ID

553

Description

NCI Cooperative Group Treatment by Cycle Form-CALGB-90104 Combination Chemotherapy in Treating Patients With Bladder Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A9C01F91-F376-264F-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A9C01F91-F376-264F-E034-0003BA12F5E7

Keywords

Versions (2)
  1. 8/26/12 8/26/12 -
  2. 11/28/14 11/28/14 - Martin Dugas
Uploaded on

August 26, 2012

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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Bladder Cancer NCT00014534 Treatment - NCI Cooperative Group Treatment by Cycle Form-CALGB-90104 - 2056083v3.0

English

No Instruction available.

1 forms  
  1. StudyEvent: NCI Cooperative Group Treatment by Cycle Form-CALGB-90104
    1. No Instruction available.
Mskcc 00-138; Calgb-90104; Ecog
Description

Mskcc 00-138; Calgb-90104; Ecog

Coordinating Group Protocol Number
Description

CoordinatingGroupProtocolNumber

Data type

text

Coordinating Group Code
Description

CoordinatingGroupCode

Data type

text

Alias
NCI Thesaurus ValueDomain
C25162
UMLS 2011AA ValueDomain
C0805701
Protocol Title
Description

ProtocolTitle

Data type

text

Alias
NCI Thesaurus ObjectClass
C25320
UMLS 2011AA ObjectClass
C1507394
NCI Thesaurus Property
C42774
UMLS 2011AA Property
C1705823
Patient Study ID, Coordinating Group
Description

PatientStudyID,CoordinatingGroup

Data type

text

Patient Study ID, Participating Group
Description

PatientStudyID,ParticipatingGroup

Data type

text

Participating Group Code
Description

ParticipatingGroupCode

Data type

text

Alias
NCI Thesaurus ValueDomain
C25162
UMLS 2011AA ValueDomain
C0805701
Institution Name
Description

InstitutionName

Data type

text

Affiliate
Description

AffiliateName

Data type

text

Patient Last Name (initials acceptable)
Description

PatientName,Last

Data type

text

Patient First Name (initials acceptable)
Description

PatientName,First

Data type

text

Patient Middle Name (initials acceptable)
Description

PatientName,Middle

Data type

text

Form Administration
Description

Form Administration

Person Completing Form, Last Name
Description

PersonCompletingForm,LastName

Data type

text

Person Completing Form, First Name
Description

PersonCompletingForm,FirstName

Data type

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Are data amended?
Description

AmendedDataInd

Data type

text

Alias
NCI Thesaurus ObjectClass
C25474
UMLS 2011AA ObjectClass
C1511726
NCI Thesaurus Property
C25416
UMLS 2011AA Property
C1691222
Treatment Cycles
Description

Treatment Cycles

Current Cycle Number
Description

CourseIdentification

Data type

text

Cycle Start Date
Description

CourseBeginDate

Data type

date

Chemotherapy Agent Name
Description

ChemotherapyAgentName

Data type

text

Agent Start Date
Description

AgentBeginDate

Data type

date

Agent End Date
Description

AgentEndDate

Data type

date

Agent Admin Route
Description

AgentAdminRoute

Data type

text

Agent Total Dose (per day)
Description

AgentTotalDose

Data type

double

Agent Dose Level
Description

AgentDoseLevelValue

Data type

text

Alias
NCI Thesaurus Property
C25488
UMLS 2011AA Property
C0178602
NCI Thesaurus ObjectClass
C1708
UMLS 2011AA ObjectClass
C0450442
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
NCI Thesaurus Property
C25554
UMLS 2011AA Property
C0441889
Agent Dose Units
Description

AgentDoseUnits

Data type

text

Ccrr Module For Nci Cooperative Group Treatment By Cycle Form-calgb-90104
Description

Ccrr Module For Nci Cooperative Group Treatment By Cycle Form-calgb-90104

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Similar models

No Instruction available.

1 forms
  1. StudyEvent: NCI Cooperative Group Treatment by Cycle Form-CALGB-90104
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Mskcc 00-138; Calgb-90104; Ecog
CoordinatingGroupProtocolNumber
Item
Coordinating Group Protocol Number
text
CoordinatingGroupCode
Item
Coordinating Group Code
text
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
ProtocolTitle
Item
Protocol Title
text
C25320 (NCI Thesaurus ObjectClass)
C1507394 (UMLS 2011AA ObjectClass)
C42774 (NCI Thesaurus Property)
C1705823 (UMLS 2011AA Property)
PatientStudyID,CoordinatingGroup
Item
Patient Study ID, Coordinating Group
text
PatientStudyID,ParticipatingGroup
Item
Patient Study ID, Participating Group
text
ParticipatingGroupCode
Item
Participating Group Code
text
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
InstitutionName
Item
Institution Name
text
AffiliateName
Item
Affiliate
text
PatientName,Last
Item
Patient Last Name (initials acceptable)
text
PatientName,First
Item
Patient First Name (initials acceptable)
text
PatientName,Middle
Item
Patient Middle Name (initials acceptable)
text
Item Group
Form Administration
PersonCompletingForm,LastName
Item
Person Completing Form, Last Name
text
PersonCompletingForm,FirstName
Item
Person Completing Form, First Name
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
Item
Are data amended?
text
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
CL.1
Code List
Are data amended?
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item Group
Treatment Cycles
CourseIdentification
Item
Current Cycle Number
text
CourseBeginDate
Item
Cycle Start Date
date
ChemotherapyAgentName
Item
Chemotherapy Agent Name
text
AgentBeginDate
Item
Agent Start Date
date
AgentEndDate
Item
Agent End Date
date
AgentAdminRoute
Item
Agent Admin Route
text
AgentTotalDose
Item
Agent Total Dose (per day)
double
AgentDoseLevelValue
Item
Agent Dose Level
text
C25488 (NCI Thesaurus Property)
C0178602 (UMLS 2011AA Property)
C1708 (NCI Thesaurus ObjectClass)
C0450442 (UMLS 2011AA ObjectClass)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C25554 (NCI Thesaurus Property)
C0441889 (UMLS 2011AA Property)
AgentDoseUnits
Item
Agent Dose Units
text
Item Group
Ccrr Module For Nci Cooperative Group Treatment By Cycle Form-calgb-90104
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