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  1. StudyEvent: AMC-052 HPV On-Study Form
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Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
HIV status
HumanImmunodeficiencyVirusDiagnosisDate
Item
Date of HIV+ diagnosis
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C14219 (NCI Thesaurus ObjectClass)
C0019682 (UMLS 2011AA ObjectClass)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
Item
CDC HIV Risk Group
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C14219 (NCI Thesaurus Property)
C0019682 (UMLS 2011AA Property)
C17102 (NCI Thesaurus Property-2)
C0035647 (UMLS 2011AA Property-2)
C25161 (NCI Thesaurus Property-3)
C0008902 (UMLS 2011AA Property-3)
C25372 (NCI Thesaurus ValueDomain)
C0683312 (UMLS 2011AA ValueDomain)
Code List
CDC HIV Risk Group
CL Item
Hemophilia (Hemophiliac)
C3093 (NCI Thesaurus)
C0684275 (UMLS 2011AA)
CL Item
Heterosexual Contact (Heterosexual contact)
CL Item
Homosexual Or Bisexual Contact (Homosexual or bisexual contact)
CL Item
Iv Drug User (IV drug user)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
CL Item
Transfusion Recipient (Transfusion recipient)
PatientHumanImmunodeficiencyVirusRiskCategorySpecify
Item
Other, specify
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C14219 (NCI Thesaurus Property)
C0019682 (UMLS 2011AA Property)
C17102 (NCI Thesaurus Property-2)
C0035647 (UMLS 2011AA Property-2)
C25161 (NCI Thesaurus Property-3)
C0008902 (UMLS 2011AA Property-3)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
LaboratoryProcedureCD4+LowestResultCount
Item
Lowest CD4+ count ever reported
float
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C12537 (NCI Thesaurus Property-2)
C0039215 (UMLS 2011AA Property-2)
C43517 (NCI Thesaurus Property-3)
C1708760 (UMLS 2011AA Property-3)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
PriorChemotherapyAdministeredInd-3
Item
Prior Systemic Chemotherapy
boolean
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C15632 (NCI Thesaurus ObjectClass)
C0392920 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus ObjectClass-2)
C0332152 (UMLS 2011AA ObjectClass-2)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
PatientRadiationTherapyReceivedInd-2
Item
Has the patient received radiation therapy?
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C15313 (NCI Thesaurus Property)
C1522449 (UMLS 2011AA Property)
C25639 (NCI Thesaurus Property-2)
C1514756 (UMLS 2011AA Property-2)
Item Group
Condyloma
HumanPapillomavirusDiseaseGenitalAnalCondylomaPersonalMedicalHistoryInd-2
Item
History of anal, perianal, or genital condyloma (If yes check all that apply)
boolean
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C14226 (NCI Thesaurus ObjectClass-2)
C0021344 (UMLS 2011AA ObjectClass-2)
C13348 (NCI Thesaurus Property)
C0559522 (UMLS 2011AA Property)
C18772 (NCI Thesaurus Property-2)
C0262926 (UMLS 2011AA Property-2)
C4054 (NCI Thesaurus Property-3)
C0281779 (UMLS 2011AA Property-3)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
Item
History of penile or genital condyloma
text
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C14226 (NCI Thesaurus ObjectClass-2)
C0021344 (UMLS 2011AA ObjectClass-2)
C13348 (NCI Thesaurus Property)
C0559522 (UMLS 2011AA Property)
C12409 (NCI Thesaurus Property-2)
C0030851 (UMLS 2011AA Property-2)
C18772 (NCI Thesaurus Property-3)
C0262926 (UMLS 2011AA Property-3)
C2960 (NCI Thesaurus Property-4)
C0009663 (UMLS 2011AA Property-4)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
Code List
History of penile or genital condyloma
CL Item
Active Genital Condyloma (Active genital condyloma)
CL Item
Active Penile Condyloma (Active penile condyloma)
CL Item
No History (No history)
CL Item
Yes, Resolved With History Of Treatment (Yes, resolved with history of treatment)
CL Item
Yes, Resolved Without Treatment (Yes, resolved without treatment)
Item
History of perianal condyloma
text
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C14226 (NCI Thesaurus ObjectClass-2)
C0021344 (UMLS 2011AA ObjectClass-2)
C18772 (NCI Thesaurus Property)
C0262926 (UMLS 2011AA Property)
C52247 (NCI Thesaurus Property-2)
C1282914 (UMLS 2011AA Property-2)
C4054 (NCI Thesaurus Property-3)
