ID
4703
Descripción
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
Palabras clave
Versiones (2)
- 26/8/12 26/8/12 -
- 20/3/14 20/3/14 - Martin Dugas
Subido en
20 de marzo de 2014
DOI
Para solicitar uno, por favor iniciar sesión.
Licencia
Creative Commons BY-NC 3.0 Legacy
Comentarios del modelo :
Puede comentar sobre el modelo de datos aquí. A través de las burbujas de diálogo en los grupos de elementos y elementos, puede agregar comentarios específicos.
Comentarios de grupo de elementos para :
Comentarios del elemento para :
Para descargar modelos de datos, debe haber iniciado sesión. Por favor iniciar sesión o Registrate gratis.
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.
Descripción
IDs
Descripción
Patient Name
Tipo de datos
string
Alias
- UMLS CUI
- C1299487
Descripción
ParticipatingGroup
Tipo de datos
text
Alias
- NCI Thesaurus ObjectClass
- C17005
- UMLS 2011AA ObjectClass
- C1257890
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
Descripción
PatientHospitalNumber
Tipo de datos
text
Descripción
ParticipatingGroupProtocolNo.
Tipo de datos
text
Descripción
AffiliateName
Tipo de datos
text
Descripción
ParticipatingGroupPatientID
Tipo de datos
text
Descripción
Treatment Cycle Information
Descripción
Drug dose
Tipo de datos
float
Alias
- UMLS CUI
- C0678766
Descripción
Agent
Tipo de datos
string
Alias
- UMLS CUI
- C0450442
Descripción
OffTreatmentReason
Tipo de datos
string
Alias
- UMLS CUI
- CL436968
Descripción
OffTreatmentReason,Other
Tipo de datos
string
Alias
- UMLS CUI
- CL436968
Descripción
Treatment Schedule - Systemic Therapy
Descripción
Treatment Schedule - Other Therapy
Descripción
OptionalProtocolTherapyInd
Tipo de datos
string
Alias
- UMLS CUI
- C1707479
Descripción
OptionalProtocolTherapyName
Tipo de datos
string
Alias
- UMLS CUI
- C1707479
Descripción
ConcurrentNon-ProtocolTherapyInd
Tipo de datos
string
Alias
- UMLS CUI
- C1707479
Descripción
Concomitant Therapy
Tipo de datos
string
Alias
- UMLS CUI
- C1707479
Descripción
Comments
Descripción
Signature
Descripción
PersonCompletingForm,FirstName
Tipo de datos
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
Descripción
FormCompletionDate,Original
Tipo de datos
date
Similar models
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)