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ID

9291

Description

E1900 Cover Page for Hematology Form Combination Chemotherapy With or Without Monoclonal Antibody Therapy Followed by Stem Cell Transplant in Treating Patients With Acute Myeloid Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B19AB29D-AC61-25E1-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B19AB29D-AC61-25E1-E034-0003BA12F5E7

Keywords

Versions (2)
  1. 5/25/12 5/25/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
Uploaded on

January 9, 2015

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License

Creative Commons BY-NC 3.0 Legacy
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    Leukemia NCT00049517 Lab - E1900 Cover Page for Hematology Form - 2075140v3.0

    English

    No Instruction available.

    1 forms  
    1. StudyEvent: E1900 Cover Page for Hematology Form
      1. No Instruction available.
    Header
    Description

    Header

    DCI Name
    Description

    Generic drug form

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C3242750
    NCI Thesaurus Property
    C19464
    NCI Thesaurus ObjectClass
    C25474
    NCI Thesaurus ObjectClass-2
    C25452
    Patient Initials
    Description

    Patient Initials

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2986440
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25536
    ECOG Protocol Number
    Description

    ECOGProtocolNumber

    Data type

    text

    ECOG Protocol Number
    Description

    ECOGProtocolNumber

    Data type

    text

    ECOG Protocol Number
    Description

    ECOGProtocolNumber

    Data type

    text

    ECOG Patient ID
    Description

    ECOGPatientID

    Data type

    text

    ECOG Patient ID
    Description

    ECOGPatientID

    Data type

    text

    Participating Group Protocol No.
    Description

    ParticipatingGroupProtocolNo.

    Data type

    text

    Participating Group Patient ID
    Description

    ParticipatingGroupPatientID

    Data type

    text

    Institution/Affiliate
    Description

    MainMemberInstitution/Affiliate

    Data type

    text

    On Treatment
    Description

    On Treatment

    On Treatment Time Period
    Description

    OnTreatmentTimePeriod

    Data type

    text

    Off Treatment
    Description

    Off Treatment

    Off Treatment Time Period
    Description

    OffTreatmentTimePeriod

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C25190
    UMLS 2011AA ObjectClass
    C0027361
    NCI Thesaurus Property
    C25616
    UMLS 2011AA Property
    C1948053
    NCI Thesaurus Property-2
    C25601
    UMLS 2011AA Property-2
    C1518544
    NCI Thesaurus Property-3
    C25207
    UMLS 2011AA Property-3
    C0040223
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    Ccrr Module For E1900 Cover Page For Hematology Form
    Description

    Ccrr Module For E1900 Cover Page For Hematology Form

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    Similar models

    No Instruction available.

    1 forms
    1. StudyEvent: E1900 Cover Page for Hematology Form
      1. No Instruction available.
    Name
    Type
    Description | Question | Decode (Coded Value)
    Data type
    Alias
    Item Group
    Header
    Generic drug form
    Item
    DCI Name
    text
    C25191 (NCI Thesaurus ValueDomain)
    C3242750 (UMLS CUI-1)
    C19464 (NCI Thesaurus Property)
    C25474 (NCI Thesaurus ObjectClass)
    C25452 (NCI Thesaurus ObjectClass-2)
    Patient Initials
    Item
    Patient Initials
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2986440 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25536 (NCI Thesaurus Property)
    ECOGProtocolNumber
    Item
    ECOG Protocol Number
    text
    ECOGProtocolNumber
    Item
    ECOG Protocol Number
    text
    ECOGProtocolNumber
    Item
    ECOG Protocol Number
    text
    ECOGPatientID
    Item
    ECOG Patient ID
    text
    ECOGPatientID
    Item
    ECOG Patient ID
    text
    ParticipatingGroupProtocolNo.
    Item
    Participating Group Protocol No.
    text
    ParticipatingGroupPatientID
    Item
    Participating Group Patient ID
    text
    MainMemberInstitution/Affiliate
    Item
    Institution/Affiliate
    text
    Item Group
    On Treatment
    Item
    On Treatment Time Period
    text
    CL.1
    Code List
    On Treatment Time Period
    CL Item
    Induction (Induction)
    CL042203 (NCI Metathesaurus)
    CL Item
    Induction, Additional Forms (Induction, additional Forms)
    CL Item
    Consolidation (Consolidation)
    CL Item
    Post-transplant (Post-Transplant)
    Item Group
    Off Treatment
    Item
    Off Treatment Time Period
    text
    C25190 (NCI Thesaurus ObjectClass)
    C0027361 (UMLS 2011AA ObjectClass)
    C25616 (NCI Thesaurus Property)
    C1948053 (UMLS 2011AA Property)
    C25601 (NCI Thesaurus Property-2)
    C1518544 (UMLS 2011AA Property-2)
    C25207 (NCI Thesaurus Property-3)
    C0040223 (UMLS 2011AA Property-3)
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    CL.2
    Code List
    Off Treatment Time Period
    CL Item
    3 Months (3 months)
    CL Item
    6 Months (6 months)
    CL Item
    9 Months (9 months)
    CL Item
    12 Months (12 months)
    CL Item
    15 Months (15 months)
    CL Item
    18 Months (18 months)
    CL Item
    24 Months (24 months)
    CL Item
    30 Months (30 months)
    CL Item
    36 Months (36 months)
    CL Item
    42 Months (42 months)
    CL Item
    48 Months (48 months)
    CL Item
    54 Months (54 months)
    CL Item
    60 Months (60 months)
    CL Item
    2 Years (2 years)
    CL Item
    3 Years (3 years)
    CL Item
    4 Years (4 years)
    CL Item
    5 Years (5 years)
    CL Item
    6 Years (6 years)
    CL Item
    7 Years (7 years)
    CL Item
    8 Years (8 years)
    CL Item
    9 Years (9 years)
    CL Item
    10 Years (10 years)
    Item Group
    Ccrr Module For E1900 Cover Page For Hematology Form
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