- 9/20/21 - 1 form, 13 itemgroups, 64 items, 1 language
Itemgroups: Header Module, On Treatment Report Period, Data amendment, Assessment Date, Mini Mental Examination Section, GDS, ADL, MOS Social Support Survey - Emotional/Informational Support, MOS Social Support Survey - Tangible support, Comorbidity Questionnaire, Comorbidity Questionnaire1, Medications/Sexual Function, Weight
- 9/20/21 - 1 form, 19 itemgroups, 46 items, 1 language
Itemgroups: Header module, Record the highest grade of toxicity diagnosed since the previous evaluation. If this is the first evaluation, record the highest toxicity diagnosed since day 0. The toxicity grades are based on the NCI CTCAE Version 3.0., Allergy/Immunologic toxicity, GI toxicity, Renal toxicity, Hemorrhagic toxicity, Cardiovascular toxicity, Neurologic toxicity, Coagulation toxicity, Vascular toxicity, Pulmonary toxicity, Hepatic toxicity, Did the patient develop any of the following clinical sugns/symptoms of abnormal liver function during this assessment period, Indicated the etiology of the abnormal liver function, VOD, GVHD, Infection, Other, Unknown