ID
11619
Description
ECOG Second Primary Form (E2100) Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AC346EE2-C452-2587-E034-0003BA12F5E7
Link
Keywords
Versions (2)
- 8/26/12 8/26/12 -
- 7/8/15 7/8/15 -
Uploaded on
July 8, 2015
DOI
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License
Creative Commons BY-NC 3.0 Legacy
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ECOG Second Primary Form (E2100)
Form No. 630
- StudyEvent: ECOG Second Primary Form (E2100)
Description
Second Primary Cancers
Description
Date of Diagnosis of Second Primary Cancer (M D Y)
Data type
date
Alias
- UMLS CUI-1
- C2316983
- UMLS CUI-2
- C0751623
Description
Site of Second Primary Cancer
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C25251
- NCI Thesaurus ObjectClass-2
- C9305
- NCI Thesaurus ObjectClass-3
- C25666
- NCI Thesaurus Property
- C25341
- NCI Thesaurus Property-2
- C25421
- NCI Thesaurus ValueDomain
- C25704
- UMLS CUI-1
- C1515974
- UMLS CUI-2
- C0751623
Description
Include information on histologic subtype(s). (Please attach copies of any corroborating pathology reports.)
Data type
text
Alias
- UMLS CUI-1
- C0449574
Description
Briefly describe cancer therapy the patient has received prior to the diagnosis of the second primary and other than that given on ECOG protocols
Data type
text
Alias
- UMLS CUI-1
- C0920425
- UMLS CUI-2
- C0332132
- UMLS CUI-3
- C0751623
Description
Briefly describe treatment planned or given for the diagnosis of this second primary
Data type
text
Alias
- UMLS CUI-1
- C0920425
Description
Comments
Description
Comments
Data type
text
Alias
- UMLS CUI-1
- C0947611
Description
Investigator Signature
Data type
text
Alias
- NCI Thesaurus Property
- C25678
- NCI Thesaurus ObjectClass
- C17089
- UMLS CUI-1
- C1519316
- UMLS CUI-2
- C0035173
Description
Date
Data type
date
Alias
- UMLS CUI-1
- C0011008
Description
Ccrr Module For Ecog Second Primary Form (e2100)
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Form No. 630
- StudyEvent: ECOG Second Primary Form (E2100)
C1830427 (UMLS CUI-2)
C0237753 (UMLS 2011AA ValueDomain)
C16154 (NCI Thesaurus ValueDomain-2)
C1704379 (UMLS 2011AA ValueDomain-2)
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C2348585 (UMLS CUI-2)
C25416 (NCI Thesaurus Property)
C1511726 (UMLS CUI-1)
C1691222 (UMLS CUI-2)
C0751623 (UMLS CUI-2)
C9305 (NCI Thesaurus ObjectClass-2)
C25666 (NCI Thesaurus ObjectClass-3)
C25341 (NCI Thesaurus Property)
C25421 (NCI Thesaurus Property-2)
C25704 (NCI Thesaurus ValueDomain)
C1515974 (UMLS CUI-1)
C0751623 (UMLS CUI-2)
C0332132 (UMLS CUI-2)
C0751623 (UMLS CUI-3)
C17089 (NCI Thesaurus ObjectClass)
C1519316 (UMLS CUI-1)
C0035173 (UMLS CUI-2)