ID
23023
Description
IBCSG Long Term Follow-Up Medication Form (18-LTF-M) Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=889C3F60-2C7B-8540-E040-BB89AD4303DD
Lien
Mots-clés
Versions (2)
- 26/08/2012 26/08/2012 -
- 20/06/2017 20/06/2017 - Martin Dugas
Téléchargé le
20 juin 2017
DOI
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Creative Commons BY-NC 3.0
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IBCSG Long Term Follow-Up Medication Form (18-LTF-M)
Instructions: This form is to be completed if the patient received bone active medication, non-steroidal, anti-inflammatory drug or extended adjuvant therapy during this follow-up period. Use minus one (-1) to indicate that an answer is unknown, unobtainable or not done
- StudyEvent: IBCSG Long Term Follow-Up Medication Form (18-LTF-M)
Description
Long Term Follow-up Medication
Alias
- UMLS CUI-1
- C1517942
- UMLS CUI-2
- C0013227
Description
Medication Osteoporosis Administered Indicator
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25180
- NCI Thesaurus Property
- C3298
- NCI Thesaurus ObjectClass
- C459
- NCI Thesaurus Property-2
- C25382
- UMLS CUI [1,1]
- C0029456
- UMLS CUI [1,2]
- C0013227
Description
Medication Osteoporosis
Type de données
integer
Alias
- NCI Thesaurus ValueDomain
- C25284
- NCI Thesaurus Property
- C3298
- NCI Thesaurus ObjectClass
- C459
- NCI Thesaurus Property-2
- C25382
- UMLS CUI [1,1]
- C0029456
- UMLS CUI [1,2]
- C0013227
Description
Medication Osteoporosis, specify
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- NCI Thesaurus Property
- C3298
- NCI Thesaurus ObjectClass
- C459
- NCI Thesaurus Property-2
- C25382
- UMLS CUI [1,1]
- C0029456
- UMLS CUI [1,2]
- C0013227
Description
Concomitant Medication Corticosteroids
Type de données
text
Alias
- NCI Thesaurus ObjectClass
- C459
- NCI Thesaurus ObjectClass-2
- C25730
- NCI Thesaurus Property
- C2322
- NCI Thesaurus Property-2
- C25382
- NCI Thesaurus ValueDomain
- C25180
- UMLS CUI [1,1]
- C0001617
- UMLS CUI [1,2]
- C0013227
Description
Concomitant Medication OtherCorticosteroid
Type de données
text
Alias
- NCI Thesaurus ObjectClass
- C459
- NCI Thesaurus ObjectClass-2
- C25730
- NCI Thesaurus Property
- C17649
- NCI Thesaurus Property-2
- C2322
- NCI Thesaurus Property-3
- C25382
- NCI Thesaurus ValueDomain
- C25685
- UMLS CUI [1]
- C0013227C0001617
Description
Nonsteroidal Antiinflammatory Drug Regular Use
Type de données
text
Alias
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C18772
- NCI Thesaurus Property-2
- C257
- NCI Thesaurus Property-3
- C25340
- NCI Thesaurus Property-4
- C25647
- NCI Thesaurus ValueDomain
- C25180
- UMLS CUI [1,1]
- C0003211
- UMLS CUI [1,2]
- C0205272
Description
Nonsteroidal Antiinflammatory Drug Medication
Type de données
text
Alias
- NCI Thesaurus ObjectClass
- C459
- NCI Thesaurus ObjectClass-2
- C257
- NCI Thesaurus Property
- C25616
- NCI Thesaurus Property-2
- C25651
- NCI Thesaurus ValueDomain
- C25685
- UMLS CUI [1,1]
- C0013227
- UMLS CUI [1,2]
- C0003211
Description
Adjuvant Hormonal Therapy
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25180
- NCI Thesaurus ObjectClass
- C15445
- NCI Thesaurus ObjectClass-2
- C2140
- NCI Thesaurus Property
- C25382
- UMLS CUI [1]