C0281779 (UMLS 2011AA Property-3)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
Code List
History of perianal condyloma
CL Item
Active Perianal Condyloma (Active perianal condyloma)
CL Item
No History (No history)
CL Item
Yes, Resolved With History Of Treatment (Yes, resolved with history of treatment)
CL Item
Yes, Resolved Without Treatment (Yes, resolved without treatment)
Item
History of intraanal condlyoma
text
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C14226 (NCI Thesaurus ObjectClass-2)
C0021344 (UMLS 2011AA ObjectClass-2)
C25234 (NCI Thesaurus Property)
C0205102 (UMLS 2011AA Property)
C18772 (NCI Thesaurus Property-2)
C0262926 (UMLS 2011AA Property-2)
C4054 (NCI Thesaurus Property-3)
C0281779 (UMLS 2011AA Property-3)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
Code List
History of intraanal condlyoma
CL Item
Active Intraanal Condyloma (Active intraanal condyloma)
CL Item
No History (No history)
CL Item
Yes, Resolved With History Of Treatment (Yes, resolved with history of treatment)
CL Item
Yes, Resolved Without Treatment (Yes, resolved without treatment)
Item Group
Anal cytology/biopsy
Item
Anal cytology performed (prior to screening to AMC052)
text
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C16491 (NCI Thesaurus ObjectClass)
C0010819 (UMLS 2011AA ObjectClass)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C28048 (NCI Thesaurus ObjectClass-2)
Code List
Anal cytology performed (prior to screening to AMC052)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Participant Does Not Recall (Participant does not recall)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Anal cytology result (if yes)
text
C16491 (NCI Thesaurus ObjectClass)
C0010819 (UMLS 2011AA ObjectClass)
C19157 (NCI Thesaurus ObjectClass-2)
C0370003 (UMLS 2011AA ObjectClass-2)
C28048 (NCI Thesaurus ObjectClass-3)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Anal cytology result (if yes)
CL Item
Asc-h (ASC-H)
CL Item
Ascus (ASCUS)
CL Item
High Grade Sil (High grade SIL)
CL Item
Low Grade Sil (Low grade SIL)
CL Item
Normal (Normal)
C14165 (NCI Thesaurus)
C0205307 (UMLS 2011AA)
CL Item
No Information Available (Results not available)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Anal or perianal biopsy performed (prior to screening to AMC052)
text
C15189 (NCI Thesaurus ObjectClass)
C0005558 (UMLS 2011AA ObjectClass)
C43362 (NCI Thesaurus ObjectClass-2)
C0003461 (UMLS 2011AA ObjectClass-2)
C28048 (NCI Thesaurus ObjectClass-3)
C52247 (NCI Thesaurus ObjectClass-4)
C1282914 (UMLS 2011AA ObjectClass-3)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
Code List
Anal or perianal biopsy performed (prior to screening to AMC052)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Participant Does Not Recall (Participant does not recall)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Most severe anal biopsy result
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C15189 (NCI Thesaurus ObjectClass)
C0005558 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C28048 (NCI Thesaurus ObjectClass-2)
Code List
Most severe anal biopsy result
CL Item
Condyloma (Condyloma)
CL Item
High-grade Ain (High-grade AIN)
CL Item
Invasive Cancer (Invasive cancer)
CL Item
Low-grade Ain (Low-grade AIN)
CL Item
Normal (Normal)
C14165 (NCI Thesaurus)
C0205307 (UMLS 2011AA)
CL Item
Squamous Metaplasia (Squamous metaplasia)
C3237 (NCI Thesaurus)
C0025570 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item Group
Footer module
Smoking history
Item
Smoked at least 100 cigarettes (5 packs) during lifetime
boolean
C25180 (NCI Thesaurus ValueDomain)
C1519384 (UMLS CUI-1)
C17934 (NCI Thesaurus ObjectClass)
C18772 (NCI Thesaurus Property)
Item
Document type
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C42651 (NCI Thesaurus ObjectClass)
C0442711 (UMLS 2011AA ObjectClass)
C19498 (NCI Thesaurus ObjectClass-2)
C1547673 (UMLS 2011AA ObjectClass-2)
C25695 (NCI Thesaurus Property)
C1515023 (UMLS 2011AA Property)
Code List
Document type
CL Item
Lab Report (Lab Report)
CL Item
Physician/provider Report Or Clinical Note (Physician/provider report or clinical note)
CL Item
Subject Recall (Subject recall)

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