No Instruction available.

  1. StudyEvent: CALGB 50901 Confirmation of Lost to Follow-Up Form
    1. No Instruction available.
Criteria For Lost To Follow-up Status
Beschreibung

Criteria For Lost To Follow-up Status

Has it been at least 2 years since you were last able to contact the patient
Beschreibung

PatientLostFollow-upInd-2

Datentyp

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25560
UMLS 2011AA Property
C0745777
NCI Thesaurus Property-2
C16033
UMLS 2011AA Property-2
C1522577
Date of Last Contact (prior to this confirmation)
Beschreibung

LastContactDate

Datentyp

date

Alias
NCI Thesaurus Property
C25164
UMLS 2011AA Property
C0011008
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C47954
UMLS 2011AA ObjectClass
C1705415
NCI Thesaurus ObjectClass-2
C25551
UMLS 2011AA ObjectClass-2
C1517741
Contact Type (Please indicate when steps were taken to contact the patient. Both Social Security Death Index and Certified/Registered Letter methods must be attempted without success after 2 years without contact before a patient can be declared lost)
Beschreibung

PatientContactTextType

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25461
UMLS 2011AA Property
C0337611
Contact Type (Please indicate when steps were taken to contact the patient. Both Social Security Death Index and Certified/Registered Letter methods must be attempted without success after 2 years without contact before a patient can be declared lost)
Beschreibung

PatientContactTextType

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25461
UMLS 2011AA Property
C0337611
Specify most recent date
Beschreibung

PatientLastAttemptContactDate

Datentyp

date

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25461
UMLS 2011AA Property
C0337611
NCI Thesaurus Property-2
C25551
UMLS 2011AA Property-2
C1517741
NCI Thesaurus Property-3
C39769
UMLS 2011AA Property-3
C1516084
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
Specify most recent date
Beschreibung

PatientLastAttemptContactDate

Datentyp

date

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25461
UMLS 2011AA Property
C0337611
NCI Thesaurus Property-2
C25551
UMLS 2011AA Property-2
C1517741
NCI Thesaurus Property-3
C39769
UMLS 2011AA Property-3
C1516084
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
Patient Contact Status
Beschreibung

PatientAttemptContactStatus

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25461
UMLS 2011AA Property
C0337611
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
NCI Thesaurus Property-2
C39769
UMLS 2011AA Property-2
C1516084
Investigator Signature (Required for patients who have been lost for 2 years: I verify that the above information is correct and that all attempts to contact this patient have failed)
Beschreibung

Investigator Signature

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS CUI-1
C2346576
NCI Thesaurus Property
C25678
NCI Thesaurus ObjectClass
C17089
Date
Beschreibung

Investigator Signature Date

Datentyp

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS CUI-1
C2346576
NCI Thesaurus Property
C25678
UMLS CUI-2
C0011008
NCI Thesaurus ValueDomain-2
C25367
NCI Thesaurus ObjectClass
C17089
Patient No Longer Lost To Follow-up
Beschreibung

Patient No Longer Lost To Follow-up

New information for this patient is now available for
Beschreibung

PatientViableFollow-UpStatus

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C16033
UMLS 2011AA Property
C1522577
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
NCI Thesaurus Property-2
C25324
UMLS 2011AA Property-2
C0443348
Vital Status (based on new data)
Beschreibung

Patient Status

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS CUI-1
C3846084
NCI Thesaurus ValueDomain
C18003
NCI Thesaurus ValueDomain-2
C25688
NCI Thesaurus Property
C25717
Date of Last Contact or Death
Beschreibung

Date last contact

Datentyp

date

Alias
NCI Thesaurus ObjectClass
C16960
UMLS CUI-1
C0805839
NCI Thesaurus Property
C25461
NCI Thesaurus Property-2
C25551
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ValueDomain-2
C25367

Ähnliche Modelle

No Instruction available.

