No Instruction available.

  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP DENTAL EXAMINATION FORM (S0307)
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Header
Item
Time
text
Code List
Time
CL Item
Prestudy (Prestudy)
CL Item
End Of Protocol Treatment (End of protocol treatment)
Institution Name
Item
Institution/Affiliate
text
C25454 (NCI Thesaurus ObjectClass)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
C25191 (NCI Thesaurus ValueDomain)
C21541 (NCI Thesaurus ValueDomain-2)
Investigator Name
Item
Physician
text
C25191 (NCI Thesaurus ValueDomain)
C2826892 (UMLS CUI-1)
C25364 (NCI Thesaurus Property)
C17089 (NCI Thesaurus ObjectClass)
C25644 (NCI Thesaurus ObjectClass-2)
Participating Group
Item
Participating Group Name
text
C25191 (NCI Thesaurus ValueDomain)
C2347449 (UMLS CUI-1)
C25608 (NCI Thesaurus ObjectClass)
C17005 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
Study Number Participating Group
Item
Participating Group Study No.
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Trial subject ID Participating Group
Item
Participating Group Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Trial subject ID SWOG
Item
SWOG Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1519429 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25699 (NCI Thesaurus Property-2)
Protocol ID SWOG
Item
SWOG Study No.
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1519429 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25699 (NCI Thesaurus Property-2)
Registration Number
Item
Registration Step
text
C25337 (NCI Thesaurus ValueDomain)
C1514821 (UMLS CUI-1)
C25646 (NCI Thesaurus ObjectClass)
C0237753 (UMLS CUI-2)
C16154 (NCI Thesaurus Property)
C16154 (NCI Thesaurus ValueDomain-2)
Patient Initials
Item
Patient Initials (L, F, M)
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
Item Group
Examination Date
ExaminationDate
Item
Examination Date
date
C25164 (NCI Thesaurus Property)
C0011008 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C0031809 (NCI Metathesaurus ObjectClass)
Item Group
Periodontal Examination
Item
Dental plaque levels
text
C12506 (NCI Thesaurus Property)
C0040426 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
C0226984 (NCI Metathesaurus ObjectClass)
Code List
Dental plaque levels
CL Item
None (None)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Mild (Mild)
C70666 (NCI Thesaurus)
C2945599 (UMLS 2011AA)
CL Item
Moderate (Moderate)
CL Item
Severe (Severe)
Item
Calculus
text
C12506 (NCI Thesaurus Property)
C0040426 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
C0226984 (NCI Metathesaurus ObjectClass)
Code List
Calculus
CL Item
None (None)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Mild (Mild)
C70666 (NCI Thesaurus)
C2945599 (UMLS 2011AA)
CL Item
Moderate (Moderate)
CL Item
Severe (Severe)
Item
Gingivitis
text
C32677 (NCI Thesaurus Property)
C0017562 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
C0226984 (NCI Metathesaurus ObjectClass)
Code List
Gingivitis
CL Item
None (None)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Mild (Mild)
C70666 (NCI Thesaurus)
C2945599 (UMLS 2011AA)
CL Item
Moderate (Moderate)
CL Item
Severe (Severe)
CL Item
Patchy (Patchy)
CL Item
Generalized (Generalized)
Item
Periodontis
text
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
C33304 (NCI Thesaurus Property)
C0031093 (UMLS 2011AA Property)
Code List
Periodontis
CL Item
All Pockets 4 Mm Or Less (All pockets 4 mm or less)
CL Item
Pockets > 6 Mm (Pockets > 6 mm)
CL Item
Pockets >=4 Mm <=6 Mm (Pockets >=4 mm =<6 mm)
DentalToothIdentifierSpecify
Item
Teeth Numbers
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C41136 (NCI Thesaurus ObjectClass)
C0226984 (UMLS 2011AA ObjectClass)
C12506 (NCI Thesaurus ObjectClass-2)
C0040426 (UMLS 2011AA ObjectClass-2)
