No Instruction available.

1 forms
  1. StudyEvent: Screening
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Screening
Protocol ID NCI
Item
DCP Protocol #
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1513882 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C19202 (NCI Thesaurus Property-2)
NationalCancerInstituteInstituteCode
Item
Institution Code
text
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
C21541 (NCI Thesaurus ObjectClass)
C0018704 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
ParticipantIdentifier
Item
Participant ID
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25364 (NCI Thesaurus ValueDomain)
C0600091 (UMLS 2011AA ValueDomain)
VisitTypeText
Item
Visit Type
text
C25284 (NCI Thesaurus Property)
C0332307 (UMLS 2011AA Property)
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25716 (NCI Thesaurus ObjectClass)
C0545082 (UMLS 2011AA ObjectClass)
VisitDate
Item
Visit Date
date
C25164 (NCI Thesaurus Property)
C0011008 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
C25716 (NCI Thesaurus ObjectClass)
C0545082 (UMLS 2011AA ObjectClass)
Item Group
Screening
ScreeningInformedConsentSignedDate
Item
Date Screening Informed Consent Signed
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C48261 (NCI Thesaurus ObjectClass)
C1710032 (UMLS 2011AA ObjectClass)
C16735 (NCI Thesaurus ObjectClass-2)
C0021430 (UMLS 2011AA ObjectClass-2)
C25679 (NCI Thesaurus Property)
Item
Not Obtained (If the screening date is not applicable check box.)
text
C25180 (NCI Thesaurus Property)
C1522602 (UMLS 2011AA Property)
CL310460 (NCI Metathesaurus ObjectClass)
CL052458 (NCI Metathesaurus ObjectClass-2)
C0021212 (NCI Metathesaurus ValueDomain)
CL.2
Code List
Not Obtained (If the screening date is not applicable check box.)
CL Item
Not Applicable (Not Applicable)
C48660 (NCI Thesaurus)
C1272460 (UMLS 2011AA)
Item
Not Obtained (If the screening date is not applicable check box.)
text
C25180 (NCI Thesaurus Property)
C1522602 (UMLS 2011AA Property)
CL310460 (NCI Metathesaurus ObjectClass)
CL052458 (NCI Metathesaurus ObjectClass-2)
C0021212 (NCI Metathesaurus ValueDomain)
CL.2
Code List
Not Obtained (If the screening date is not applicable check box.)
CL Item
Not Applicable (Not Applicable)
C48660 (NCI Thesaurus)
C1272460 (UMLS 2011AA)
ScreenDate
Item
Screening Date
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C48261 (NCI Thesaurus Property)
C1710032 (UMLS 2011AA Property)
C15207 (NCI Thesaurus ObjectClass)
ProtocolScreenIndicator
Item
Is the participant a screen failure? (If the participant is a screen failure, please select the primary reason for the screen failure.)
boolean
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C48261 (NCI Thesaurus Property)
C1710032 (UMLS 2011AA Property)
C15207 (NCI Thesaurus ObjectClass)
Item
If yes, specify primary reason for screen failure (Select the primary reason for the screen failure.)
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25638 (NCI Thesaurus ValueDomain-2)
C0392360 (UMLS 2011AA ValueDomain-2)
C48261 (NCI Thesaurus Property)
C1710032 (UMLS 2011AA Property)
C15207 (NCI Thesaurus ObjectClass)
CL.4
Code List
If yes, specify primary reason for screen failure (Select the primary reason for the screen failure.)
CL Item
Did Not Meet Eligibility Criteria, Specify (Did not meet eligibility criteria, specify)
CL Item
Investigator Decision (Investigator decision)
CL Item
Other, Specify (Other, specify)
CL Item
Participant Decision (Participant Decision)
OtherSpecifyText
Item
Other, Specify (Enter the free text for the primary reason for the screen failure.)
text
C25685 (NCI Thesaurus Property)
C1521902 (UMLS 2011AA Property)
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C17649 (NCI Thesaurus ObjectClass)
C0205394 (UMLS 2011AA ObjectClass)
C25638 (NCI Thesaurus Property-2)
C0392360 (UMLS 2011AA Property-2)
Research Comments
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C0947611 (UMLS CUI-1)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
Item
Who referred participant?
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25683 (NCI Thesaurus Property)
C0449416 (UMLS 2011AA Property)
C52582 (NCI Thesaurus Property-2)
C0034927 (UMLS 2011AA Property-2)
C25683 (NCI Thesaurus ValueDomain)
C0449416 (UMLS 2011AA ValueDomain)
C42614 (NCI Thesaurus ValueDomain-2)
C0027365 (UMLS 2011AA ValueDomain-2)
C52582 (NCI Thesaurus ValueDomain-3)
C0034927 (UMLS 2011AA ValueDomain-3)
CL.5
Code List
Who referred participant?
CL Item
Physician (Physician)
C25741 (NCI Thesaurus)
C0031831 (UMLS 2011AA)
CL Item
Health Care Provider (Health Care Provider)
C16666 (NCI Thesaurus)
C0018724 (UMLS 2011AA)
CL Item
Friend Family (Family/Friend)
C25173 (NCI Thesaurus)
C0015576 (UMLS 2011AA)
C72884 (NCI Thesaurus-3)
C0079382 (UMLS 2011AA-4)
CL Item
Self (Self)
C25200 (NCI Thesaurus)
C0036588 (UMLS 2011AA)
CL Item
Other (Other, specify)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
PatientReferralSourceOtherSpecify
Item
Other, specify
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25683 (NCI Thesaurus Property)
C0449416 (UMLS 2011AA Property)
C52582 (NCI Thesaurus Property-2)
C0034927 (UMLS 2011AA Property-2)
Item
How did participant find out about the study?
text
C29867 (NCI Thesaurus ObjectClass)
C0679646 (UMLS 2011AA ObjectClass)
C63536 (NCI Thesaurus Property)
C2603343 (UMLS 2011AA Property)
C62262 (NCI Thesaurus Property-2)
C1880355 (UMLS 2011AA Property-2)
C25683 (NCI Thesaurus ValueDomain)
C0449416 (UMLS 2011AA ValueDomain)
C42614 (NCI Thesaurus ValueDomain-2)
C0027365 (UMLS 2011AA ValueDomain-2)
C62262 (NCI Thesaurus ValueDomain-3)
C1880355 (UMLS 2011AA ValueDomain-3)
CL.6
Code List
How did participant find out about the study?
CL Item
Physician (Physician)
C25741 (NCI Thesaurus)
C0031831 (UMLS 2011AA)
CL Item
Nurse (Nurse)
C20821 (NCI Thesaurus)
C0028661 (UMLS 2011AA)
CL Item
Friend Family (Family/Friend)
C25173 (NCI Thesaurus)
C0015576 (UMLS 2011AA)
C72884 (NCI Thesaurus-3)
C0079382 (UMLS 2011AA-4)
CL Item
Web Site National Cancer Institute (NCI web site)
C19202 (NCI Thesaurus)
C1513882 (UMLS 2011AA)
C67518 (NCI Thesaurus-3)
C2349146 (UMLS 2011AA-4)
CL Item
Written Material (Written material)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
CL Item
Specify Other (Other, specify)
C25685 (NCI Thesaurus)
C1521902 (UMLS 2011AA)
C17649 (NCI Thesaurus-3)
C0205394 (UMLS 2011AA-4)
ParticipantDiscoverStudyOtherSpecify
Item
Other, specify
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C29867 (NCI Thesaurus ObjectClass)
C0679646 (UMLS 2011AA ObjectClass)
C63536 (NCI Thesaurus Property)
C2603343 (UMLS 2011AA Property)
C62262 (NCI Thesaurus Property-2)
C1880355 (UMLS 2011AA Property-2)
Item Group
Dcp Template Footer
Protocol Title
Item
Protocol Title
text
C25191 (NCI Thesaurus ValueDomain)
C2986303 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C42774 (NCI Thesaurus Property)
Protocol Version
Item
Protocol Version
text
C25704 (NCI Thesaurus ValueDomain)
C2985700 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C25364 (NCI Thesaurus Property)
Protocol Version
Item
Protocol Version
text
C25704 (NCI Thesaurus ValueDomain)
C2985700 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C25364 (NCI Thesaurus Property)
Protocol Version Date
Item
Protocol Date
date
C25164 (NCI Thesaurus ValueDomain)
C2985700 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C0011008 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25367 (NCI Thesaurus ValueDomain-2)
PageNumber
Item
Page #
float
C25337 (NCI Thesaurus Property)
C0237753 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C0439643 (NCI Metathesaurus ObjectClass)
CaseReportFormTotalPageNumber
Item
Total Page Number
text
C40988 (NCI Thesaurus ObjectClass)
C1516308 (UMLS 2011AA ObjectClass)
C25337 (NCI Thesaurus Property)
C0237753 (UMLS 2011AA Property)
C25304 (NCI Thesaurus Property-2)
C0439810 (UMLS 2011AA Property-2)
C42783 (NCI Thesaurus Property-3)
C1704732 (UMLS 2011AA Property-3)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
DCPTemplateVersionText
Item
DCP Template Version
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C0728990 (NCI Metathesaurus ObjectClass)
C25714 (NCI Thesaurus Property)
C0333052 (UMLS 2011AA Property)
Back to the top of the page 

Contact

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

Fields marked with * are required.

Help

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