ID
11194
Beschrijving
USMCI 8214/Z6091: Tissue Sample Submission Form NCT01167725 Standard Therapy With or Without Surgery and Mitomycin C in Treating Patients With Advanced Limited Peritoneal Dissemination of Colon Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=62328DCB-01DD-B01D-E040-BB89AD435CDE
Link
Trefwoorden
Versies (4)
- 27-08-12 27-08-12 -
- 09-01-15 09-01-15 - Martin Dugas
- 21-06-15 21-06-15 -
- 20-09-21 20-09-21 -
Geüploaded op
21 juni 2015
DOI
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Licentie
Creative Commons BY-NC 3.0 Legacy
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USMCI 8214/Z6091: Tissue Sample Submission Form NCT01167725
INSTRUCTIONS: For patients in group 2 who consented to tissue specimen collection, submit form via RDC at time of cytoreductive surgery. Form must also accompany specimen. Complete all requested information for each tissue submitted
- StudyEvent: USMCI 8214/Z6091: Tissue Sample Submission Form
Beschrijving
Biopsy specimen
Beschrijving
SpecimenSubmittedType
Datatype
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus ObjectClass
- C19157
- UMLS 2011AA ObjectClass
- C0370003
- NCI Thesaurus Property
- C25695
- UMLS 2011AA Property
- C1515023
Beschrijving
SpecimenMalignantNeoplasmSubmissionGastrointestinalType
Datatype
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus Property
- C9305
- UMLS 2011AA Property
- C0006826
- NCI Thesaurus ObjectClass
- C19157
- UMLS 2011AA ObjectClass
- C0370003
- NCI Thesaurus Property-2
- C25695
- UMLS 2011AA Property-2
- C1515023
Beschrijving
SpecimenCollectedDate
Datatype
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ObjectClass
- C19157
- UMLS 2011AA ObjectClass
- C0370003
- NCI Thesaurus Property
- C25452
- NCI Thesaurus Property-2
- C25275
- UMLS 2011AA Property
- C2745955
Beschrijving
SpecimenBlocksSlideSubmissionCount
Datatype
float
Alias
- NCI Thesaurus ObjectClass
- C19157
- UMLS 2011AA ObjectClass
- C0370003
- NCI Thesaurus Property
- C25325
- UMLS 2011AA Property
- C0444330
- NCI Thesaurus Property-2
- C25436
- UMLS 2011AA Property-2
- C1533157
- NCI Thesaurus Property-3
- C25694
- UMLS 2011AA Property-3
- C1515022
- NCI Thesaurus ValueDomain
- C25463
- UMLS 2011AA ValueDomain
- C0750480
Beschrijving
SpecimenAccessionNumber
Datatype
float
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
- NCI Thesaurus ObjectClass
- C19157
- UMLS 2011AA ObjectClass
- C0370003
- NCI Thesaurus Property
- C25402
- UMLS 2011AA Property
- C1510755
Beschrijving
SpecimenResectionWeightMeasurement
Datatype
float
Maateenheden
- gm
Alias
- NCI Thesaurus ValueDomain
- C25209
- UMLS 2011AA ValueDomain
- C0242485
- NCI Thesaurus Property
- C25208
- UMLS 2011AA Property
- C0043100
- NCI Thesaurus Property-2
- C15232
- UMLS 2011AA Property-2
- C0728940
- NCI Thesaurus ObjectClass
- C19157
- UMLS 2011AA ObjectClass
- C0370003
Beschrijving
Footern Module
Beschrijving
Person Completing Form First Name
Datatype
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS CUI-1
- C1550483
- NCI Thesaurus ObjectClass-2
- C25657
- UMLS CUI-2
- C1443235
- NCI Thesaurus Property
- C25364
- NCI Thesaurus Property-2
- C25509
- NCI Thesaurus ValueDomain
- C25191
Beschrijving
Person Completing Form Last Name
Datatype
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS CUI-1
- C1550483
- NCI Thesaurus ObjectClass-2
- C25657
- UMLS CUI-2
- C1301584
- NCI Thesaurus Property
- C25364
- NCI Thesaurus Property-2
- C25551
- NCI Thesaurus ValueDomain
- C25191
Beschrijving
SpecimenLabSubmittedDate
Datatype
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus Property
- C25294
- UMLS 2011AA Property
- C0022885
- NCI Thesaurus ObjectClass
- C19157
- UMLS 2011AA ObjectClass
- C0370003
- NCI Thesaurus Property-2
- C25695
- UMLS 2011AA Property-2
- C1515023
Beschrijving
SpecimenSubmissionContactPersonE-mailAddressText
Datatype
text
Alias
- NCI Thesaurus ObjectClass
- C19157
- UMLS 2011AA ObjectClass
- C0370003
- NCI Thesaurus ObjectClass-2
- C25461
- UMLS 2011AA ObjectClass-2
- C0337611
- NCI Thesaurus ObjectClass-3
- C25694
- UMLS 2011AA ObjectClass-3
- C1515022
- NCI Thesaurus Property
- C42775
- UMLS 2011AA Property
- C1705961
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
Beschrijving
Person Completing Form Phone
Datatype
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS CUI-1
- C1550483
- NCI Thesaurus ObjectClass
