ID

11619

Beschrijving

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

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AC346EE2-C452-2587-E034-0003BA12F5E7

Trefwoorden

Versies (2)
  1. 26-08-12 26-08-12 -
  2. 08-07-15 08-07-15 -
Geüploaded op

8 juli 2015

DOI

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Licentie

Creative Commons BY-NC 3.0 Legacy
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ECOG Second Primary Form (E2100)

Engels

Form No. 630

1 Formulieren  
  1. StudyEvent: ECOG Second Primary Form (E2100)
    1. Form No. 630
ECOG data
Beschrijving

ECOG data

ECOG Patient ID
Beschrijving

ECOG Patient ID

Datatype

float

Alias
UMLS CUI-1
C1512162
UMLS CUI-2
C1830427
Registration Step
Beschrijving

RegistrationStep

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ValueDomain-2
C16154
UMLS 2011AA ValueDomain-2
C1704379
Patient's Name
Beschrijving

Patient's Name

Datatype

text

Alias
UMLS CUI-1
C1299487
Participating Group Protocol No.
Beschrijving

Participating Group Protocol No.

Datatype

float

Alias
UMLS CUI-1
C2826693
UMLS CUI-2
C3274381
Participating Group Patient ID
Beschrijving

Participating Group Patient ID

Datatype

integer

Alias
UMLS CUI-1
C2348585
Institution/Affiliate
Beschrijving

Institution/Affiliate

Datatype

text

Alias
UMLS CUI-1
C1301943
ECOG Protocol No.
Beschrijving

ECOG Protocol No.

Datatype

float

Alias
UMLS CUI-1
C1512162
UMLS CUI-2
C2348585
Are data amended?
Beschrijving

Are data amended?

Datatype

boolean

Alias
NCI Thesaurus ObjectClass
C25474
NCI Thesaurus Property
C25416
UMLS CUI-1
C1511726
UMLS CUI-2
C1691222
Second Primary Cancers
Beschrijving

Second Primary Cancers

Date of Diagnosis of Second Primary Cancer (M D Y)
Beschrijving

Date of Diagnosis of Second Primary Cancer (M D Y)

Datatype

date

Alias
UMLS CUI-1
C2316983
UMLS CUI-2
C0751623
Site of Second Primary Cancer
Beschrijving

Site of Second Primary Cancer

Datatype

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
Include information on histologic subtype(s). (Please attach copies of any corroborating pathology reports.)
Beschrijving

Include information on histologic subtype(s). (Please attach copies of any corroborating pathology reports.)

Datatype

text

Alias
UMLS CUI-1
C0449574
Briefly describe cancer therapy the patient has received prior to the diagnosis of the second primary and other than that given on ECOG protocols
Beschrijving

Briefly describe cancer therapy the patient has received prior to the diagnosis of the second primary and other than that given on ECOG protocols

Datatype

text

Alias
UMLS CUI-1
C0920425
UMLS CUI-2
C0332132
UMLS CUI-3
C0751623
Briefly describe treatment planned or given for the diagnosis of this second primary
Beschrijving

Briefly describe treatment planned or given for the diagnosis of this second primary

Datatype

text

Alias
UMLS CUI-1
C0920425
Comments
Beschrijving

Comments

Comments
Beschrijving

Comments

Datatype

text

Alias
UMLS CUI-1
C0947611
Investigator Signature
Beschrijving

Investigator Signature

Datatype

text

Alias
NCI Thesaurus Property
C25678
NCI Thesaurus ObjectClass
C17089
UMLS CUI-1
C1519316
UMLS CUI-2
C0035173
Date
Beschrijving

Date

Datatype

date

Alias
UMLS CUI-1
C0011008
Ccrr Module For Ecog Second Primary Form (e2100)
Beschrijving

Ccrr Module For Ecog Second Primary Form (e2100)

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Similar models

Form No. 630

1 Formulieren
  1. StudyEvent: ECOG Second Primary Form (E2100)
    1. Form No. 630
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
ECOG data
ECOGPatientID
Item
ECOG Patient ID
float
C1512162 (UMLS CUI-1)
C1830427 (UMLS CUI-2)
RegistrationStep
Item
Registration Step
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16154 (NCI Thesaurus ValueDomain-2)
C1704379 (UMLS 2011AA ValueDomain-2)
Patient'sName
Item
Patient's Name
text
C1299487 (UMLS CUI-1)
ParticipatingGroupProtocolNo.
Item
Participating Group Protocol No.
float
C2826693 (UMLS CUI-1)
C3274381 (UMLS CUI-2)
ParticipatingGroupPatientID
Item
Participating Group Patient ID
integer
C2348585 (UMLS CUI-1)
MainMemberInstitution/Affiliate
Item
Institution/Affiliate
text
C1301943 (UMLS CUI-1)
ECOG Protocol No.
Item
ECOG Protocol No.
float
C1512162 (UMLS CUI-1)
C2348585 (UMLS CUI-2)
AmendedDataInd
Item
Are data amended?
boolean
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)
C1511726 (UMLS CUI-1)
C1691222 (UMLS CUI-2)
Item Group
Second Primary Cancers
DateofDiagnosisofSecondPrimaryCancer
Item
Date of Diagnosis of Second Primary Cancer (M D Y)
date
C2316983 (UMLS CUI-1)
C0751623 (UMLS CUI-2)
Second Primary Malignant Neoplasm Anatomic Site
Item
Site of Second Primary Cancer
text
C25251 (NCI Thesaurus ObjectClass)
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)
Includeinformationonhistologicsubtype(s).
Item
Include information on histologic subtype(s). (Please attach copies of any corroborating pathology reports.)
text
C0449574 (UMLS CUI-1)
cancer therapy prior to diagnosis
Item
Briefly describe cancer therapy the patient has received prior to the diagnosis of the second primary and other than that given on ECOG protocols
text
C0920425 (UMLS CUI-1)
C0332132 (UMLS CUI-2)
C0751623 (UMLS CUI-3)
Treatment planned/given
Item
Briefly describe treatment planned or given for the diagnosis of this second primary
text
C0920425 (UMLS CUI-1)
Item Group
Comments
Comments
Item
Comments
text
C0947611 (UMLS CUI-1)
InvestigatorSignature
Item
Investigator Signature
text
C25678 (NCI Thesaurus Property)
C17089 (NCI Thesaurus ObjectClass)
C1519316 (UMLS CUI-1)
C0035173 (UMLS CUI-2)
Date
Item
Date
date
C0011008 (UMLS CUI-1)
Item Group
Ccrr Module For Ecog Second Primary Form (e2100)
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