ID

10243

Descripción

AMC-076 HPV On-Study Form (ONS) Infrared Coagulator Ablation or Observation in Preventing Anal Cancer in HIV-Positive Patients With Anal Neoplasia NCT01164722 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A80C062E-17BA-F42E-E040-BB89AD432F38

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A80C062E-17BA-F42E-E040-BB89AD432F38

Palabras clave

Versiones (2)
  1. 26/8/12 26/8/12 -
  2. 20/5/15 20/5/15 - Martin Dugas
Subido en

20 de mayo de 2015

DOI

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Licencia

Creative Commons BY-NC 3.0 Legacy
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Anal Cancer NCT01164722 AMC-076

Inglés

No Instruction available.

1 formularios  
  1. StudyEvent: AMC-076 HPV On-Study Form (ONS)
    1. No Instruction available.
Header Module
Descripción

Header Module

Alias
UMLS CUI-1
C1320722
Visit number
Descripción

HospitalAdmissionOrdinalNumber

Tipo de datos

float

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C16696
UMLS 2011AA ObjectClass
C0019994
NCI Thesaurus Property
C25385
UMLS 2011AA Property
C0809949
Comments
Descripción

ResearchCommentsText

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
UMLS 2011AA Property
C0282411
HIV
Descripción

HIV

Alias
UMLS CUI-1
C0019682
Date of HIV+ diagnosis (mm/dd/yyyy)
Descripción

HumanImmunodeficiencyVirusDiagnosisDate

Tipo de datos

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C14219
UMLS 2011AA ObjectClass
C0019682
NCI Thesaurus Property
C15220
UMLS 2011AA Property
C0011900
Date of AIDS diagnosis (mm/dd/yyyy)
Descripción

AcquiredImmunodeficiencySyndromeDiagnosisDate

Tipo de datos

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus Property
C15220
UMLS 2011AA Property
C0011900
NCI Thesaurus ObjectClass
C2851
UMLS 2011AA ObjectClass
C0001175
CDC HIV Risk Group
Descripción

PatientHumanImmunodeficiencyVirusRiskCategory

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C14219
UMLS 2011AA Property
C0019682
NCI Thesaurus Property-2
C17102
UMLS 2011AA Property-2
C0035647
NCI Thesaurus Property-3
C25161
UMLS 2011AA Property-3
C0008902
NCI Thesaurus ValueDomain
C25372
UMLS 2011AA ValueDomain
C0683312
Other, specify
Descripción

PatientHumanImmunodeficiencyVirusRiskCategorySpecify

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C14219
UMLS 2011AA Property
C0019682
NCI Thesaurus Property-2
C17102
UMLS 2011AA Property-2
C0035647
NCI Thesaurus Property-3
C25161
UMLS 2011AA Property-3
C0008902
Condyloma
Descripción

Condyloma

History of anal, perianal, or genital condyloma (If "Yes", answer the following)
Descripción

HumanPapillomavirusDiseaseGenitalAnalCondylomaPersonalMedicalHistoryInd-2

Tipo de datos

boolean

Alias
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus ObjectClass-2
C14226
UMLS 2011AA ObjectClass-2
C0021344
NCI Thesaurus Property
C13348
UMLS 2011AA Property
C0559522
NCI Thesaurus Property-2
C18772
UMLS 2011AA Property-2
C0262926
NCI Thesaurus Property-3
C4054
UMLS 2011AA Property-3
C0281779
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
History of penile or genital condyloma
Descripción

HumanPapillomavirusDiseaseGenitalPenisCondylomaPersonalMedicalHistoryStatus

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus ObjectClass-2
C14226
UMLS 2011AA ObjectClass-2
C0021344
NCI Thesaurus Property
C13348
UMLS 2011AA Property
C0559522
NCI Thesaurus Property-2
C12409
UMLS 2011AA Property-2
C0030851
NCI Thesaurus Property-3
C18772
UMLS 2011AA Property-3
C0262926
NCI Thesaurus Property-4
C2960
UMLS 2011AA Property-4
C0009663
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
History of perianal condyloma
Descripción

