Instructions: Submit a copy of this form to the SWOG Statistical Center. Mail required materials and this form to the following pathologist: David Head, MD Vanderbilt Clinical Labs 4605 TVC 1161 21st Ave. S. Nashville, TN 37232

Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Ccrr Module For S0100 Pathology Submission Form
C0030664 (UMLS CUI-1)
C0023418 (UMLS CUI-2)
Study Number
Item
SWOG Study No.
text
C0008976 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
Registration Step
Item
Registration Step
text
C1514821 (UMLS CUI-1)
Patient ID
Item
SWOG Patient ID
text
C2348585 (UMLS CUI [1])
Patient Initials
Item
Patient Initials
text
C2986440 (UMLS CUI [1])
Institution
Item
Institution/Affiliate
text
C1301943 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
Treating Physician
Item
Physician
text
C25364 (NCI Thesaurus Property)
C25741 (NCI Thesaurus ObjectClass)
C25705 (NCI Thesaurus ObjectClass-2)
C1710470 (UMLS CUI [1])
Item
Reason for Submission
text
C0030673 (UMLS CUI [1,1])
C0392360 (UMLS CUI [1,2])
Code List
Reason for Submission
CL Item
Prestudy (Prestudy)
Number of Slides
Item
No. of Slides
text
C1705201 (UMLS CUI [1,1])
C0449788 (UMLS CUI [1,2])
Specimen Collection Date
Item
Date Sample Obtained
date
C1302413 (UMLS CUI [1])
Peripheral Smear Slide
Item
1 W Peripheral Smear Slide, Enclosed
boolean
C25180 (NCI Thesaurus ValueDomain)
C2238079 (UMLS CUI [1,1])
C1705201 (UMLS CUI [1,2])
Aspirate Slide
Item
1 WG Stained BM Aspirate Slide, Enclosed
boolean
C25180 (NCI Thesaurus ValueDomain)
C0370199 (UMLS CUI [1,1])
C1705201 (UMLS CUI [1,2])
Unstained Smear Slides
Item
5 Unstained Smear Slides, Enclosed
boolean
C25180 (NCI Thesaurus ValueDomain)
C0444186 (UMLS CUI [1,1])
C1705201 (UMLS CUI [1,2])
BM Report
Item
BM Report, Enclosed
boolean
C25180 (NCI Thesaurus ValueDomain)
C0684224 (UMLS CUI [1])
Leukemia Addendum
Item
Pathology Submission form - Leukemia Addendum, Enclosed
boolean
C25180 (NCI Thesaurus ValueDomain)
C0023418 (UMLS CUI [1,1])
C1510776 (UMLS CUI [1,2])
Stained biopsy touch prep
Item
1 Stained biopsy touch prep, Enclosed
boolean
C0005558 (UMLS CUI [1,1])
C2986582 (UMLS CUI [1,2])
C2827487 (UMLS CUI [1,3])
Unstained biopsy touch preps
Item
4 Unstained biopsy touch preps, Enclosed
boolean
C25180 (NCI Thesaurus ValueDomain)
C0005558 (UMLS CUI [1,1])
C2827487 (UMLS CUI [1,2])
C1883469 (UMLS CUI [1,3])
H&E biopsy
Item
1 H&E section of the biopsy, Enclosed
boolean
C25180 (NCI Thesaurus ValueDomain)
C0523207 (UMLS CUI [1,1])
C0005558 (UMLS CUI [1,2])
Unstained peripheral blood smears
Item
4 Unstained peripheral blood smears, Enclosed
boolean
C25180 (NCI Thesaurus ValueDomain)
C2238079 (UMLS CUI [1,1])
C1705201 (UMLS CUI [1,2])
C1883469 (UMLS CUI [1,3])
Specimen ID
Item
Specimen #
text
C0370003 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
Comments
Item
Notes
text
C0947611 (UMLS CUI [1,1])
C0030664 (UMLS CUI [1,2])
C0023418 (UMLS CUI [1,3])

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