ID
9355
Descrizione
S1007 Cover Sheet for Patient-Completed Questionnaires Form (QLCS1007) Tamoxifen Citrate, Letrozole, Anastrozole, or Exemestane With or Without Chemotherapy in Treating Patients With Invasive RxPONDER Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=90DA93B9-5312-5D33-E040-BB89AD434FA6
collegamento
Keywords
versioni (3)
- 27/08/12 27/08/12 -
- 09/01/15 09/01/15 - Martin Dugas
- 09/01/15 09/01/15 - Martin Dugas
Caricato su
9 gennaio 2015
DOI
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Licenza
Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT01272037 Quality of Life - S1007 Cover Sheet for Patient-Completed Questionnaires Form (QLCS1007) - 3140796v1.0
Instructions: Please complete this form at randomization, 6 months, 12 months, and 3 years post-randomization. Prestudy forms are an eligibility requirement and must be completed within 14 days prior to registration. All dates are MONTH, DAY, YEAR. Place an X in appropriate boxes. Circle AMENDED items in red and write AMENDED across the top of the form
- StudyEvent: S1007 Cover Sheet for Patient-Completed Questionnaires Form (QLCS1007)
Descrizione
Unnamed 1
Descrizione
QualityofLifeCompleteAssessmentInd-2
Tipo di dati
boolean
Alias
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
- NCI Thesaurus ObjectClass
- C17047
- UMLS 2011AA ObjectClass
- C0518214
- NCI Thesaurus Property
- C25250
- UMLS 2011AA Property
- C0205197
- NCI Thesaurus Property-2
- C25367
Descrizione
PatientQuestionnaireAssistanceInd
Tipo di dati
boolean
Alias
- NCI Thesaurus ValueDomain
- C25180
- UMLS 2011AA ValueDomain
- C1522602
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C17048
- UMLS 2011AA Property
- C0034394
- NCI Metathesaurus Property
- C0018896
Descrizione
PatientQuestionnaireAssistanceOtherSpecify
Tipo di dati
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
- NCI Thesaurus ValueDomain-2
- C17649
- UMLS 2011AA ValueDomain-2
- C0205394
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C17048
- UMLS 2011AA Property
- C0034394
- NCI Metathesaurus Property
- C0018896
Descrizione
PatientQuestionnaireAdministeredMethodType
Tipo di dati
text
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus ObjectClass-2
- C17048
- UMLS 2011AA ObjectClass-2
- C0034394
- NCI Thesaurus Property
- C16847
- UMLS 2011AA Property
- C0449851
- NCI Thesaurus Property-2
- C25382
- UMLS 2011AA Property-2
- C1521801
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
Descrizione
PatientQuestionnaireAdministeredMethodSpecify
Tipo di dati
text
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus ObjectClass-2
- C17048
- UMLS 2011AA ObjectClass-2
- C0034394
- NCI Thesaurus Property
- C16847
- UMLS 2011AA Property
- C0449851
- NCI Thesaurus Property-2
- C25382
- UMLS 2011AA Property-2
- C1521801
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
Descrizione
Incomplete documentation, reason
Tipo di dati
text
Alias
- NCI Thesaurus ValueDomain
- C25638
- UMLS CUI-1
- C1548386
- NCI Thesaurus ObjectClass
- C16960
- UMLS CUI-2
- C0566251
- NCI Metathesaurus Property
- C0034394
Descrizione
Unnamed 3
Descrizione
Person Completing Form Last Name
Tipo di dati
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS CUI-1
- C1550483
- NCI Thesaurus ObjectClass-2
- C25657
- UMLS CUI-2
- C1301584
- NCI Thesaurus Property
- C25364
- NCI Thesaurus Property-2
- C25551
- NCI Thesaurus ValueDomain
- C25191
Descrizione
Person Completing Form Phone
Tipo di dati
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS CUI-1
- C1550483