HumanPapillomavirusDiseaseAnalCondylomaSurroundingPersonalMedicalHistoryStatus

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C2991
NCI Thesaurus ObjectClass-2
C14226
NCI Thesaurus Property
C18772
NCI Thesaurus Property-2
C52247
NCI Thesaurus Property-3
C4054
NCI Thesaurus ValueDomain
C25688
UMLS CUI-1
C0262926
UMLS CUI-2
C0281779
History of intraanal condlyoma
Descripción

HumanPapillomavirusDiseaseAnalCondylomaInternalPersonalMedicalHistoryStatus

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus ObjectClass-2
C14226
UMLS 2011AA ObjectClass-2
C0021344
NCI Thesaurus Property
C25234
UMLS 2011AA Property
C0205102
NCI Thesaurus Property-2
C18772
UMLS 2011AA Property-2
C0262926
NCI Thesaurus Property-3
C4054
UMLS 2011AA Property-3
C0281779
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
Lowest CD4+ Count
Descripción

Lowest CD4+ Count

Lowest CD4+ count ever reported
Descripción

LaboratoryProcedureCD4+LowestResultCount

Tipo de datos

float

Alias
NCI Thesaurus ObjectClass
C25294
UMLS 2011AA ObjectClass
C0022885
NCI Thesaurus Property
C20200
UMLS 2011AA Property
C1274040
NCI Thesaurus Property-2
C12537
UMLS 2011AA Property-2
C0039215
NCI Thesaurus Property-3
C43517
UMLS 2011AA Property-3
C1708760
NCI Thesaurus ValueDomain
C25463
UMLS 2011AA ValueDomain
C0750480
Document type
Descripción

ProtocolDocumentSubmittedType

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C42651
UMLS 2011AA ObjectClass
C0442711
NCI Thesaurus ObjectClass-2
C19498
UMLS 2011AA ObjectClass-2
C1547673
NCI Thesaurus Property
C25695
UMLS 2011AA Property
C1515023
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Similar models

No Instruction available.

