ID

9837

Description

AMC-053 Enrollment Form (ENR) Bortezomib, Ifosfamide, Carboplatin, and Etoposide, With or Without Rituximab, in Treating Patients With Relapsed or Refractory AIDS-Related Non-Hodgkin Lymphoma NCT00598169 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=8B73192C-C22B-46D4-E040-BB89AD433800

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=8B73192C-C22B-46D4-E040-BB89AD433800

Keywords

Versions (3)
  1. 4/19/12 4/19/12 -
  2. 2/4/15 2/4/15 - Martin Dugas
  3. 2/4/15 2/4/15 - Martin Dugas
Uploaded on

February 4, 2015

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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Registration Enrollment Form (ENR AMC-053 )

German English

Keine Anleitung vorhanden.

1 forms  
  1. StudyEvent: AMC-053 Enrollment Form (ENR)
    1. Keine Anleitung vorhanden.
Hauptmodul
Description

Hauptmodul

Principal Investigator
Description

Principal Investigator

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
NCI Thesaurus Property
C25364
NCI Thesaurus ObjectClass
C19924
UMLS CUI-1
C1521895
Geplantes Startdatum der Behandlung (mm / tt / jjjj)
Description

Treatment Begin Date

Data type

date

Measurement units
  • mm/dd/yyyy
Alias
NCI Thesaurus ObjectClass
C15368
NCI Thesaurus ObjectClass-2
C25631
NCI Thesaurus Property
C25431
NCI Thesaurus Property-2
C25275
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ValueDomain-2
C25431
UMLS CUI-1
C3173309
mm/dd/yyyy
Alter (in Jahren)
Description

Patient Age

Data type

float

Measurement units
  • years
Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus ValueDomain
C29848
NCI Thesaurus ValueDomain-2
C25463
NCI Thesaurus Property
C25150
UMLS CUI-1
C0001779
years
Karnofsky Performance Status
Description

Karnofsky Performance Status

Data type

integer

Alias
NCI Thesaurus Property
C25367
NCI Thesaurus ObjectClass
C20641
NCI Thesaurus ValueDomain
C25338
UMLS CUI-1
C0206065
Datum: Einverständniserklärung unterschrieben (mm / tt / jjjj)
Description

Date Informed Consent Signed

Data type

date

Measurement units
  • mm/dd/yyyy
Alias
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ValueDomain-2
C25367
NCI Thesaurus ObjectClass
C16468
NCI Thesaurus Property
C25679
UMLS CUI-1
C2985782
mm/dd/yyyy
Kommentare
Description

Comments

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
UMLS CUI-1
C0947611
Einschluss / Ausschlusskriterien
Description

Einschluss / Ausschlusskriterien

Einschlusskriterien
Description

AIDSMalignancyConsortiumPatientInclusionClinicalTrialEligibilityCriteria053Type

Data type

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass-2
C19707
UMLS 2011AA ObjectClass-2
C1515830
NCI Thesaurus Property
C16112
UMLS 2011AA Property
C1516637
NCI Thesaurus Property-2
C25532
UMLS 2011AA Property-2
C1512693
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Ausschlusskriterien
Description

Ausschlusskriterien

Ausschlusskriterien
Description

AIDSMalignancyConsortiumPatientExclusionClinicalTrialEligibilityCriteria053Type

Data type

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass-2
C19707
UMLS 2011AA ObjectClass-2
C1515830
NCI Thesaurus Property
C16112
UMLS 2011AA Property
C1516637
NCI Thesaurus Property-2
C25370
UMLS 2011AA Property-2
C0680251
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
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Similar models

Keine Anleitung vorhanden.

1 forms
  1. StudyEvent: AMC-053 Enrollment Form (ENR)
    1. Keine Anleitung vorhanden.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Hauptmodul
Principal Investigator
Item
Principal Investigator
text
C25191 (NCI Thesaurus ValueDomain)
C25364 (NCI Thesaurus Property)
C19924 (NCI Thesaurus ObjectClass)
C1521895 (UMLS CUI-1)
Treatment Begin Date
Item
Geplantes Startdatum der Behandlung (mm / tt / jjjj)
date
C15368 (NCI Thesaurus ObjectClass)
C25631 (NCI Thesaurus ObjectClass-2)
C25431 (NCI Thesaurus Property)
C25275 (NCI Thesaurus Property-2)
C25164 (NCI Thesaurus ValueDomain)
C25431 (NCI Thesaurus ValueDomain-2)
C3173309 (UMLS CUI-1)
Patient Age
Item
Alter (in Jahren)
float
C16960 (NCI Thesaurus ObjectClass)
C29848 (NCI Thesaurus ValueDomain)
C25463 (NCI Thesaurus ValueDomain-2)
C25150 (NCI Thesaurus Property)
C0001779 (UMLS CUI-1)
Karnofsky Performance Status
Item
Karnofsky Performance Status
integer
C25367 (NCI Thesaurus Property)
C20641 (NCI Thesaurus ObjectClass)
C25338 (NCI Thesaurus ValueDomain)
C0206065 (UMLS CUI-1)
Date Informed Consent Signed
Item
Datum: Einverständniserklärung unterschrieben (mm / tt / jjjj)
date
C25164 (NCI Thesaurus ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
C16468 (NCI Thesaurus ObjectClass)
C25679 (NCI Thesaurus Property)
C2985782 (UMLS CUI-1)
Comments
Item
Kommentare
text
C25704 (NCI Thesaurus ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0947611 (UMLS CUI-1)
Item Group
Einschluss / Ausschlusskriterien
Item
Einschlusskriterien
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C19707 (NCI Thesaurus ObjectClass-2)
C1515830 (UMLS 2011AA ObjectClass-2)
C16112 (NCI Thesaurus Property)
C1516637 (UMLS 2011AA Property)
C25532 (NCI Thesaurus Property-2)
C1512693 (UMLS 2011AA Property-2)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.1
Code List
Einschlusskriterien
CL Item
Alter des Teilnehmers (in Jahren) (Participant's age (in years))
Item Group
Ausschlusskriterien
Item
Ausschlusskriterien
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C19707 (NCI Thesaurus ObjectClass-2)
C1515830 (UMLS 2011AA ObjectClass-2)
C16112 (NCI Thesaurus Property)
C1516637 (UMLS 2011AA Property)
C25370 (NCI Thesaurus Property-2)
C0680251 (UMLS 2011AA Property-2)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.2
Code List
Ausschlusskriterien
CL Item
Hat der Teilnehmer eine aktive Hepatitis B-Infektion (Does the participant have an active hepatitis B infection)
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