Item
Overall periodontal disease level
text
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
C33304 (NCI Thesaurus Property)
C0031093 (UMLS 2011AA Property)
Code List
Overall periodontal disease level
CL Item
None (None)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Mild (Mild)
C70666 (NCI Thesaurus)
C2945599 (UMLS 2011AA)
CL Item
Moderate (Moderate)
CL Item
Severe (Severe)
Item Group
Dentition Examination
Item
Dentition Examination
text
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C41136 (NCI Thesaurus ObjectClass)
C0226984 (UMLS 2011AA ObjectClass)
Code List
Dentition Examination
CL Item
None (None)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
DentalToothCariesDescriptionSpecify
Item
Deep carries (within 3 mm or pulp: List teeth numbers)
text
C41136 (NCI Thesaurus ObjectClass)
C0226984 (UMLS 2011AA ObjectClass)
C12506 (NCI Thesaurus ObjectClass-2)
C0040426 (UMLS 2011AA ObjectClass-2)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
CL159156 (NCI Metathesaurus Property)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
DentalToothFractureDescriptionSpecify
Item
Fractured teeth / restorations (List teeth numbers)
text
C41136 (NCI Thesaurus ObjectClass)
C0226984 (UMLS 2011AA ObjectClass)
C12506 (NCI Thesaurus ObjectClass-2)
C0040426 (UMLS 2011AA ObjectClass-2)
C3046 (NCI Thesaurus Property)
C0016658 (UMLS 2011AA Property)
C25365 (NCI Thesaurus Property-2)
C0678257 (UMLS 2011AA Property-2)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
Item Group
Endodontic Examination
Item
Endodontic Examination
text
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C41136 (NCI Thesaurus ObjectClass)
C0226984 (UMLS 2011AA ObjectClass)
Code List
Endodontic Examination
CL Item
None (None)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
InternalDentalToothTreatmentText
Item
Endodontically treated teeth (List teeth numbers)
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C15368 (NCI Thesaurus Property)
C0226984 (NCI Metathesaurus ObjectClass)
InternalDentalToothFailureText
Item
Failing root canals (List teeth numbers)
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25745 (NCI Thesaurus Property)
C0231174 (UMLS 2011AA Property)
C0226984 (NCI Metathesaurus ObjectClass)
Item Group
Removable Dentures
Item
Removable Dentures
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C63720 (NCI Thesaurus ObjectClass)
C0011394 (UMLS 2011AA ObjectClass)
C25340 (NCI Thesaurus Property)
C0457083 (UMLS 2011AA Property)
Code List
Removable Dentures
CL Item
None (None)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Complete Dentures (Complete dentures)
CL Item
Removable Partial Dentures (Removable partial dentures)
DentureUseAgeYearCount
Item
Age of dentures
float
C29848 (NCI Thesaurus ValueDomain)
C0439234 (UMLS 2011AA ValueDomain)
C25463 (NCI Thesaurus ValueDomain-2)
C0750480 (UMLS 2011AA ValueDomain-2)
C63720 (NCI Thesaurus ObjectClass)
C0011394 (UMLS 2011AA ObjectClass)
C25340 (NCI Thesaurus Property)
C0457083 (UMLS 2011AA Property)
DentureAdjustmentMostRecentDate
Item
Last reline/adjustment date
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C63720 (NCI Thesaurus ObjectClass)
C0011394 (UMLS 2011AA ObjectClass)
C25577 (NCI Thesaurus ValueDomain-2)
C1513491 (UMLS 2011AA ValueDomain-2)
C49157 (NCI Thesaurus Property)
C0456081 (UMLS 2011AA Property)
Item
Stability
text
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C63720 (NCI Thesaurus ObjectClass)
C0011394 (UMLS 2011AA ObjectClass)
C54072 (NCI Thesaurus Property)
C0205360 (UMLS 2011AA Property)
Code List
Stability
CL Item
Good (Good)
CL Item
Fair (Fair)
CL Item
Poor (Poor)
Item
Stability
text
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C63720 (NCI Thesaurus ObjectClass)
C0011394 (UMLS 2011AA ObjectClass)