- C2367461
Description
Adjuvant Hormone Therapy Begin Date
Type de données
date
Alias
- NCI Thesaurus ObjectClass
- C15445
- NCI Thesaurus ObjectClass-2
- C2140
- NCI Thesaurus Property
- C25431
- NCI Thesaurus Property-2
- C25275
- NCI Thesaurus ValueDomain
- C25164
- NCI Thesaurus ValueDomain-2
- C25431
- UMLS CUI [1,1]
- C2367461
- UMLS CUI [1,2]
- C0808070
Description
Adjuvant Hormone Therapy End Date
Type de données
date
Alias
- NCI Thesaurus ObjectClass
- C15445
- NCI Thesaurus ObjectClass-2
- C2140
- NCI Thesaurus Property
- C25275
- NCI Thesaurus Property-2
- C25496
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI [1,1]
- C2367461
- UMLS CUI [1,2]
- C0806020
Description
Adjuvant Hormonal Therapy Type
Type de données
integer
Alias
- NCI Thesaurus ValueDomain
- C25284
- NCI Thesaurus ObjectClass
- C15445
- NCI Thesaurus ObjectClass-2
- C2140
- NCI Thesaurus Property
- C25382
- UMLS CUI [1]
- C2367461
Description
New Adjuvant Hormone Therapy, specify
Type de données
text
Alias
- NCI Thesaurus ObjectClass
- C25586
- NCI Thesaurus ObjectClass-2
- C15445
- NCI Thesaurus ObjectClass-3
- C2140
- NCI Thesaurus Property
- C25382
- NCI Thesaurus ValueDomain
- C25685
- UMLS CUI [1]
- C2367461
Description
Prior Treatment Discontinued Reason
Type de données
integer
Alias
- NCI Thesaurus ValueDomain
- C25638
- NCI Thesaurus ObjectClass
- C25629
- NCI Thesaurus ObjectClass-2
- C15368
- NCI Thesaurus Property
- C25484
- UMLS CUI [1,1]
- C4288399
- UMLS CUI [1,2]
- C0566251
Description
Off-treatment Reason
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- NCI Thesaurus ObjectClass
- C25601
- NCI Thesaurus Property
- C25365
- UMLS CUI [1,1]
- C1518544
- UMLS CUI [1,2]
- C0566251
Description
Footer Module
Alias
- UMLS CUI-1
- C2825232
Description
Investigator Signature
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- NCI Thesaurus Property
- C25678
- NCI Thesaurus ObjectClass
- C17089
- NCI Thesaurus Property-2
- C25479
- UMLS CUI [1]
- C2346576
Description
Investigator Signature Date
Type de données
date
Unités de mesure
- day month year
Alias
- NCI Thesaurus ValueDomain
- C25164
- NCI Thesaurus Property
- C25678
- NCI Thesaurus ValueDomain-2
- C25367
- NCI Thesaurus ObjectClass
- C17089
- UMLS CUI [1,1]
- C2346576
- UMLS CUI [1,2]
- C0011008
Similar models
Instructions: This form is to be completed if the patient received bone active medication, non-steroidal, anti-inflammatory drug or extended adjuvant therapy during this follow-up period. Use minus one (-1) to indicate that an answer is unknown, unobtainable or not done
- StudyEvent: IBCSG Long Term Follow-Up Medication Form (18-LTF-M)
C16696 (NCI Thesaurus ObjectClass)
C25385 (NCI Thesaurus Property)
C1549755 (UMLS CUI [1])
C16960 (NCI Thesaurus ObjectClass)
C25364 (NCI Thesaurus Property)
C25530 (NCI Thesaurus Property-2)
C4037772 (UMLS CUI [1,1])
C1512890 (UMLS CUI [1,2])
C25320 (NCI Thesaurus ObjectClass)
C25364 (NCI Thesaurus Property)
C25530 (NCI Thesaurus Property-2)
C1507394 (UMLS CUI [1,1])
C1512890 (UMLS CUI [1,2])
C0030705 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus ValueDomain)
C0600091 (UMLS 2011AA ValueDomain)
C25196 (NCI Thesaurus Property)
C0034656 (UMLS 2011AA Property)
C21541 (NCI Thesaurus ObjectClass)