- NCI Thesaurus ObjectClass
- C25190
- UMLS CUI-2
- C1515258
- NCI Thesaurus ObjectClass-2
- C25657
- NCI Thesaurus Property
- C25395
Descrizione
Comments
Similar models
Instructions: Please complete this form at randomization, 6 months, 12 months, and 3 years post-randomization. Prestudy forms are an eligibility requirement and must be completed within 14 days prior to registration. All dates are MONTH, DAY, YEAR. Place an X in appropriate boxes. Circle AMENDED items in red and write AMENDED across the top of the form
- StudyEvent: S1007 Cover Sheet for Patient-Completed Questionnaires Form (QLCS1007)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1519429 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25699 (NCI Thesaurus Property-2)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1519429 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25699 (NCI Thesaurus Property-2)
C1514821 (UMLS CUI-1)
C25646 (NCI Thesaurus ObjectClass)
C0237753 (UMLS CUI-2)
C16154 (NCI Thesaurus Property)
C16154 (NCI Thesaurus ValueDomain-2)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
C1115437 (UMLS CUI-1)
C40988 (NCI Thesaurus ObjectClass)
C25250 (NCI Thesaurus Property)
C25367 (NCI Thesaurus ValueDomain-2)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
C25191 (NCI Thesaurus ValueDomain)
C21541 (NCI Thesaurus ValueDomain-2)
C2826892 (UMLS CUI-1)
C25364 (NCI Thesaurus Property)
C17089 (NCI Thesaurus ObjectClass)
C25644 (NCI Thesaurus ObjectClass-2)
C2347449 (UMLS CUI-1)
C25608 (NCI Thesaurus ObjectClass)
C17005 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
C0332307 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C25616 (NCI Thesaurus Property)
C1948053 (UMLS 2011AA Property)
C0034656 (UMLS 2011AA)
C1512698 (UMLS 2011AA ValueDomain)
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25250 (NCI Thesaurus Property)
C0205197 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property-2)
C1522602 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C17048 (NCI Thesaurus Property)
C0034394 (UMLS 2011AA Property)
C0018896 (NCI Metathesaurus Property)
C1521902 (UMLS 2011AA ValueDomain)
C17649 (NCI Thesaurus ValueDomain-2)
C0205394 (UMLS 2011AA ValueDomain-2)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C17048 (NCI Thesaurus Property)
C0034394 (UMLS 2011AA Property)
C0018896 (NCI Metathesaurus Property)
C0030705 (UMLS 2011AA ObjectClass)
C17048 (NCI Thesaurus ObjectClass-2)
C0034394 (UMLS 2011AA ObjectClass-2)
C16847 (NCI Thesaurus Property)
C0449851 (UMLS 2011AA Property)
C25382 (NCI Thesaurus Property-2)
C1521801 (UMLS 2011AA Property-2)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C0205394 (UMLS 2011AA)
C0030705 (UMLS 2011AA ObjectClass)
C17048 (NCI Thesaurus ObjectClass-2)
C0034394 (UMLS 2011AA ObjectClass-2)
C16847 (NCI Thesaurus Property)
C0449851 (UMLS 2011AA Property)
C25382 (NCI Thesaurus Property-2)
C1521801 (UMLS 2011AA Property-2)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C1548386 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C0566251 (UMLS CUI-2)
C0034394 (NCI Metathesaurus Property)
C0011065 (UMLS 2011AA)
C0205394 (UMLS 2011AA)
C1550483 (UMLS CUI-1)
C25657 (NCI Thesaurus ObjectClass-2)
C1301584 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25551 (NCI Thesaurus Property-2)
C25191 (NCI Thesaurus ValueDomain)
C1550483 (UMLS CUI-1)
C25190 (NCI Thesaurus ObjectClass)
C1515258 (UMLS CUI-2)
C25657 (NCI Thesaurus ObjectClass-2)
C25395 (NCI Thesaurus Property)
C0947611 (UMLS CUI-1)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)