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Instructions: Please complete and submit this form within 14 days after the lumbar puncture. All dates are MONTH, DAY, YEAR. Explain any blank fields or blank dates in the Comments section. Place an X in appropriate boxes. Circle AMENDED items in red.

1 forms  
Header
Description

Header

Alias
UMLS CUI-1
C1320722
SWOG Patient ID
Description

SWOGPatientID

Data type

text

Alias
UMLS CUI-1
C2348585
UMLS CUI-2
C1519429
SWOG Study No.
Description

SWOGStudyNo.

Data type

text

Alias
UMLS CUI-1
C3274381
UMLS CUI-2
C1519429
Registration Step
Description

RegistrationStep

Data type

text

Alias
UMLS CUI-1
C1514821
Patient Initials (L, F, M)
Description

PatientInitials

Data type

text

Alias
UMLS CUI-1
C2986440
Institution/Affiliate
Description

MainMemberInstitution/Affiliate

Data type

text

Alias
UMLS CUI-1
C0565990
Physician
Description

Treating Physician

Data type

text

Alias
NCI Thesaurus Property
C25364
NCI Thesaurus ObjectClass
C25741
NCI Thesaurus ObjectClass-2
C25705
UMLS CUI-1
C1710470
Lumbar Puncture
Description

Lumbar Puncture

Alias
UMLS CUI-1
C0037943
Date of Lumbar Puncture
Description

dateofLumbarPuncture

Data type

date

Alias
UMLS CUI-1
C0037943
UMLS CUI-2
C0011008
CNS disease
Description

CNSSiteInd

Data type

text

Alias
UMLS CUI-1
C0007682
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Similar models

Instructions: Please complete and submit this form within 14 days after the lumbar puncture. All dates are MONTH, DAY, YEAR. Explain any blank fields or blank dates in the Comments section. Place an X in appropriate boxes. Circle AMENDED items in red.

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Header
C1320722 (UMLS CUI-1)
SWOGPatientID
Item
SWOG Patient ID
text
C2348585 (UMLS CUI-1)
C1519429 (UMLS CUI-2)
SWOGStudyNo.
Item
SWOG Study No.
text
C3274381 (UMLS CUI-1)
C1519429 (UMLS CUI-2)
RegistrationStep
Item
Registration Step
text
C1514821 (UMLS CUI-1)
PatientInitials
Item
Patient Initials (L, F, M)
text
C2986440 (UMLS CUI-1)
Institution
Item
Institution/Affiliate
text
C0565990 (UMLS CUI-1)
TreatingPhysician
Item
Physician
text
C25364 (NCI Thesaurus Property)
C25741 (NCI Thesaurus ObjectClass)
C25705 (NCI Thesaurus ObjectClass-2)
C1710470 (UMLS CUI-1)
Item Group
Lumbar Puncture
C0037943 (UMLS CUI-1)
Lumbar Puncture Date
Item
Date of Lumbar Puncture
date
C0037943 (UMLS CUI-1)
C0011008 (UMLS CUI-2)
Item
CNS disease
text
C0007682 (UMLS CUI-1)
CL.1
Code List
CNS disease
CL Item
Present (Present)
CL Item
Absent (Absent)
CL Item
Indeterminate (Indeterminate)
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