Descripción

Incomplete documentation, reason

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25638
UMLS CUI-1
C1548386
NCI Thesaurus ObjectClass
C16960
UMLS CUI-2
C0566251
NCI Metathesaurus Property
C0034394
Unnamed 4
Descripción

Unnamed 4

By
Descripción

By

Tipo de datos

text

Phone
Descripción

Phone

Tipo de datos

text

Notes
Descripción

Notes

Notes
Descripción

Comments

Tipo de datos

text

Ccrr Module For Southwest Oncology Group Quality Of Life Cover Sheet
Descripción

Ccrr Module For Southwest Oncology Group Quality Of Life Cover Sheet

Volver a la parte superior de la página

Similar models

No Instruction available.

1 formularios
  1. StudyEvent: Southwest Oncology Group Quality of Life Cover Sheet
    1. No Instruction available.
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
Unnamed 1
SWOGPatientID
Item
SWOG Patient ID
text
SWOGStudyNo.
Item
SWOG Study No.
text
RegistrationStep
Item
Registration Step
text
Item
Assessment
text
CL.1
Code List
Assessment
CL Item
Prestudy (Prestudy)
CL Item
Week 7 (Week 7)
CL Item
Week 13 (Week 13)
Patient Initials
Item
Patient Initials (L, F M)
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
MainMemberInstitution/Affiliate
Item
Institution/Affiliate
text
RegisteredInvestigator
Item
Physician
text
Item Group
Unnamed 2
Item
Amended Data
text
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
CL.2
Code List
Amended Data
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item Group
Unnamed 3
WastheMedicalConditionsQuestionnairecompleted(PrestudyOnly)?
Item
Was the Medical Conditions Questionnaire completed (Prestudy Only)?
boolean
WastheFACT-LTOIcompleted?
Item
Was the FACT-L TOI completed?
boolean
Date
Item
Date
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
Date
Item
Date
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
Ifcompleted,ingeneral,didthepatientrequireassistance?
Item
If completed, in general, did the patient require assistance?
boolean
IfYes,describe
Item
If Yes, describe
text
Item
If completed, questionnaire(s) administered
text
CL.6
Code List
If completed, questionnaire(s) administered
CL Item
In The Clinic (In the clinic)
CL Item
By Telephone (By telephone)
CL Item
Other (please Specify) (Other (please specify))
Other(pleasespecify)
Item
Other (please specify)
text
Item
If Not Completed, please give reason (select one)
text
C25638 (NCI Thesaurus ValueDomain)
C1548386 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C0566251 (UMLS CUI-2)
C0034394 (NCI Metathesaurus Property)
CL.7
Code List
If Not Completed, please give reason (select one)
CL Item
Illness/deteriorating Health (Illness/deteriorating health)
CL Item
Not Illness Related (Not illness related)
CL Item
Institution Error (Institution error)
CL Item
Death (Death)
C28554 (NCI Thesaurus)
C0011065 (UMLS 2011AA)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
Item Group
Unnamed 4
By
Item
By
text
Phone
Item
Phone
text
Item Group
Notes
Comments
Item
Notes
text
Item Group
Ccrr Module For Southwest Oncology Group Quality Of Life Cover Sheet
Volver a la parte superior de la página 

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