C25364 (NCI Thesaurus Property)
C1301943 (UMLS CUI [1,1])
C0805701 (UMLS CUI [1,2])
C1547383 (UMLS 2011AA ValueDomain)
C21541 (NCI Thesaurus ObjectClass)
C0018704 (UMLS 2011AA ObjectClass)
C21541 (NCI Thesaurus ValueDomain-2)
C0018704 (UMLS 2011AA ValueDomain-2)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C0013227 (UMLS CUI-2)
C3298 (NCI Thesaurus Property)
C459 (NCI Thesaurus ObjectClass)
C25382 (NCI Thesaurus Property-2)
C0029456 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
C1298908 (UMLS CUI-1)
C1705108 (UMLS CUI-1)
C3298 (NCI Thesaurus Property)
C459 (NCI Thesaurus ObjectClass)
C25382 (NCI Thesaurus Property-2)
C0029456 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
C3298 (NCI Thesaurus Property)
C459 (NCI Thesaurus ObjectClass)
C25382 (NCI Thesaurus Property-2)
C0029456 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
C25730 (NCI Thesaurus ObjectClass-2)
C2322 (NCI Thesaurus Property)
C25382 (NCI Thesaurus Property-2)
C25180 (NCI Thesaurus ValueDomain)
C0001617 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
C1298908 (UMLS CUI-1)
C1705108 (UMLS CUI-1)
C25730 (NCI Thesaurus ObjectClass-2)
C17649 (NCI Thesaurus Property)
C2322 (NCI Thesaurus Property-2)
C25382 (NCI Thesaurus Property-3)
C25685 (NCI Thesaurus ValueDomain)
C0013227C0001617 (UMLS CUI [1])
C18772 (NCI Thesaurus Property)
C257 (NCI Thesaurus Property-2)
C25340 (NCI Thesaurus Property-3)
C25647 (NCI Thesaurus Property-4)
C25180 (NCI Thesaurus ValueDomain)
C0003211 (UMLS CUI [1,1])
C0205272 (UMLS CUI [1,2])
C1298908 (UMLS CUI-1)
C1705108 (UMLS CUI-1)
C257 (NCI Thesaurus ObjectClass-2)
C25616 (NCI Thesaurus Property)
C25651 (NCI Thesaurus Property-2)
C25685 (NCI Thesaurus ValueDomain)
C0013227 (UMLS CUI [1,1])
C0003211 (UMLS CUI [1,2])
C15445 (NCI Thesaurus ObjectClass)
C2140 (NCI Thesaurus ObjectClass-2)
C25382 (NCI Thesaurus Property)
C2367461 (UMLS CUI [1])
C1298908 (UMLS CUI-1)
C1705108 (UMLS CUI-1)
C2140 (NCI Thesaurus ObjectClass-2)
C25431 (NCI Thesaurus Property)
C25275 (NCI Thesaurus Property-2)
C25164 (NCI Thesaurus ValueDomain)
C25431 (NCI Thesaurus ValueDomain-2)
C2367461 (UMLS CUI [1,1])
C0808070 (UMLS CUI [1,2])
C2140 (NCI Thesaurus ObjectClass-2)
C25275 (NCI Thesaurus Property)
C25496 (NCI Thesaurus Property-2)
C25164 (NCI Thesaurus ValueDomain)
C2367461 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
C15445 (NCI Thesaurus ObjectClass)
C2140 (NCI Thesaurus ObjectClass-2)
C25382 (NCI Thesaurus Property)
C2367461 (UMLS CUI [1])
C15445 (NCI Thesaurus ObjectClass-2)
C2140 (NCI Thesaurus ObjectClass-3)
C25382 (NCI Thesaurus Property)
C25685 (NCI Thesaurus ValueDomain)
C2367461 (UMLS CUI [1])
C25629 (NCI Thesaurus ObjectClass)
C15368 (NCI Thesaurus ObjectClass-2)
C25484 (NCI Thesaurus Property)
C4288399 (UMLS CUI [1,1])
C0566251 (UMLS CUI [1,2])
C0085183 (UMLS CUI-3)
C25601 (NCI Thesaurus ObjectClass)
C25365 (NCI Thesaurus Property)
C1518544 (UMLS CUI [1,1])
C0566251 (UMLS CUI [1,2])
C25678 (NCI Thesaurus Property)
C17089 (NCI Thesaurus ObjectClass)
C25479 (NCI Thesaurus Property-2)
C2346576 (UMLS CUI [1])
C25678 (NCI Thesaurus Property)
C25367 (NCI Thesaurus ValueDomain-2)
C17089 (NCI Thesaurus ObjectClass)
C2346576 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])