ID
4703
Beschreibung
CALGB: 49903 ADVANCED TREATMENT SUMMARY FORM; All Patients Trastuzumab With or Without Tamoxifen in Treating Women With Progressive Stage IV Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A73D1CA4-8ADF-4761-E034-0003BA0B1A09
Link
Stichworte
Versionen (2)
- 26.08.12 26.08.12 -
- 20.03.14 20.03.14 - Martin Dugas
Hochgeladen am
20. März 2014
DOI
Für eine Beantragung loggen Sie sich ein.
Lizenz
Creative Commons BY-NC 3.0 Legacy
Modell Kommentare :
Hier können Sie das Modell kommentieren. Über die Sprechblasen an den Itemgruppen und Items können Sie diese spezifisch kommentieren.
Itemgroup Kommentare für :
Item Kommentare für :
Um Formulare herunterzuladen müssen Sie angemeldet sein. Bitte loggen Sie sich ein oder registrieren Sie sich kostenlos.
Breast Cancer NCT00053339 Treatment - CALGB: 49903 ADVANCED TREATMENT SUMMARY FORM; All Patients - 2054479v3.0
INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice. Print text in capital letters. Avoid contact with the edges of the boxes. Circle amended items and check "Amended data" box to the right. If submitting by mail, retain a copy for your records and send the original to the CALGB Data Management Center. If faxing, use an original form for maximum clarity in transmission and fax to 919-416-4990. If submitting electronically, click the Send button when you have completed the PDF version of the form.
Beschreibung
IDs
Beschreibung
Patient Name
Datentyp
string
Alias
- UMLS CUI
- C1299487
Beschreibung
ParticipatingGroup
Datentyp
text
Alias
- NCI Thesaurus ObjectClass
- C17005
- UMLS 2011AA ObjectClass
- C1257890
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
Beschreibung
PatientHospitalNumber
Datentyp
text
Beschreibung
ParticipatingGroupProtocolNo.
Datentyp
text
Beschreibung
AffiliateName
Datentyp
text
Beschreibung
ParticipatingGroupPatientID
Datentyp
text
Beschreibung
Treatment Cycle Information
Beschreibung
Drug dose
Datentyp
float
Alias
- UMLS CUI
- C0678766
Beschreibung
Agent
Datentyp
string
Alias
- UMLS CUI
- C0450442
Beschreibung
OffTreatmentReason
Datentyp
string
Alias
- UMLS CUI
- CL436968
Beschreibung
OffTreatmentReason,Other
Datentyp
string
Alias
- UMLS CUI
- CL436968
Beschreibung
Treatment Schedule - Systemic Therapy
Beschreibung
Treatment Schedule - Other Therapy
Beschreibung
OptionalProtocolTherapyInd
Datentyp
string
Alias
- UMLS CUI
- C1707479
Beschreibung
OptionalProtocolTherapyName
Datentyp
string
Alias
- UMLS CUI
- C1707479
Beschreibung
ConcurrentNon-ProtocolTherapyInd
Datentyp
string
Alias
- UMLS CUI
- C1707479
Beschreibung
Concomitant Therapy
Datentyp
string
Alias
- UMLS CUI
- C1707479
Beschreibung
Comments
Beschreibung
Signature
Ähnliche Modelle
INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice. Print text in capital letters. Avoid contact with the edges of the boxes. Circle amended items and check "Amended data" box to the right. If submitting by mail, retain a copy for your records and send the original to the CALGB Data Management Center. If faxing, use an original form for maximum clarity in transmission and fax to 919-416-4990. If submitting electronically, click the Send button when you have completed the PDF version of the form.
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
C1705108 (UMLS 2011AA)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C0205394 (UMLS 2011AA)
C1298908 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0027361 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)