Información:
Error:
ID
9239
Descripción
Follow-up Assessment (FA) Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B122D2BC-9A32-4DD0-E034-0003BA12F5E7
Link
Palabras clave
Versiones (2)
- 19/9/12 19/9/12 -
- 9/1/15 9/1/15 - Martin Dugas
Subido en
9 de enero de 2015
DOI
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Licencia
Creative Commons BY-NC 3.0 Legacy
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Melanoma (Skin) Follow-Up - Follow-up Assessment (FA) - 2074729v3.0
No Instruction available.
- StudyEvent: Follow-up Assessment (FA)
Similar models
No Instruction available.
- StudyEvent: Follow-up Assessment (FA)
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
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)
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)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
InstitutionName
Item
Institution:
text
DateofHistoryandPhysical:
Item
Date of History and Physical:
text
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C18772 (NCI Thesaurus ObjectClass-2)
C0262926 (UMLS 2011AA ObjectClass-2)
C0031809 (UMLS 2011AA ObjectClass)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C18772 (NCI Thesaurus ObjectClass-2)
C0262926 (UMLS 2011AA ObjectClass-2)
DateofP/AandLateralChestX-ray
Item
Date of P/A and Lateral Chest X-ray
text
DateLDHObtained
Item
Date of LDH: (Year Month Day)
text
IsLDHgreaterthanupperlimitofinstitutionalnorm:
Item
Is LDH greater than upper limit of institutional norm:
boolean
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
CompletedBy
Item
Completed by:
text
FormCompletionDate,Original
Item
Date: (Year Month Day)
date