ID

23034

Beschreibung

IBCSG Long Term Follow-Up Second Non-Breast Malignancy (18-LTF-SM) Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=889C7665-5F80-48C7-E040-BB89AD436937

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=889C7665-5F80-48C7-E040-BB89AD436937

Stichworte

Versionen (2)
  1. 26.08.12 26.08.12 -
  2. 20.06.17 20.06.17 - Martin Dugas
Hochgeladen am

20. Juni 2017

DOI

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Lizenz

Creative Commons BY-NC 3.0
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IBCSG Long Term Follow-Up Second Non-Breast Malignancy (18-LTF-SM)

Englisch

Complete this form for patients who have a proven second (non-breast) malignancy. Use minus one (-1) to indicate an answer is unknown, unobtainable or not done

1 Formulare  
Header Module
Beschreibung

Header Module

Alias
UMLS CUI-1
C1320722
Visit number
Beschreibung

Hospital Admission Ordinal Number

Datentyp

integer

Alias
NCI Thesaurus ValueDomain
C25337
NCI Thesaurus ObjectClass
C16696
NCI Thesaurus Property
C25385
UMLS CUI [1]
C1549755
IBCSG Patient ID
Beschreibung

Patient International Breast Cancer Study Group Identifier Number

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25337
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C25530
UMLS CUI [1,1]
C2348585
UMLS CUI [1,2]
C1512890
IBCSG Study No.
Beschreibung

Protocol International Breast Cancer Study Group Identifier Number

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25337
NCI Thesaurus ObjectClass
C25320
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C25530
UMLS CUI [1,1]
C3274381
UMLS CUI [1,2]
C1512890
Randomization No.
Beschreibung

Randomization Number

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus ValueDomain
C25364
NCI Thesaurus Property
C25196
UMLS CUI [1]
C2986235
Institution Code Number
Beschreibung

Institution Identifier Number

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25337
NCI Thesaurus ObjectClass
C21541
NCI Thesaurus Property
C25364
UMLS CUI [1,1]
C1301943
UMLS CUI [1,2]
C0805701
Institution Name
Beschreibung

Institution Name

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25191
NCI Thesaurus ObjectClass
C21541
NCI Thesaurus ValueDomain-2
C21541
NCI Thesaurus Property
C25364
UMLS CUI [1]
C1301943
Second Non-breast Malignancy
Beschreibung

Second Non-breast Malignancy

Alias
UMLS CUI-1
C0085183
Specify site (non-breast)
Beschreibung

Cancer Site

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25704
NCI Thesaurus ObjectClass
C25586
NCI Thesaurus Property
C25341
NCI Thesaurus ObjectClass-2
C9305
UMLS CUI [1]
C3173298
Specify type (non-breast)
Beschreibung

Primary Tumor Diagnosis

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25704
NCI Thesaurus ObjectClass
C3262
NCI Thesaurus ObjectClass-2
C25251
NCI Thesaurus Property
C15220
UMLS CUI [1,1]
C0677930
UMLS CUI [1,2]
C0011900
Date of Diagnosis of Second Primary Cancer (non-breast day month year)
Beschreibung

Second Primary Neoplasm Diagnosis Date

Datentyp

date

Alias
NCI Thesaurus ObjectClass
C3262
NCI Thesaurus ObjectClass-2
C25251
NCI Thesaurus ObjectClass-3
C25666
NCI Thesaurus Property
C15220
NCI Thesaurus ValueDomain
C25164
UMLS CUI [1,1]
C0085183
UMLS CUI [1,2]
C2316983
Footer Module
Beschreibung

Footer Module

Alias
UMLS CUI-1
C2825232
Investigator/Designee Signature
Beschreibung

Investigator Signature

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25704
NCI Thesaurus Property
C25678
NCI Thesaurus ObjectClass
C17089
NCI Thesaurus Property-2
C25479
UMLS CUI [1]
C2346576
Investigator Signature Date
Beschreibung

