ID

493

Description

AMC-045 History of AIDS Defining Disease Form (F03) 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=72873427-47DC-3052-E040-BB89AD43686C

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=72873427-47DC-3052-E040-BB89AD43686C

Keywords

  1. 8/26/12 8/26/12 -
  2. 3/14/15 3/14/15 - Martin Dugas
Uploaded on

August 26, 2012

DOI

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License

Creative Commons BY-NC 3.0 Legacy

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Anal Cancer NCT00324415 On-Study - AMC-045 History of AIDS Defining Disease Form (F03) - 2937261v1.0

No Instruction available.

  1. StudyEvent: AMC-045 History of AIDS Defining Disease Form (F03)
    1. No Instruction available.
Header Module
Description

Header Module

Visit number
Description

HospitalAdmissionOrdinalNumber

Data type

double

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C16696
UMLS 2011AA ObjectClass
C0019994
NCI Thesaurus Property
C25385
UMLS 2011AA Property
C0809949
Unnamed1
Description

Unnamed1

Date of Evaluation (mm/dd/yyyy)
Description

LesionAssessmentDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C3824
UMLS 2011AA ObjectClass
C0221198
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus ValueDomain
C25367
History of opportunistic diseases and predisposing disease
Description

OpportunisticInfectionSusceptibilityDiseasePersonalMedicalHistoryInd-2

Data type

text

Alias
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus ObjectClass
C3289
UMLS 2011AA ObjectClass
C0029118
NCI Thesaurus ObjectClass
C16505
UMLS 2011AA ObjectClass
C0220898
NCI Metathesaurus Property
C0262926
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Disease Type
Description

AcquiredImmunodeficiencySyndromeAssociatedDiseaseDiagnosisType

Data type

text

Alias
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus ObjectClass
C2851
UMLS 2011AA ObjectClass
C0001175
NCI Thesaurus ObjectClass
C25281
UMLS 2011AA ObjectClass
C0332281
NCI Thesaurus Property
C15220
UMLS 2011AA Property
C0011900
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Disease status (Please select the disease status of the diseases listed)
Description

DiseaseResponseSiteStatus

Data type

text

Alias
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
Unnamed2
Description

Unnamed2

Comments
Description

ResearchCommentsText

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
UMLS 2011AA Property
C0282411

Similar models

No Instruction available.

  1. StudyEvent: AMC-045 History of AIDS Defining Disease Form (F03)
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Header Module
HospitalAdmissionOrdinalNumber
Item
Visit number
double
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16696 (NCI Thesaurus ObjectClass)
C0019994 (UMLS 2011AA ObjectClass)
C25385 (NCI Thesaurus Property)
C0809949 (UMLS 2011AA Property)
LesionAssessmentDate
Item
Date of Evaluation (mm/dd/yyyy)
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C3824 (NCI Thesaurus ObjectClass)
C0221198 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25367 (NCI Thesaurus ValueDomain)
Item
History of opportunistic diseases and predisposing disease
text
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C3289 (NCI Thesaurus ObjectClass)
C0029118 (UMLS 2011AA ObjectClass)
C16505 (NCI Thesaurus ObjectClass)
C0220898 (UMLS 2011AA ObjectClass)
C0262926 (NCI Metathesaurus Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
Code List
History of opportunistic diseases and predisposing disease
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Disease Type
text
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C2851 (NCI Thesaurus ObjectClass)
C0001175 (UMLS 2011AA ObjectClass)
C25281 (NCI Thesaurus ObjectClass)
C0332281 (UMLS 2011AA ObjectClass)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Disease Type
CL Item
Candidiasis Of Bronchi, Trachea Or Lungs (Candidiasis of bronchi, trachea or lungs)
CL Item
Candidiasis, Esophageal (Candidiasis, esophageal)
CL Item
Cervical Cancer (Cervical cancer, invasive)
C0007847 (NCI Metathesaurus)
CL Item
Coccidioidomycosis, Disseminated Or Extrapulmonary (Coccidioidomycosis, disseminated or extrapulmonary)
CL Item
Cryptococcosis (Cryptococcosis, extrapulmonary)
C2967 (NCI Thesaurus)
C0010414 (UMLS 2011AA)
CL Item
Cryptosporidiosis, Chronic Intestinal (Cryptosporidiosis, chronic intestinal)
CL Item
Cmv Other Than Liver, Spleen Or Nodes, Onset At Age >1month (CMV other than liver, spleen or nodes, onset at age >1month)
CL Item
Cmv Retinitis (CMV retinitis)
CL Item
Encephalopathy (Encephalopathy, HIV-related)
C26920 (NCI Thesaurus)
C0085584 (UMLS 2011AA)
CL Item
Herpes Simplex: Chronic Ulcers (> 1 Month's Duration) Or Bronchitis, Pneumonitis Or Esophagitis (onset At Age > 1 Month) (Herpes simplex: chronic ulcers (> 1 month's duration) or bronchitis, pneumonitis or esophagitis (onset at age > 1 month))
CL Item
Histoplasmosis, Disseminated Or Extrapulmonary (Histoplasmosis, disseminated or extrapulmonary)
CL Item
Isosporiasis, Chronic Intestinal (> 1 Mon) (Isosporiasis, chronic intestinal (> 1 mon))
CL Item
Kaposi's Sarcoma Aids Related (Kaposi's sarcoma)
CL Item
Non-hodgkin's Lymphoma (Lymphoma, systemic non-Hodgkin's)
C3211 (NCI Thesaurus)
C0024305 (UMLS 2011AA)
CL Item
Lymphoma, Primary, Of Brain (Lymphoma, primary, of brain)
CL Item
Mycobacterium Avium Complex Or Mycobacterium Kansasii Disseminated Or Extrapulmonary (Mycobacterium avium complex or Mycobacterium kansasii disseminated or extrapulmonary)
CL Item
Mycobacterium Tuberculosis Of Any Site, Pulmonary, Disseminated Or Extrapulmonary (Mycobacterium tuberculosis of any site, pulmonary, disseminated or extrapulmonary)
CL Item
Mycobacterium, Other Species Or Unidentified Species, Disseminated Or Extrapulmonary (Mycobacterium, other species or unidentified species, disseminated or extrapulmonary)
CL Item
Pneumocystis Jirovecii Pneumonia (Pneumocystis jirovecii pneumonia)
CL Item
Pneumonia (Pneumonia, recurrent)
C3333 (NCI Thesaurus)
C0032285 (UMLS 2011AA)
CL Item
Progressive Multifocal Leukoencephalopathy (pml) (Progressive multifocal leukoencephalopathy)
CL Item
Salmonella Septicemia, Recurrent (Salmonella septicemia, recurrent)
CL Item
Toxoplasmosis Of The Brain, Onset At Age >1month (Toxoplasmosis of the brain, onset at age >1month)
CL Item
Wasting Syndrome, Due To Hiv (Wasting syndrome, due to HIV)
Item
Disease status (Please select the disease status of the diseases listed)
text
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
Code List
Disease status (Please select the disease status of the diseases listed)
CL Item
Active (Currently active)
C45329 (NCI Thesaurus)
C0205177 (UMLS 2011AA)
CL Item
Present (Ever present)
C25626 (NCI Thesaurus)
C0150312 (UMLS 2011AA)
CL Item
Never Present (Never present)
Item Group
Unnamed2
ResearchCommentsText
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0282411 (UMLS 2011AA Property)

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