ID

9759

Description

NCI Cooperative Group Hematology Laboratory Test Form (CALGB-90104) Combination Chemotherapy in Treating Patients With Bladder Cancer NCT00014534 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A9C02B5C-8C97-26B5-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A9C02B5C-8C97-26B5-E034-0003BA12F5E7

Keywords

Versions (6)
  1. 8/26/12 8/26/12 -
  2. 12/22/14 12/22/14 - Martin Dugas
  3. 1/8/15 1/8/15 - Martin Dugas
  4. 1/22/15 1/22/15 - Martin Dugas
  5. 1/22/15 1/22/15 - Martin Dugas
  6. 1/22/15 1/22/15 - Martin Dugas
Uploaded on

January 22, 2015

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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Hematology Laboratory Test Form Bladder Cancer (NCT00014534)

English

No Instruction available.

1 forms  
  1. StudyEvent: NCI Cooperative Group Hematology Laboratory Test Form (CALGB-90104)
    1. No Instruction available.
Administrative documentation
Description

Administrative documentation

Alias
UMLS CUI-1
C1320722
Coordinating Group Protocol Number
Description

CoordinatingGroupProtocolNumber

Data type

text

Alias
UMLS CUI-1
C3274381
UMLS CUI-2
C1711341
Coordinating Group Code
Description

CoordinatingGroupCode

Data type

text

Alias
NCI Thesaurus ValueDomain
C25162
UMLS CUI-1
C0805701
Protocol Title
Description

Protocol Title

Data type

text

Alias
NCI Thesaurus ObjectClass
C25320
UMLS CUI-1
C2986303
NCI Thesaurus Property
C42774
Patient Study ID, Coordinating Group
Description

PatientStudyID,CoordinatingGroup

Data type

text

Alias
UMLS CUI-1
C2348585
Patient Study ID, Participating Group
Description

PatientStudyID,ParticipatingGroup

Data type

text

Alias
UMLS CUI-1
C2348585
UMLS CUI-2
C2347449
Participating Group Code
Description

ParticipatingGroupCode

Data type

text

Alias
NCI Thesaurus ValueDomain
C25162
UMLS CUI-1
C0805701
Institution Name
Description

InstitutionName

Data type

text

Affiliate
Description

AffiliateName

Data type

text

Patient Last Name (initials acceptable)
Description

PatientName,Last

Data type

text

Alias
UMLS CUI-1
C1301584
Patient First Name (initials acceptable)
Description

PatientName,First

Data type

text

Alias
UMLS CUI-1
C1443235
Patient Middle Name (initials acceptable)
Description

PatientName,Middle

Data type

text

Alias
UMLS CUI-1
C1320720
Person Completing Form, Last Name
Description

PersonCompletingForm,LastName

Data type

text

Person Completing Form, First Name
Description

PersonCompletingForm,FirstName

Data type

text

Alias
NCI Thesaurus ObjectClass
C25190
NCI Thesaurus Property
C25364
UMLS CUI-1
C0027361
UMLS CUI-2
C0600091
Are data amended?
Description

Amended Data

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C25474
NCI Thesaurus Property
C25416
UMLS CUI-1
C0680532
Hematology Laboratory Tests
Description

Hematology Laboratory Tests

Alias
UMLS CUI-1
C0474523
Peripheral WBC Count
Description

Lab,Hematology,WBC

Data type

float

Alias
UMLS CUI-1
C0023508
Hemoglobin
Description

Lab,Hematology,Hemoglobin

Data type

float

Alias
UMLS CUI-1
C0019046
Peripheral Hematocrit Count
Description

Peripheral Hematocrit Count (%)

Data type

float

Measurement units
  • %
Alias
UMLS CUI-1
C0518014
%
Peripheral Platelet Count
Description

Lab,Hematology,Platelets

Data type

float

Alias
UMLS CUI-1
C1287267
Peripheral Neutrophils
Description

Lab,Hematology,Neutrophils,CellPercentage

Data type

float

Measurement units
  • %
Alias
UMLS CUI-1
C0362987
%
Peripheral Neutrophil Count
Description

Lab,Hematology,NeutrophilCount

Data type

float

Alias
UMLS CUI-1
C0200633
Unit (Normal Range)
Description

Lab,UnitsofMeasure

Data type

text

Alias
UMLS CUI-1
C1519795
Normal Range-Peripheral WBC Count
Description

WBC count(x1000),LLN

Data type

float

Alias
UMLS CUI-1
C0023508
UMLS CUI-2
C1518030
Normal Range-Hemoglobin
Description

Hemoglobin LLN

Data type

float

Measurement units
  • g/dl
Alias
UMLS CUI-1
C0019046
UMLS CUI-2
C1518030
g/dl
Normal Range-Peripheral Hematocrit Count (%)
Description

Hematocrit normal range

Data type

text

Alias
UMLS CUI-1
C0518014
UMLS CUI-2
C0086715
Normal Range-Peripheral Platelet Count
Description