1 formularios
  1. StudyEvent: AMC-076 HPV On-Study Form (ONS)
    1. No Instruction available.
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
Header Module
C1320722 (UMLS CUI-1)
HospitalAdmissionOrdinalNumber
Item
Visit number
float
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16696 (NCI Thesaurus ObjectClass)
C0019994 (UMLS 2011AA ObjectClass)
C25385 (NCI Thesaurus Property)
C0809949 (UMLS 2011AA Property)
ResearchCommentsText
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0282411 (UMLS 2011AA Property)
Item Group
HIV
C0019682 (UMLS CUI-1)
HumanImmunodeficiencyVirusDiagnosisDate
Item
Date of HIV+ diagnosis (mm/dd/yyyy)
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C14219 (NCI Thesaurus ObjectClass)
C0019682 (UMLS 2011AA ObjectClass)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
AcquiredImmunodeficiencySyndromeDiagnosisDate
Item
Date of AIDS diagnosis (mm/dd/yyyy)
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
C2851 (NCI Thesaurus ObjectClass)
C0001175 (UMLS 2011AA ObjectClass)
Item
CDC HIV Risk Group
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C14219 (NCI Thesaurus Property)
C0019682 (UMLS 2011AA Property)
C17102 (NCI Thesaurus Property-2)
C0035647 (UMLS 2011AA Property-2)
C25161 (NCI Thesaurus Property-3)
C0008902 (UMLS 2011AA Property-3)
C25372 (NCI Thesaurus ValueDomain)
C0683312 (UMLS 2011AA ValueDomain)
CL.1
Code List
CDC HIV Risk Group
CL Item
Homosexual Or Bisexual Contact (Homosexual or bisexual contact)
CL Item
Heterosexual Contact (Heterosexual contact)
CL Item
Iv Drug User (IV drug user)
CL Item
Transfusion Recipient (Transfusion recipient)
CL Item
Hemophilia (Hemophiliac)
C3093 (NCI Thesaurus)
C0684275 (UMLS 2011AA)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
PatientHumanImmunodeficiencyVirusRiskCategorySpecify
Item
Other, specify
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C14219 (NCI Thesaurus Property)
C0019682 (UMLS 2011AA Property)
C17102 (NCI Thesaurus Property-2)
C0035647 (UMLS 2011AA Property-2)
C25161 (NCI Thesaurus Property-3)
C0008902 (UMLS 2011AA Property-3)
Item Group
Condyloma
HumanPapillomavirusDiseaseGenitalAnalCondylomaPersonalMedicalHistoryInd-2
Item
History of anal, perianal, or genital condyloma (If "Yes", answer the following)
boolean
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C14226 (NCI Thesaurus ObjectClass-2)
C0021344 (UMLS 2011AA ObjectClass-2)
C13348 (NCI Thesaurus Property)
C0559522 (UMLS 2011AA Property)
C18772 (NCI Thesaurus Property-2)
C0262926 (UMLS 2011AA Property-2)
C4054 (NCI Thesaurus Property-3)
C0281779 (UMLS 2011AA Property-3)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
Item
History of penile or genital condyloma
text
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C14226 (NCI Thesaurus ObjectClass-2)
C0021344 (UMLS 2011AA ObjectClass-2)
C13348 (NCI Thesaurus Property)
C0559522 (UMLS 2011AA Property)
C12409 (NCI Thesaurus Property-2)
C0030851 (UMLS 2011AA Property-2)
C18772 (NCI Thesaurus Property-3)
C0262926 (UMLS 2011AA Property-3)
C2960 (NCI Thesaurus Property-4)
C0009663 (UMLS 2011AA Property-4)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.3
Code List
History of penile or genital condyloma
CL Item
Yes, Resolved With History Of Treatment (Yes, resolved with history of treatment)
CL Item
Yes, Resolved Without Treatment (Yes, resolved without treatment)
CL Item
Active Genital Condyloma (Active genital condyloma)
CL Item
Active Penile Condyloma (Active penile condyloma)
CL Item
No History (No history)
Item
History of perianal condyloma
text
C2991 (NCI Thesaurus ObjectClass)
C14226 (NCI Thesaurus ObjectClass-2)
C18772 (NCI Thesaurus Property)
C52247 (NCI Thesaurus Property-2)
C4054 (NCI Thesaurus Property-3)
C25688 (NCI Thesaurus ValueDomain)
C0262926 (UMLS CUI-1)
C0281779 (UMLS CUI-2)
CL.4
Code List
History of perianal condyloma
CL Item
Yes, Resolved With History Of Treatment (Yes, resolved with history of treatment)
CL Item
Yes, Resolved Without Treatment (Yes, resolved without treatment)
CL Item
Active Perianal Condyloma (Active perianal condyloma)
CL Item
No History (No history)
Item
History of intraanal condlyoma
text
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C14226 (NCI Thesaurus ObjectClass-2)
C0021344 (UMLS 2011AA ObjectClass-2)
C25234 (NCI Thesaurus Property)
C0205102 (UMLS 2011AA Property)
C18772 (NCI Thesaurus Property-2)
C0262926 (UMLS 2011AA Property-2)
C4054 (NCI Thesaurus Property-3)
C0281779 (UMLS 2011AA Property-3)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.5
Code List
History of intraanal condlyoma
CL Item
Yes, Resolved With History Of Treatment (Yes, resolved with history of treatment)
CL Item
Yes, Resolved Without Treatment (Yes, resolved without treatment)
CL Item
Active Intraanal Condyloma (Active intraanal condyloma)
CL Item
No History (No history)
Item Group
Lowest CD4+ Count
LaboratoryProcedureCD4+LowestResultCount
Item
Lowest CD4+ count ever reported
float
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C12537 (NCI Thesaurus Property-2)
C0039215 (UMLS 2011AA Property-2)
C43517 (NCI Thesaurus Property-3)
C1708760 (UMLS 2011AA Property-3)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
Item
Document type
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C42651 (NCI Thesaurus ObjectClass)
C0442711 (UMLS 2011AA ObjectClass)
C19498 (NCI Thesaurus ObjectClass-2)
C1547673 (UMLS 2011AA ObjectClass-2)
C25695 (NCI Thesaurus Property)
C1515023 (UMLS 2011AA Property)
CL.6
Code List
Document type
CL Item
Lab Report (Lab Report)
CL Item
Physician/provider Report Or Clinical Note (Physician/provider report or clinical note)
CL Item
Subject Recall (Subject recall)
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