ID

11770

Description

Anal Cancer NCT00324415 On-Study - AMC-045 Vital Signs Form (F20) - 2937179v1.0 Cisplatin, Fluorouracil, Cetuximab, and Radiation Therapy in Treating Patients With HIV and Stage I, Stage II, or Stage III Anal Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=7285E88F-E0EF-C8EB-E040-BB89AD437ABB

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=7285E88F-E0EF-C8EB-E040-BB89AD437ABB

Keywords

Versions (3)
  1. 8/26/12 8/26/12 -
  2. 8/8/14 8/8/14 - Martin Dugas
  3. 7/31/15 7/31/15 - Martin Dugas
Uploaded on

July 31, 2015

DOI

To request one please log in.

License

Creative Commons BY-NC 3.0 Legacy
Model comments :

You can comment on the data model here. Via the speech bubbles at the itemgroups and items you can add comments to those specificially.

Back to model comments
Itemgroup comments for :

Item comments for :

In order to download data models you must be logged in. Please log in or register for free.

Vital Signs Anal Cancer NCT00324415

English

No Instruction available.

1 forms  
  1. StudyEvent: AMC-045 Vital Signs Form (F20)
    1. No Instruction available.
Header Module
Description

Header Module

Visit number
Description

Hospital Admission Ordinal Number

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
NCI Thesaurus ObjectClass
C16696
NCI Thesaurus Property
C25385
UMLS CUI-1
C1549755
Date of evaluation
Description

Assessment Performed Date

Data type

date

Measurement units
  • DD.MM.YYYY
Alias
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ObjectClass
C25367
NCI Thesaurus ValueDomain
C25367
NCI Thesaurus Property
C38000
UMLS CUI-1-1
C2985720
DD.MM.YYYY
Time Test Completed
Description

Patient Complete Vital Signs Physical Examination Time

Data type

time

Measurement units
  • hh:mm
Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C20989
NCI Thesaurus Property
C25250
NCI Metathesaurus Property
C0518766
NCI Thesaurus ValueDomain
C25207
UMLS CUI-1-1
C2825565
hh:mm
Vital Signs
Description

Vital Signs

Alias
UMLS CUI-1
C0518766
Height
Description

Height

Data type

float

Measurement units
  • cm
Alias
NCI Thesaurus ValueDomain
C25209
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25347
UMLS CUI-1-1
C0005890
cm
Body weight
Description

Body weight

Data type

float

Measurement units
  • kg
Alias
NCI Thesaurus ValueDomain
C25209
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25208
UMLS CUI-1-1
C0005910
kg
Body surface area
Description

Body surface area

Data type

float

Measurement units
  • m²
Alias
NCI Thesaurus ObjectClass
C25190
NCI Thesaurus ValueDomain
C25712
NCI Thesaurus Property
C25157
UMLS CUI-1-1
C0005902
m²
Systolic
Description

Systolic

Data type

integer

Measurement units
  • mmHg
Alias
NCI Thesaurus ValueDomain
C25209
NCI Thesaurus Property
C25214
NCI Thesaurus ObjectClass
C25298
UMLS CUI-1-1
C0871470
mmHg
Diastolic
Description

Diastolic

Data type

integer

Measurement units
  • mmHg
Alias
NCI Thesaurus ValueDomain
C25209
NCI Thesaurus Property
C25214
NCI Thesaurus ObjectClass
C25299
UMLS CUI-1-1
C0428883
mmHg
Heart rate
Description

Heart rate

Data type

integer

Measurement units
  • bpm
Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C20989
NCI Thesaurus Property
C49672
NCI Thesaurus Property
C49677
NCI Thesaurus ValueDomain
C25712
UMLS CUI-1-1
C0018810
bpm
Respiratory Rate
Description

Respiratory Rate

Data type

integer

Measurement units
  • /min
Alias
NCI Thesaurus ObjectClass
C25190
NCI Thesaurus Property
C20989
NCI Thesaurus Property
C49672
NCI Thesaurus Property
C49678
NCI Thesaurus ValueDomain
C25712
UMLS CUI-1-1
C0231832
/min
Temperature
Description

Temperature

Data type

float

Measurement units
  • °C
Alias
NCI Thesaurus ObjectClass
C25190
NCI Thesaurus Property
C20989
NCI Thesaurus Property
C25206
NCI Thesaurus Property
C49672
NCI Thesaurus ValueDomain
C25712
UMLS CUI-1-1
C0005903
°C
Karnofsky Performance Status
Description

Karnofsky Performance Status Score

Data type

integer

Measurement units
  • %
Alias
NCI Thesaurus Property
C25367
NCI Thesaurus ObjectClass
C20641
NCI Thesaurus ValueDomain
C25338
UMLS CUI-1-1
C0206065
Footer Module
Description

Footer Module

Comments
Description

Research Comments Text

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
UMLS CUI-1
C0947611
Back to the top of the page

Similar models

No Instruction available.

