ID

9242

Description

S0201 Southwest Oncology Group Notice of Death Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A8BA67DA-F224-11AC-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A8BA67DA-F224-11AC-E034-0003BA12F5E7

Keywords

Versions (3)
  1. 9/19/12 9/19/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
  3. 7/3/15 7/3/15 -
Uploaded on

January 9, 2015

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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Melanoma (Skin) null Follow-Up - S0201 Southwest Oncology Group Notice of Death - 2055562v3.0

English

No Instruction available.

1 forms  
  1. StudyEvent: S0201 Southwest Oncology Group Notice of Death
    1. No Instruction available.
Unnamed 1
Description

Unnamed 1

SWOG Patient ID
Description

SWOGPatientID

Data type

text

Most Recent SWOG Study No.
Description

MostRecentSWOGStudyNo.

Data type

text

Patient Initials (L, F M)
Description

Patient Initials

Data type

text

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

MainMemberInstitution/Affiliate

Data type

text

Physician (Groups other than SWOG)
Description

TreatingPhysician

Data type

text

Alias
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ObjectClass
C25741
UMLS 2011AA ObjectClass
C0031831
NCI Thesaurus ObjectClass-2
C25705
UMLS 2011AA ObjectClass-2
C1522326
Group Name
Description

ParticipatingGroupName

Data type

text

Study No.
Description

StudyNo.

Data type

text

Pt. ID
Description

Pt.ID

Data type

text

Unnamed 2
Description

Unnamed 2

Date of Death (month/day/year)
Description

DeathDocumentedDate

Data type

date

Causes Of Death
Description

Causes Of Death

Any cancer (select one)
Description

Anycancer

Data type

text

If cancer was the primary cause or if cancer possibly or definitely contributed to death, and the patient had had multiple tumor types, specify those which were causes of death
Description

PersonCancerAssociatedDeathType

Data type

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C28554
UMLS 2011AA Property
C0011065
NCI Thesaurus Property-2
C9305
UMLS 2011AA Property-2
C0006826
NCI Thesaurus Property-3
C25281
UMLS 2011AA Property-3
C0332281
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Cancer of most recent SWOG study, specify cancer
Description

SouthwestOncologyGroupMalignantNeoplasmMostRecentProtocolSpecify

Data type

text

Alias
NCI Thesaurus ObjectClass
C25699
UMLS 2011AA ObjectClass
C1519429
NCI Thesaurus ObjectClass-2
C9305
UMLS 2011AA ObjectClass-2
C0006826
NCI Thesaurus Property
C25320
UMLS 2011AA Property
C1507394
NCI Thesaurus Property-2
C25577
UMLS 2011AA Property-2
C1513491
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
Cancer of other SWOG study, specify cancer
Description

CancerofotherSWOGstudy,specifycancer

Data type

text

Other cancer, specify
Description

Othercancer,specify

Data type

text

Toxicity from disease related treatment (select one)
Description

Toxicityfromdiseaserelatedtreatment

Data type

text

If Primary Cause, Contributory or Possible, specify treatment and toxicity
Description

IfPrimaryCause,ContributoryorPossible,specifytreatmentandtoxicity

Data type

text

Non-cancer and non-treatment related causes (select one)
Description

Non-cancerandnon-treatmentrelatedcauses

Data type

text

If Primary Cause, Contributory or Possible, specify
Description

IfPrimaryCause,ContributoryorPossible,specify

Data type

text

Autopsy done?
Description

AutopsyInd

Data type

text

Death information obtained from (select all that apply)
Description

DeathInformationSource

Data type

text

Other, specify (death information obtained)
Description

PatientDeathSourceSpecify

Data type

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C28554
UMLS 2011AA Property
C0011065
Notes
Description

Notes

Notes
Description

Comments

Data type

text

Ccrr Module For S0201 Southwest Oncology Group Notice Of Death
Description

Ccrr Module For S0201 Southwest Oncology Group Notice Of Death

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Similar models

No Instruction available.