Investigator Signature Date

Datentyp

date

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
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Ähnliche Modelle

Complete this form for patients who have a proven second (non-breast) malignancy. Use minus one (-1) to indicate an answer is unknown, unobtainable or not done

1 Formulare
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Header Module
C1320722 (UMLS CUI-1)
Hospital Admission Ordinal Number
Item
Visit number
integer
C25337 (NCI Thesaurus ValueDomain)
C16696 (NCI Thesaurus ObjectClass)
C25385 (NCI Thesaurus Property)
C1549755 (UMLS CUI [1])
Patient International Breast Cancer Study Group Identifier Number
Item
IBCSG Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C25364 (NCI Thesaurus Property)
C25530 (NCI Thesaurus Property-2)
C2348585 (UMLS CUI [1,1])
C1512890 (UMLS CUI [1,2])
Protocol International Breast Cancer Study Group Identifier Number
Item
IBCSG Study No.
text
C25337 (NCI Thesaurus ValueDomain)
C25320 (NCI Thesaurus ObjectClass)
C25364 (NCI Thesaurus Property)
C25530 (NCI Thesaurus Property-2)
C3274381 (UMLS CUI [1,1])
C1512890 (UMLS CUI [1,2])
Randomization Number
Item
Randomization No.
text
C16960 (NCI Thesaurus ObjectClass)
C25364 (NCI Thesaurus ValueDomain)
C25196 (NCI Thesaurus Property)
C2986235 (UMLS CUI [1])
Institution Identifier Number
Item
Institution Code Number
text
C25337 (NCI Thesaurus ValueDomain)
C21541 (NCI Thesaurus ObjectClass)
C25364 (NCI Thesaurus Property)
C1301943 (UMLS CUI [1,1])
C0805701 (UMLS CUI [1,2])
Institution Name
Item
Institution Name
text
C25191 (NCI Thesaurus ValueDomain)
C21541 (NCI Thesaurus ObjectClass)
C21541 (NCI Thesaurus ValueDomain-2)
C25364 (NCI Thesaurus Property)
C1301943 (UMLS CUI [1])
Item Group
Second Non-breast Malignancy
C0085183 (UMLS CUI-1)
Cancer Site
Item
Specify site (non-breast)
text
C25704 (NCI Thesaurus ValueDomain)
C25586 (NCI Thesaurus ObjectClass)
C25341 (NCI Thesaurus Property)
C9305 (NCI Thesaurus ObjectClass-2)
C3173298 (UMLS CUI [1])
Primary Tumor Diagnosis
Item
Specify type (non-breast)
text
C25704 (NCI Thesaurus ValueDomain)
C3262 (NCI Thesaurus ObjectClass)
C25251 (NCI Thesaurus ObjectClass-2)
C15220 (NCI Thesaurus Property)
C0677930 (UMLS CUI [1,1])
C0011900 (UMLS CUI [1,2])
Second Primary Neoplasm Diagnosis Date
Item
Date of Diagnosis of Second Primary Cancer (non-breast day month year)
date
C3262 (NCI Thesaurus ObjectClass)
C25251 (NCI Thesaurus ObjectClass-2)
C25666 (NCI Thesaurus ObjectClass-3)
C15220 (NCI Thesaurus Property)
C25164 (NCI Thesaurus ValueDomain)
C0085183 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
Item Group
Footer Module
C2825232 (UMLS CUI-1)
Investigator Signature
Item
Investigator/Designee Signature
text
C25704 (NCI Thesaurus ValueDomain)
C25678 (NCI Thesaurus Property)
C17089 (NCI Thesaurus ObjectClass)
C25479 (NCI Thesaurus Property-2)
C2346576 (UMLS CUI [1])
Investigator Signature Date
Item
Investigator Signature Date
date
C25164 (NCI Thesaurus ValueDomain)
C25678 (NCI Thesaurus Property)
C25367 (NCI Thesaurus ValueDomain-2)
C17089 (NCI Thesaurus ObjectClass)
C2346576 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
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