ID

9741

Description

E1900 Hematology Form Combination Chemotherapy With or Without Monoclonal Antibody Therapy Followed by Stem Cell Transplant in Treating Patients With Acute Myeloid Leukemia NCT00049517 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A729522D-1C90-2FD4-E034-0003BA0B1A09

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A729522D-1C90-2FD4-E034-0003BA0B1A09

Keywords

Versions (2)
  1. 9/19/12 9/19/12 -
  2. 1/21/15 1/21/15 - Martin Dugas
Uploaded on

January 21, 2015

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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Hematology Form AML (E1900, NCT00049517)

German English

No Instruction available.

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

Header

ECOG Protocol No.
Description

ECOGProtocolNo.

Data type

text

Alias
UMLS CUI-1
C3274381
UMLS CUI-2
C1512162
ECOG Patient ID
Description

ECOGPatientID

Data type

text

Alias
UMLS CUI-1
C2348585
UMLS CUI-2
C1512162
Registration Step
Description

RegistrationStep

Data type

text

Alias
UMLS CUI-1
C1514821
Reporting period
Description

TreatmentPhase

Data type

text

Alias
UMLS CUI-1
C3538994
Patient's Name
Description

Patient Name

Data type

text

Alias
UMLS CUI-1
C1299487
Participating Group Protocol No.
Description

Participating Group ProtocolNo.

Data type

text

Alias
UMLS CUI-1
C3274381
UMLS CUI-2
C2347449
Participating Group Patient ID
Description

ParticipatingGroupPatientID

Data type

text

Alias
UMLS CUI-1
C2348585
UMLS CUI-2
C2347449
Institution/Affiliate
Description

MainMemberInstitution/Affiliate

Data type

text

Alias
UMLS CUI-1
C1301943
Are data amended? (If yes, please circle amended items in red)
Description

AmendedDataInd

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C25474
NCI Thesaurus Property
C25416
UMLS CUI-1
C0680532
Comments
Description

Comments

Data type

text

Investigator Signature
Description

InvestigatorSignature

Data type

text

Alias
NCI Thesaurus Property
C25678
UMLS 2011AA Property
C1519316
NCI Thesaurus ObjectClass
C17089
UMLS 2011AA ObjectClass
C0035173
Date
Description

InvestigatorSignatureDate

Data type

date

Hematology lab
Description

Hematology lab

Alias
UMLS CUI-1
C0474523
Laboratory Name
Description

SpecimenLabIdentifierName

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
NCI Thesaurus Property
C25364
NCI Thesaurus ObjectClass
C37984
NCI Thesaurus ObjectClass-2
C19157
UMLS CUI-1
C1882331
Date obtained
Description

Lab,Hematology,SampleCollectionDate

Data type

date

Measurement units
  • M D Y
Alias
UMLS CUI-1
C1317250
M D Y
Peripheral WBC count (x1000), LLN
Description

WBCcount(x1000),LLN

Data type

float

Alias
UMLS CUI-1
C0023508
UMLS CUI-2
C1518030
Peripheral WBC count (x1000), Value
Description

Lab,Hematology,WBC

Data type

float

Alias
UMLS CUI-1
C0023508
Granulocyte count AGC/ANC
Description

Lab,Hematology,GranulocyteCount

Data type

float

Alias
UMLS CUI-1
C0857490
Peripheral Platelet count (x1000), LLN (Peripheral Platelet count x1000, Value)
Description

Plateletscount(x1000),LLN

Data type

float

Alias
NCI Thesaurus ValueDomain
C25712
NCI Thesaurus ValueDomain-2
C25555
UMLS CUI-1
C0005821
UMLS CUI-2
C1518030
Platelets
Description

Platelets

Data type

float

Alias
UMLS CUI-1
C0005821
Hemoglobin LLN
Description

Hemoglobin(g/dl),LLN

Data type

float

Measurement units
  • g/dl
Alias
UMLS CUI-1
C0019046
UMLS CUI-2
C1518030
g/dl
Hemoglobin Value
Description

Lab,Hematology,Hemoglobin

Data type

float

Measurement units
  • g/dl
Alias
UMLS CUI-1
C0019046
g/dl
Blasts
Description

Lab,Hematology,Blasts,CellPercentage

Data type

float

Measurement units
  • %
Alias
UMLS CUI-1
C1982687
%
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Similar models

No Instruction available.