1 forms
  1. StudyEvent: AMC-045 Vital Signs Form (F20)
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Header Module
Visit Number
Item
Visit number
text
C25337 (NCI Thesaurus ValueDomain)
C16696 (NCI Thesaurus ObjectClass)
C25385 (NCI Thesaurus Property)
C1549755 (UMLS CUI-1)
Assessment Date
Item
Date of evaluation
date
C25164 (NCI Thesaurus ValueDomain)
C25367 (NCI Thesaurus ObjectClass)
C25367 (NCI Thesaurus ValueDomain)
C38000 (NCI Thesaurus Property)
C2985720 (UMLS CUI-1-1)
Time Test Given
Item
Time Test Completed
time
C16960 (NCI Thesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C25250 (NCI Thesaurus Property)
C0518766 (NCI Metathesaurus Property)
C25207 (NCI Thesaurus ValueDomain)
C2825565 (UMLS CUI-1-1)
Item Group
Vital Signs
C0518766 (UMLS CUI-1)
Height
Item
Height
float
C25209 (NCI Thesaurus ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C25347 (NCI Thesaurus Property)
C0005890 (UMLS CUI-1-1)
Weight
Item
Body weight
float
C25209 (NCI Thesaurus ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C25208 (NCI Thesaurus Property)
C0005910 (UMLS CUI-1-1)
BSA
Item
Body surface area
float
C25190 (NCI Thesaurus ObjectClass)
C25712 (NCI Thesaurus ValueDomain)
C25157 (NCI Thesaurus Property)
C0005902 (UMLS CUI-1-1)
Systolic blood pressure
Item
Systolic
integer
C25209 (NCI Thesaurus ValueDomain)
C25214 (NCI Thesaurus Property)
C25298 (NCI Thesaurus ObjectClass)
C0871470 (UMLS CUI-1-1)
Diastolic blood pressure
Item
Diastolic
integer
C25209 (NCI Thesaurus ValueDomain)
C25214 (NCI Thesaurus Property)
C25299 (NCI Thesaurus ObjectClass)
C0428883 (UMLS CUI-1-1)
Heart rate
Item
Heart rate
integer
C16960 (NCI Thesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C49672 (NCI Thesaurus Property)
C49677 (NCI Thesaurus Property)
C25712 (NCI Thesaurus ValueDomain)
C0018810 (UMLS CUI-1-1)
Respiratory Rate
Item
Respiratory Rate
integer
C25190 (NCI Thesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C49672 (NCI Thesaurus Property)
C49678 (NCI Thesaurus Property)
C25712 (NCI Thesaurus ValueDomain)
C0231832 (UMLS CUI-1-1)
Body Temperature
Item
Temperature
float
C25190 (NCI Thesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C25206 (NCI Thesaurus Property)
C49672 (NCI Thesaurus Property)
C25712 (NCI Thesaurus ValueDomain)
C0005903 (UMLS CUI-1-1)
Item
Karnofsky Performance Status
integer
C25367 (NCI Thesaurus Property)
C20641 (NCI Thesaurus ObjectClass)
C25338 (NCI Thesaurus ValueDomain)
C0206065 (UMLS CUI-1-1)
CL.1
Code List
Karnofsky Performance Status
CL Item
Dead (0)
CL Item
Moribund, Fatal Processes Progressing Rapidly (10)
CL Item
Normal, No Complaints, No Evidence Of Disease (100)
CL Item
Very Sick, Hospitalization Indicated. Death Not Imminent (20)
CL Item
Severely Disabled, Hospitalization Indicated. Death Not Imminent (30)
CL Item
Disabled, Requires Special Care And Assistance (40)
CL Item
Requires Considerable Assistance And Frequent Medical Care (50)
CL Item
Requires Occasional Assistance, But Is Able To Care For Most Of His/her Needs (60)
CL Item
Cares For Self, Unable To Carry On Normal Activity Or To Do Active Work (70)
CL Item
Normal Activity With Effort; Some Signs Or Symptoms Of Disease (80)
CL Item
Able To Carry On Normal Activity; Minor Signs Or Symptoms Of Disease (90)
Item Group
Footer Module
Comments
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0947611 (UMLS CUI-1)
Back to the top of the page 

Contact

Please use this form for feedback, questions and suggestions for improvements.

Fields marked with * are required.

Help

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial