ID
10082
Beschreibung
CALGB: SOCIAL SUPPORT FORM Comparison of Combination Chemotherapy Regimens in Treating Older Women Who Have Undergone Surgery for Breast Cancer NCT00024102 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A50BF99D-12AE-2D64-E034-080020C9C0E0
Link
Stichworte
Versionen (2)
- 18.12.14 18.12.14 - Martin Dugas
- 23.03.15 23.03.15 - Martin Dugas
Hochgeladen am
23. März 2015
DOI
Für eine Beantragung loggen Sie sich ein.
Lizenz
Creative Commons BY-NC 3.0 Legacy
Modell Kommentare :
Hier können Sie das Modell kommentieren. Über die Sprechblasen an den Itemgruppen und Items können Sie diese spezifisch kommentieren.
Itemgroup Kommentare für :
Item Kommentare für :
Um Formulare herunterzuladen müssen Sie angemeldet sein. Bitte loggen Sie sich ein oder registrieren Sie sich kostenlos.
Breast Cancer NCT00024102
INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice. Print text in capital letters. Avoid contact with the edges of the boxes. Circle amended items and check "Amended data" box to the right. If submitting by mail, retain a copy for your records and send the original to the CALGB Data Management Center. If faxing, use an original form for maximum clarity in transmission and fax to 919-416-4990. If submitting electronically, click the Send button when you have completed the PDF version of the form.
Beschreibung
Social support
Alias
- UMLS CUI-1
- C0037438
Beschreibung
Abouthowmanyclosefriendsandcloserelativesdoyouhavenow(peopleyoufeelateasewithandcantalktoaboutwhatisonyourmind)?
Datentyp
integer
Alias
- UMLS CUI-1
- C0079382
- UMLS CUI-2
- C0449788
Beschreibung
Someonetohelpifyouwereconfinedtobed
Datentyp
text
Beschreibung
Someoneyoucancountontolistentoyouwhenyouneedtotalk
Datentyp
text
Beschreibung
Someonetogiveyougoodadviceaboutacrisis
Datentyp
text
Beschreibung
Someonetotakeyoutothedoctorifyouneededit
Datentyp
text
Beschreibung
Someonewhoshowsyouloveandaffection
Datentyp
text
Beschreibung
Someonetohaveagoodtimewith
Datentyp
text
Beschreibung
Someonetogiveyouinformationtohelpyouunderstandasituation
Datentyp
text
Beschreibung
Someonetoconfideinortalktoaboutyourselforyourproblems
Datentyp
text
Beschreibung
Someone who hugs you (11.)
Datentyp
text
Beschreibung
Someonetogettogetherwithforrelaxation
Datentyp
text
Beschreibung
Someone to prepare your meals if you were unable to do it yourself (13.)
Datentyp
text
Beschreibung
Someone whose advice you really want (14.)
Datentyp
text
Beschreibung
Someone to do things with to help you get your mind off things (15.)
Datentyp
text
Beschreibung
Someone to help you with daily chores if you were sick (16.)
Datentyp
text
Beschreibung
Someone to share your most private worries and fears with (17.)
Datentyp
text
Beschreibung
Someone to turn to for suggestions about how to deal with a personal problem (18.)
Datentyp
text
Beschreibung
Someone to do something enjoyable with (19.)
Datentyp
text
Beschreibung
Someone who understands your problems (20.)
Datentyp
text
Beschreibung
Someone to love and make you feel wanted
Datentyp
text
Ähnliche Modelle
INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice. Print text in capital letters. Avoid contact with the edges of the boxes. Circle amended items and check "Amended data" box to the right. If submitting by mail, retain a copy for your records and send the original to the CALGB Data Management Center. If faxing, use an original form for maximum clarity in transmission and fax to 919-416-4990. If submitting electronically, click the Send button when you have completed the PDF version of the form.
C1705108 (UMLS 2011AA)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C0449788 (UMLS CUI-2)