ID

9233

Descrizione

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

collegamento

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

Keywords

versioni (3)
  1. 19/09/12 19/09/12 -
  2. 09/01/15 09/01/15 - Martin Dugas
  3. 03/07/15 03/07/15 -
Caricato su

9 gennaio 2015

DOI

Per favore, per richiedere un accesso.

Licenza

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

Inglese

No Instruction available.

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

Unnamed 1

SWOG Patient ID
Descrizione

SWOGPatientID

Tipo di dati

text

SWOG Study No.
Descrizione

SWOGStudyNo.

Tipo di dati

text

Registration Step
Descrizione

RegistrationStep

Tipo di dati

text

Assessment
Descrizione

Assessment

Tipo di dati

text

Patient Initials (L, F M)
Descrizione

Patient Initials

Tipo di dati

text

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

MainMemberInstitution/Affiliate

Tipo di dati

text

Physician
Descrizione

RegisteredInvestigator

Tipo di dati

text

Unnamed 2
Descrizione

Unnamed 2

Amended Data
Descrizione

AmendedDataInd

Tipo di dati

text

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

Unnamed 3

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

WastheMedicalConditionsQuestionnairecompleted(PrestudyOnly)?

Tipo di dati

boolean

Was the FACT-L TOI completed?
Descrizione

WastheFACT-LTOIcompleted?

Tipo di dati

boolean

Date
Descrizione

Date

Tipo di dati

date

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

Date

Tipo di dati

date

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

Ifcompleted,ingeneral,didthepatientrequireassistance?

Tipo di dati

boolean

If Yes, describe
Descrizione

IfYes,describe

Tipo di dati

text

If completed, questionnaire(s) administered
Descrizione

Ifcompleted,questionnaire(s)administered

Tipo di dati

text

Other (please specify)
Descrizione

Other(pleasespecify)

Tipo di dati

text

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

Incomplete documentation, reason

Tipo di dati

text

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

Unnamed 4

By
Descrizione

By

Tipo di dati

text

Phone
Descrizione

Phone

Tipo di dati

text

Notes
Descrizione

Notes

Notes
Descrizione

Comments

Tipo di dati

text

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

Ccrr Module For Southwest Oncology Group Quality Of Life Cover Sheet

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Similar models

No Instruction available.

1 moduli
  1. StudyEvent: Southwest Oncology Group Quality of Life Cover Sheet
    1. No Instruction available.
Name
genere
Description | Question | Decode (Coded Value)
Tipo di dati
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
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