Platelets LLN

Data type

float

Alias
NCI Thesaurus ValueDomain
C25712
NCI Thesaurus ValueDomain-2
C25555
UMLS CUI-1
C0005821
UMLS CUI-2
C1518030
Normal Range-Peripheral Neutrophils
Description

Peripheral Neutrophils Normal Range

Data type

text

Measurement units
  • %
Alias
UMLS CUI-1
C0362987
UMLS CUI-2
C0086715
%
Normal Range-Peripheral Neutrophil Count
Description

Peripheral Neutrophil Count Normal Range

Data type

text

Alias
UMLS CUI-1
C0200633
UMLS CUI-2
C0086715
Date
Description

Labs,SampleCollectionDate

Data type

date

Alias
UMLS CUI-1
C1317250
Comments
Description

Comments

Data type

text

Alias
UMLS CUI-1
C0947611
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Similar models

No Instruction available.

1 forms
  1. StudyEvent: NCI Cooperative Group Hematology Laboratory Test Form (CALGB-90104)
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Administrative documentation
C1320722 (UMLS CUI-1)
Coordinating Group Protocol Number
Item
Coordinating Group Protocol Number
text
C3274381 (UMLS CUI-1)
C1711341 (UMLS CUI-2)
CoordinatingGroupCode
Item
Coordinating Group Code
text
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS CUI-1)
Protocol Title
Item
Protocol Title
text
C25320 (NCI Thesaurus ObjectClass)
C2986303 (UMLS CUI-1)
C42774 (NCI Thesaurus Property)
Patient ID Coordinating Group
Item
Patient Study ID, Coordinating Group
text
C2348585 (UMLS CUI-1)
Patient ID Participating Group
Item
Patient Study ID, Participating Group
text
C2348585 (UMLS CUI-1)
C2347449 (UMLS CUI-2)
ParticipatingGroupCode
Item
Participating Group Code
text
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS CUI-1)
InstitutionName
Item
Institution Name
text
AffiliateName
Item
Affiliate
text
Patient Last Name
Item
Patient Last Name (initials acceptable)
text
C1301584 (UMLS CUI-1)
Patient First Name
Item
Patient First Name (initials acceptable)
text
C1443235 (UMLS CUI-1)
Patient Middle Name
Item
Patient Middle Name (initials acceptable)
text
C1320720 (UMLS CUI-1)
PersonCompletingForm,LastName
Item
Person Completing Form, Last Name
text
PersonCompletingForm,FirstName
Item
Person Completing Form, First Name
text
C25190 (NCI Thesaurus ObjectClass)
C25364 (NCI Thesaurus Property)
C0027361 (UMLS CUI-1)
C0600091 (UMLS CUI-2)
Amended Data
Item
Are data amended?
boolean
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)
C0680532 (UMLS CUI-1)
Item Group
Hematology Laboratory Tests
C0474523 (UMLS CUI-1)
WBC
Item
Peripheral WBC Count
float
C0023508 (UMLS CUI-1)
Hemoglobin
Item
Hemoglobin
float
C0019046 (UMLS CUI-1)
Hematocrit
Item
Peripheral Hematocrit Count
float
C0518014 (UMLS CUI-1)
Platelets
Item
Peripheral Platelet Count
float
C1287267 (UMLS CUI-1)
Peripheral Neutrophils
Item
Peripheral Neutrophils
float
C0362987 (UMLS CUI-1)
Peripheral Neutrophil Count
Item
Peripheral Neutrophil Count
float
C0200633 (UMLS CUI-1)
Item
Unit (Normal Range)
text
C1519795 (UMLS CUI-1)
CL.2
Code List
Unit (Normal Range)
CL Item
K/uL (K/uL)
CL Item
G/dl (g/dL)
CL Item
% (%)
WBC LLN
Item
Normal Range-Peripheral WBC Count
float
C0023508 (UMLS CUI-1)
C1518030 (UMLS CUI-2)
Hemoglobin LLN
Item
Normal Range-Hemoglobin
float
C0019046 (UMLS CUI-1)
C1518030 (UMLS CUI-2)
Hematocrit normal range
Item
Normal Range-Peripheral Hematocrit Count (%)
text
C0518014 (UMLS CUI-1)
C0086715 (UMLS CUI-2)
Platelets LLN
Item
Normal Range-Peripheral Platelet Count
float
C25712 (NCI Thesaurus ValueDomain)
C25555 (NCI Thesaurus ValueDomain-2)
C0005821 (UMLS CUI-1)
C1518030 (UMLS CUI-2)
Peripheral Neutrophils Normal Range
Item
Normal Range-Peripheral Neutrophils
text
C0362987 (UMLS CUI-1)
C0086715 (UMLS CUI-2)
Peripheral Neutrophil Count Normal Range
Item
Normal Range-Peripheral Neutrophil Count
text
C0200633 (UMLS CUI-1)
C0086715 (UMLS CUI-2)
Sample Collection Date
Item
Date
date
C1317250 (UMLS CUI-1)
Comments
Item
Comments
text
C0947611 (UMLS CUI-1)
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