1 forms
  1. StudyEvent: E1900 Hematology Form
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Header
ECOG Protocol Number
Item
ECOG Protocol No.
text
C3274381 (UMLS CUI-1)
C1512162 (UMLS CUI-2)
ECOG Patient ID
Item
ECOG Patient ID
text
C2348585 (UMLS CUI-1)
C1512162 (UMLS CUI-2)
Registration Step
Item
Registration Step
text
C1514821 (UMLS CUI-1)
Item
Reporting period
text
C3538994 (UMLS CUI-1)
CL.1
Code List
Reporting period
CL Item
Current Phase Of Leukemia Treatment For Patient Is Induction (induction)
CL Item
Current Phase Of Leukemia Treatment For Patient Is Consolidation (consolidation)
CL Item
post transplant (post transplant)
Patient Name
Item
Patient's Name
text
C1299487 (UMLS CUI-1)
Participating Group Protocol Number
Item
Participating Group Protocol No.
text
C3274381 (UMLS CUI-1)
C2347449 (UMLS CUI-2)
Participating Group Patient ID
Item
Participating Group Patient ID
text
C2348585 (UMLS CUI-1)
C2347449 (UMLS CUI-2)
Institution
Item
Institution/Affiliate
text
C1301943 (UMLS CUI-1)
Data amended
Item
Are data amended? (If yes, please circle amended items in red)
boolean
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)
C0680532 (UMLS CUI-1)
Comments
Item
Comments
text
InvestigatorSignature
Item
Investigator Signature
text
C25678 (NCI Thesaurus Property)
C1519316 (UMLS 2011AA Property)
C17089 (NCI Thesaurus ObjectClass)
C0035173 (UMLS 2011AA ObjectClass)
InvestigatorSignatureDate
Item
Date
date
Item Group
Hematology lab
C0474523 (UMLS CUI-1)
Laboratory Name
Item
Laboratory Name
text
C25191 (NCI Thesaurus ValueDomain)
C25364 (NCI Thesaurus Property)
C37984 (NCI Thesaurus ObjectClass)
C19157 (NCI Thesaurus ObjectClass-2)
C1882331 (UMLS CUI-1)
Sample Collection Date
Item
Date obtained
date
C1317250 (UMLS CUI-1)
WBC LLN
Item
Peripheral WBC count (x1000), LLN
float
C0023508 (UMLS CUI-1)
C1518030 (UMLS CUI-2)
WBC count
Item
Peripheral WBC count (x1000), Value
float
C0023508 (UMLS CUI-1)
Granulocyte count
Item
Granulocyte count AGC/ANC
float
C0857490 (UMLS CUI-1)
Platelets LLN
Item
Peripheral Platelet count (x1000), LLN (Peripheral Platelet count x1000, Value)
float
C25712 (NCI Thesaurus ValueDomain)
C25555 (NCI Thesaurus ValueDomain-2)
C0005821 (UMLS CUI-1)
C1518030 (UMLS CUI-2)
Platelets
Item
Platelets
float
C0005821 (UMLS CUI-1)
Hemoglobin LLN
Item
Hemoglobin LLN
float
C0019046 (UMLS CUI-1)
C1518030 (UMLS CUI-2)
Hemoglobin
Item
Hemoglobin Value
float
C0019046 (UMLS CUI-1)
Blasts
Item
Blasts
float
C1982687 (UMLS CUI-1)
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