  1. StudyEvent: CALGB 50901 Confirmation of Lost to Follow-Up Form
    1. No Instruction available.
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Criteria For Lost To Follow-up Status
PatientLostFollow-upInd-2
Item
Has it been at least 2 years since you were last able to contact the patient
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25560 (NCI Thesaurus Property)
C0745777 (UMLS 2011AA Property)
C16033 (NCI Thesaurus Property-2)
C1522577 (UMLS 2011AA Property-2)
LastContactDate
Item
Date of Last Contact (prior to this confirmation)
date
C25164 (NCI Thesaurus Property)
C0011008 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C47954 (NCI Thesaurus ObjectClass)
C1705415 (UMLS 2011AA ObjectClass)
C25551 (NCI Thesaurus ObjectClass-2)
C1517741 (UMLS 2011AA ObjectClass-2)
Item
Contact Type (Please indicate when steps were taken to contact the patient. Both Social Security Death Index and Certified/Registered Letter methods must be attempted without success after 2 years without contact before a patient can be declared lost)
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25461 (NCI Thesaurus Property)
C0337611 (UMLS 2011AA Property)
Code List
Contact Type (Please indicate when steps were taken to contact the patient. Both Social Security Death Index and Certified/Registered Letter methods must be attempted without success after 2 years without contact before a patient can be declared lost)
CL Item
Mail Contact With Patient/participant (Mail contact with Patient/Participant)
Item
Contact Type (Please indicate when steps were taken to contact the patient. Both Social Security Death Index and Certified/Registered Letter methods must be attempted without success after 2 years without contact before a patient can be declared lost)
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25461 (NCI Thesaurus Property)
C0337611 (UMLS 2011AA Property)
Code List
Contact Type (Please indicate when steps were taken to contact the patient. Both Social Security Death Index and Certified/Registered Letter methods must be attempted without success after 2 years without contact before a patient can be declared lost)
CL Item
Mail Contact With Patient/participant (Mail contact with Patient/Participant)
PatientLastAttemptContactDate
Item
Specify most recent date
date
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25461 (NCI Thesaurus Property)
C0337611 (UMLS 2011AA Property)
C25551 (NCI Thesaurus Property-2)
C1517741 (UMLS 2011AA Property-2)
C39769 (NCI Thesaurus Property-3)
C1516084 (UMLS 2011AA Property-3)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
PatientLastAttemptContactDate
Item
Specify most recent date
date
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25461 (NCI Thesaurus Property)
C0337611 (UMLS 2011AA Property)
C25551 (NCI Thesaurus Property-2)
C1517741 (UMLS 2011AA Property-2)
C39769 (NCI Thesaurus Property-3)
C1516084 (UMLS 2011AA Property-3)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
Item
Patient Contact Status
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25461 (NCI Thesaurus Property)
C0337611 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
C39769 (NCI Thesaurus Property-2)
C1516084 (UMLS 2011AA Property-2)
Code List
Patient Contact Status
CL Item
Letter Returned Unclaimed Or Marked Addressee Unknown (Letter returned unclaimed or marked addressee unknown)
CL Item
No Response 1 Month After Confirmed Receipt Of Letter (No response 1 month after confirmed receipt of letter)
Investigator Signature
Item
Investigator Signature (Required for patients who have been lost for 2 years: I verify that the above information is correct and that all attempts to contact this patient have failed)
text
C25704 (NCI Thesaurus ValueDomain)
C2346576 (UMLS CUI-1)
C25678 (NCI Thesaurus Property)
C17089 (NCI Thesaurus ObjectClass)
Investigator Signature Date
Item
Date
date
C25164 (NCI Thesaurus ValueDomain)
C2346576 (UMLS CUI-1)
C25678 (NCI Thesaurus Property)
C0011008 (UMLS CUI-2)
C25367 (NCI Thesaurus ValueDomain-2)
C17089 (NCI Thesaurus ObjectClass)
Item Group
Patient No Longer Lost To Follow-up
Item
New information for this patient is now available for
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C16033 (NCI Thesaurus Property)
C1522577 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
C25324 (NCI Thesaurus Property-2)
C0443348 (UMLS 2011AA Property-2)
Code List
New information for this patient is now available for
CL Item
Survival Status Only (Survival status only)
CL Item
Clinical And Survival Status (Clinical and survival status)
Item
Vital Status (based on new data)
text
C16960 (NCI Thesaurus ObjectClass)
C3846084 (UMLS CUI-1)
C18003 (NCI Thesaurus ValueDomain)
C25688 (NCI Thesaurus ValueDomain-2)
C25717 (NCI Thesaurus Property)
Code List
Vital Status (based on new data)
CL Item
Alive (Alive)
CL Item
Dead (Dead)
Date last contact
Item
Date of Last Contact or Death
date
C16960 (NCI Thesaurus ObjectClass)
C0805839 (UMLS CUI-1)
C25461 (NCI Thesaurus Property)
C25551 (NCI Thesaurus Property-2)
C25164 (NCI Thesaurus ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)