- C25190
- UMLS CUI-2
- C1515258
- NCI Thesaurus ObjectClass-2
- C25657
- NCI Thesaurus Property
- C25395
Beschrijving
ResponsiblePersonFaxNumber
Datatype
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus ObjectClass-2
- C25657
- UMLS 2011AA ObjectClass-2
- C1273518
- NCI Thesaurus Property
- C25210
- UMLS 2011AA Property
- C0085205
Beschrijving
SpecimenLaboratoryReceivedDate
Datatype
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus Property
- C25639
- UMLS 2011AA Property
- C1514756
- NCI Thesaurus Property-2
- C37984
- UMLS 2011AA Property-2
- C0022877
- NCI Thesaurus ObjectClass
- C19157
- UMLS 2011AA ObjectClass
- C0370003
Similar models
INSTRUCTIONS: For patients in group 2 who consented to tissue specimen collection, submit form via RDC at time of cytoreductive surgery. Form must also accompany specimen. Complete all requested information for each tissue submitted
- StudyEvent: USMCI 8214/Z6091: Tissue Sample Submission Form
C0332307 (UMLS 2011AA ValueDomain)
C25616 (NCI Thesaurus Property)
C1948053 (UMLS 2011AA Property)
C19712 (NCI Thesaurus ObjectClass)
C1515944 (UMLS 2011AA ObjectClass)
C25716 (NCI Thesaurus ObjectClass-2)
C0545082 (UMLS 2011AA ObjectClass-2)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25462 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass)
C0805701 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass)
C21541 (NCI Thesaurus ValueDomain-2)
C25364 (NCI Thesaurus Property)
C1512698 (UMLS 2011AA ValueDomain)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C52349 (NCI Thesaurus Property)
C1301820 (UMLS 2011AA Property)
C1527021 (UMLS 2011AA ValueDomain)
C25594 (NCI Thesaurus Property)
C1518422 (UMLS 2011AA Property)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C25452 (NCI Thesaurus Property-2)
C0332307 (UMLS 2011AA ValueDomain)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C25695 (NCI Thesaurus Property)
C1515023 (UMLS 2011AA Property)
C0332307 (UMLS 2011AA ValueDomain)
C9305 (NCI Thesaurus Property)
C0006826 (UMLS 2011AA Property)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C25695 (NCI Thesaurus Property-2)
C1515023 (UMLS 2011AA Property-2)
C0011008 (UMLS 2011AA ValueDomain)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C25452 (NCI Thesaurus Property)
C25275 (NCI Thesaurus Property-2)
C2745955 (UMLS 2011AA Property)
C0370003 (UMLS 2011AA ObjectClass)
C25325 (NCI Thesaurus Property)
C0444330 (UMLS 2011AA Property)
C25436 (NCI Thesaurus Property-2)
C1533157 (UMLS 2011AA Property-2)
C25694 (NCI Thesaurus Property-3)
C1515022 (UMLS 2011AA Property-3)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C25402 (NCI Thesaurus Property)
C1510755 (UMLS 2011AA Property)
C0242485 (UMLS 2011AA ValueDomain)
C25208 (NCI Thesaurus Property)
C0043100 (UMLS 2011AA Property)
C15232 (NCI Thesaurus Property-2)
C0728940 (UMLS 2011AA Property-2)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C1550483 (UMLS CUI-1)
C25657 (NCI Thesaurus ObjectClass-2)
C1443235 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25509 (NCI Thesaurus Property-2)
C25191 (NCI Thesaurus ValueDomain)
C1550483 (UMLS CUI-1)
C25657 (NCI Thesaurus ObjectClass-2)
C1301584 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25551 (NCI Thesaurus Property-2)
C25191 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25294 (NCI Thesaurus Property)
C0022885 (UMLS 2011AA Property)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C25695 (NCI Thesaurus Property-2)
C1515023 (UMLS 2011AA Property-2)
C0370003 (UMLS 2011AA ObjectClass)
C25461 (NCI Thesaurus ObjectClass-2)
C0337611 (UMLS 2011AA ObjectClass-2)
C25694 (NCI Thesaurus ObjectClass-3)
C1515022 (UMLS 2011AA ObjectClass-3)
C42775 (NCI Thesaurus Property)
C1705961 (UMLS 2011AA Property)
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C1550483 (UMLS CUI-1)
C25190 (NCI Thesaurus ObjectClass)
C1515258 (UMLS CUI-2)
C25657 (NCI Thesaurus ObjectClass-2)
C25395 (NCI Thesaurus Property)
C0237753 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25657 (NCI Thesaurus ObjectClass-2)
C1273518 (UMLS 2011AA ObjectClass-2)
C25210 (NCI Thesaurus Property)
C0085205 (UMLS 2011AA Property)
C0011008 (UMLS 2011AA ValueDomain)
C25639 (NCI Thesaurus Property)
C1514756 (UMLS 2011AA Property)
C37984 (NCI Thesaurus Property-2)
C0022877 (UMLS 2011AA Property-2)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)