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Informações:
Falhas:
ID
9233
Descrição
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
Palavras-chave
Versões (3)
- 19/09/2012 19/09/2012 -
- 09/01/2015 09/01/2015 - Martin Dugas
- 03/07/2015 03/07/2015 -
Transferido a
9 de janeiro de 2015
DOI
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Licença
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
No Instruction available.
- StudyEvent: Southwest Oncology Group Quality of Life Cover Sheet
Similar models
No Instruction available.
- StudyEvent: Southwest Oncology Group Quality of Life Cover Sheet
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de dados
Alias
SWOGPatientID
Item
SWOG Patient ID
text
SWOGStudyNo.
Item
SWOG Study No.
text
RegistrationStep
Item
Registration Step
text
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)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
MainMemberInstitution/Affiliate
Item
Institution/Affiliate
text
RegisteredInvestigator
Item
Physician
text
Item
Amended Data
text
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
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)
C0011008 (UMLS 2011AA ValueDomain)
Date
Item
Date
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA 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
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)
C1548386 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C0566251 (UMLS CUI-2)
C0034394 (NCI Metathesaurus Property)
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)
C0011065 (UMLS 2011AA)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
C0205394 (UMLS 2011AA)
By
Item
By
text
Phone
Item
Phone
text
Comments
Item
Notes
text