1 forms
  1. StudyEvent: S0201 Southwest Oncology Group Notice of Death
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Unnamed 1
SWOGPatientID
Item
SWOG Patient ID
text
MostRecentSWOGStudyNo.
Item
Most Recent SWOG Study No.
text
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
TreatingPhysician
Item
Physician (Groups other than SWOG)
text
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25741 (NCI Thesaurus ObjectClass)
C0031831 (UMLS 2011AA ObjectClass)
C25705 (NCI Thesaurus ObjectClass-2)
C1522326 (UMLS 2011AA ObjectClass-2)
ParticipatingGroupName
Item
Group Name
text
StudyNo.
Item
Study No.
text
Pt.ID
Item
Pt. ID
text
Item Group
Unnamed 2
DeathDocumentedDate
Item
Date of Death (month/day/year)
date
Item Group
Causes Of Death
Item
Any cancer (select one)
text
CL.1
Code List
Any cancer (select one)
CL Item
No2005686 (No)
CL Item
Primary_cause2005687 (Primary Cause)
CL Item
Contributory2005688 (Contributory)
CL Item
Possible2005689 (Possible)
CL Item
Unknown2005690 (Unknown)
Item
If cancer was the primary cause or if cancer possibly or definitely contributed to death, and the patient had had multiple tumor types, specify those which were causes of death
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C28554 (NCI Thesaurus Property)
C0011065 (UMLS 2011AA Property)
C9305 (NCI Thesaurus Property-2)
C0006826 (UMLS 2011AA Property-2)
C25281 (NCI Thesaurus Property-3)
C0332281 (UMLS 2011AA Property-3)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.2
Code List
If cancer was the primary cause or if cancer possibly or definitely contributed to death, and the patient had had multiple tumor types, specify those which were causes of death
CL Item
Cancer_of_most_recent_s2005692 (Cancer of most recent SWOG study, specify cancer)
CL Item
Cancer_of_oth_swog_stdy2005693 (Cancer of other SWOG study, specify cancer)
CL Item
Other_cancer_specify2005694 (Other cancer, specify)
SouthwestOncologyGroupMalignantNeoplasmMostRecentProtocolSpecify
Item
Cancer of most recent SWOG study, specify cancer
text
C25699 (NCI Thesaurus ObjectClass)
C1519429 (UMLS 2011AA ObjectClass)
C9305 (NCI Thesaurus ObjectClass-2)
C0006826 (UMLS 2011AA ObjectClass-2)
C25320 (NCI Thesaurus Property)
C1507394 (UMLS 2011AA Property)
C25577 (NCI Thesaurus Property-2)
C1513491 (UMLS 2011AA Property-2)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
CancerofotherSWOGstudy,specifycancer
Item
Cancer of other SWOG study, specify cancer
text
Othercancer,specify
Item
Other cancer, specify
text
Item
Toxicity from disease related treatment (select one)
text
CL.3
Code List
Toxicity from disease related treatment (select one)
CL Item
No2005697 (No)
CL Item
Primary_cause2005698 (Primary Cause)
CL Item
Contributory2005699 (Contributory)
CL Item
Possible2005700 (Possible)
CL Item
Unknown2005701 (Unknown)
IfPrimaryCause,ContributoryorPossible,specifytreatmentandtoxicity
Item
If Primary Cause, Contributory or Possible, specify treatment and toxicity
text
Item
Non-cancer and non-treatment related causes (select one)
text
CL.4
Code List
Non-cancer and non-treatment related causes (select one)
CL Item
No2005705 (No)
CL Item
Primary_cause2005706 (Primary Cause)
CL Item
Contributory2005707 (Contributory)
CL Item
Possible2005708 (Possible)
CL Item
Unknown2005709 (Unknown)
IfPrimaryCause,ContributoryorPossible,specify
Item
If Primary Cause, Contributory or Possible, specify
text
Item
Autopsy done?
text
CL.5
Code List
Autopsy done?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Death information obtained from (select all that apply)
text
CL.6
Code List
Death information obtained from (select all that apply)
CL Item
Autopsy Was The Source Of Information On The Patient's Death (Autopsy report)
CL Item
Death Certificate Was The Source Of Information On The Patient's Death (Medical record / Death certificate)
CL Item
Clinical Evidence Was The Source Of Information On The Patient's Death (Physician)
CL Item
Relative or friend (Relative or friend)
CL Item
Other, specify (Other, specify)
PatientDeathSourceSpecify
Item
Other, specify (death information obtained)
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C28554 (NCI Thesaurus Property)
C0011065 (UMLS 2011AA Property)
Item Group
Notes
Comments
Item
Notes
text
Item Group
Ccrr Module For S0201 Southwest Oncology Group Notice Of Death
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