C54072 (NCI Thesaurus Property)
C0205360 (UMLS 2011AA Property)
Code List
Stability
CL Item
Good (Good)
CL Item
Fair (Fair)
CL Item
Poor (Poor)
Item
Retention
text
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C38016 (NCI Thesaurus Property)
C0333117 (UMLS 2011AA Property)
C63720 (NCI Thesaurus ObjectClass)
C0011394 (UMLS 2011AA ObjectClass)
Code List
Retention
CL Item
Good (Good)
CL Item
Fair (Fair)
CL Item
Poor (Poor)
Item
Retention
text
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C38016 (NCI Thesaurus Property)
C0333117 (UMLS 2011AA Property)
C63720 (NCI Thesaurus ObjectClass)
C0011394 (UMLS 2011AA ObjectClass)
Code List
Retention
CL Item
Good (Good)
CL Item
Fair (Fair)
CL Item
Poor (Poor)
Item
Evidence of denture sores/denture stomatitis
text
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C63720 (NCI Thesaurus ObjectClass)
C0011394 (UMLS 2011AA ObjectClass)
C25340 (NCI Thesaurus Property)
C0457083 (UMLS 2011AA Property)
Code List
Evidence of denture sores/denture stomatitis
CL Item
None (None)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Mild (Mild)
C70666 (NCI Thesaurus)
C2945599 (UMLS 2011AA)
CL Item
Moderate (Moderate)
CL Item
Severe (Severe)
Trial subject ID SWOG
Item
SWOG Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1519429 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25699 (NCI Thesaurus Property-2)
Protocol ID SWOG
Item
SWOG Study No.
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1519429 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25699 (NCI Thesaurus Property-2)
Registration Number
Item
Registration Step
text
C25337 (NCI Thesaurus ValueDomain)
C1514821 (UMLS CUI-1)
C25646 (NCI Thesaurus ObjectClass)
C0237753 (UMLS CUI-2)
C16154 (NCI Thesaurus Property)
C16154 (NCI Thesaurus ValueDomain-2)
Patient Initials
Item
Patient Initials (L, F, M)
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
Item Group
Osteonecrotic Jaw Lesions
AnatomicSiteName
Item
Site
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C13717 (NCI Thesaurus ObjectClass)
C1515974 (UMLS 2011AA ObjectClass)
C25704 (NCI Thesaurus ValueDomain-2)
C1527021 (UMLS 2011AA ValueDomain-2)
C25367 (NCI Thesaurus Property)
NecroticBoneLesionText
Item
Size
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C12366 (NCI Thesaurus ObjectClass)
C0262950 (UMLS 2011AA ObjectClass)
C0221198 (NCI Metathesaurus Property)
DiseaseOnsetDate
Item
Date of onset
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C25279 (NCI Thesaurus Property)
C0332162 (UMLS 2011AA Property)
Item
Associated factor(s)
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C12366 (NCI Thesaurus ObjectClass)
C0262950 (UMLS 2011AA ObjectClass)
C0221198 (NCI Metathesaurus Property)
Code List
Associated factor(s)
CL Item
Periodontal Infection (Periodontal infection)
CL Item
Dental Extraction (Dental extraction)
CL Item
Denture Trauma (Denture trauma)
CL Item
Other Dental Surgery (Other dental surgery)
CL Item
No Identified Factor (No identified factor)
DentistSignatureText
Item
Signature of examining dentist
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25678 (NCI Thesaurus Property)
C1519316 (UMLS 2011AA Property)
C0011441 (NCI Metathesaurus ObjectClass)
Investigator Signature Date
Item
date
date
C25164 (NCI Thesaurus ValueDomain)
C2346576 (UMLS CUI-1)
C25678 (NCI Thesaurus Property)
C0011008 (UMLS CUI-2)
C25367 (NCI Thesaurus ValueDomain-2)
C17089 (NCI Thesaurus ObjectClass)
Item Group
Comments
Research Comments
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C0947611 (UMLS CUI-1)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)

Please use this form for feedback, questions and suggestions for improvements.

Fields marked with * are required.

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial