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  1. 1. Clinical Trial
  2. 2. Routine Documentation
  3. 3. Registry/Cohort Study
  4. 4. Quality Assurance
  5. 5. Data Standard
  6. 6. Patient-Reported Outcome
  7. 7. Medical Specialty
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AMC-045 Complete Physical Exam Form (F21) NCT00324415

- 7/8/15 - 1 form, 3 itemgroups, 7 items, 1 language
Itemgroups: Header module, Physical Exam, Comments
AMC-045 Complete Physical Exam Form (F21) NCT00324415 Cisplatin, Fluorouracil, Cetuximab, and Radiation Therapy in Treating Patients With HIV and Stage I, Stage II, or Stage III Anal Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=4428A103-FC35-0EB3-E044-0003BA3F9857

H and P or consult specialty - HIS

- 6/26/15 - 1 form, 32 itemgroups, 281 items, 2 languages
Itemgroups: H and P or consult specialty, HISTORY OF PRESENT ILLNESS, REVIEW OF SYSTEMS, PAST HISTORY, Female Specific History, FAMILY HISTORY, SOCIAL HISTORY, ALLERGIES, MEDICATIONS, PHYSICAL EXAM - General, PHYSICAL EXAM - HEAD, PHYSICAL EXAM - EYES, Physical Exam - Ears, Nose, Throat, Physical Exam - Neck, Physical Exam - BREAST, Physical Exam - CHEST, Physical Exam - HEART, Physical Exam - VASCULAR, Physical Exam - ABDOMEN, Physical Exam - GENITOURINARY/RECTAL: MALE, Physical Exam - GENITOURINARY/RECTAL: FEMALE, Physical Exam -MUSCULOSKELETAL, Physical Exam - EXTREMITIES, Physical Exam - LYMPHATIC, Physical Exam - SKIN, Physical Exam - Wound and Incision Care , Physical Exam - NEUROLOGIC, PSYCHIATRIC, Laboratory Results, Radiology Results, ASSESSMENT, PLAN
Form from HIS OpenVistA

SIOP CNS GCT II DRKS00003907 - Physical development and additional pretherapeutic measurements

- 6/25/15 - 1 form, 4 itemgroups, 16 items, 2 languages
Itemgroups: Physical development, Sexual development, Renal toxicity, Toxicity Pure tone audiogram or BAER
SIOP CNS GCT II: Prospective Trial for the Diagnosis and Treatment of Children, Adolescents and Young Adults With Intracranial Germ Cell Tumors. Principal Investigator Gabriele Calaminus, MD. http://clinicaltrials.gov/show/NCT01424839

AMC-051 Complete Physical Exam Form (F21) NCT00450320

- 6/3/15 - 1 form, 3 itemgroups, 7 items, 1 language
Itemgroups: Header module, Physical examination, Comments
AMC-051 Complete Physical Exam Form (F21)NCT00450320 Sirolimus in Treating Patients With HIV-Related Kaposi's Sarcoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=2FF95103-FC9E-6437-E044-0003BA3F9857

On-Study - Physical Exam (continued) - 2803398v1.0 - Physical Exam (continued)

- 1/9/15 - 1 form, 3 itemgroups, 14 items, 1 language
Itemgroups: DCP Template Header, Baseline Medical/Surgical History (continued), DCP Template Footer
The Division of Cancer Prevention's physical exam (continued) case report form (CRF) template. Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=5C120DDA-54D8-39FD-E044-0003BA3F9857

Vital Signs - 3281249v1.0 - Vital Signs

- 8/8/14 - 1 form, 1 itemgroup, 18 items, 1 language
Itemgroup: Vital Signs
Record the patient's Vital Signs while on study. Please note that if Vital Signs are taken as a part of protocol specific Physical Exam, record those Vital Signs on the Physical Exam eCRF. Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AD24E1F2-5206-264F-E040-BB89AD430ED7

Nonneoplastic Condition NCT01057121 On-Study - AMC-070 Physical Exam Form (RK2) - 3147341v1.0 - AMC-070 Physical Exam Form (RK2)

- 9/19/12 - 1 form, 4 itemgroups, 17 items, 1 language
Itemgroups: Header module, EVALUATION OF CUTANEOUS LESIONS, EVALUATION OF MARKER LESIONS, Comments
AMC-070 Physical Exam Form (RK2) Lenalidomide in Treating Patients With AIDS-Related Kaposi Sarcoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=91E4BBD6-69CA-9CA4-E040-BB89AD437D79

Physical Exam (Courses) - 3292697v1.0 - Physical Exam (Courses)

- 9/20/12 - 1 form, 1 itemgroup, 8 items, 1 language
Itemgroup: Physical Exam - Courses
Record physical exam results during treatment. Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AEA85D27-6C63-77D7-E040-BB89AD4373FC

Sarcoma NCT01016730 On-Study - AMC-063 Physical Exam Form (RK2) - 3020992v1.0 - AMC-063 Physical Exam Form (RK2)

- 9/19/12 - 1 form, 4 itemgroups, 17 items, 1 language
Itemgroups: Header module, EVALUATION OF CUTANEOUS LESIONS, EVALUATION OF MARKER LESIONS, Comments
AMC-063 Physical Exam Form (RK2) Bortezomib in Treating Patients With Relapsed or Refractory AIDS-Related Kaposi Sarcoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=8163A333-BC0C-35E0-E040-BB89AD435080

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