ID

5532

Beschrijving

AMC-045 Vital Signs Form (F20) 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=7285E88F-E0EF-C8EB-E040-BB89AD437ABB

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=7285E88F-E0EF-C8EB-E040-BB89AD437ABB

Trefwoorden

Versies (3)
  1. 26-08-12 26-08-12 -
  2. 08-08-14 08-08-14 - Martin Dugas
  3. 31-07-15 31-07-15 - Martin Dugas
Geüploaded op

8 augustus 2014

DOI

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Licentie

Creative Commons BY-NC 3.0 Legacy
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Anal Cancer NCT00324415 On-Study - AMC-045 Vital Signs Form (F20) - 2937179v1.0

Engels

No Instruction available.

1 Formulieren  
  1. StudyEvent: AMC-045 Vital Signs Form (F20)
    1. No Instruction available.
Header Module
Beschrijving

Header Module

Visit number
Beschrijving

Hospital Admission Ordinal Number

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25337
NCI Thesaurus ObjectClass
C16696
NCI Thesaurus Property
C25385
UMLS CUI-1
C1549755
Date of evaluation (mm/dd/yyyy)
Beschrijving

Assessment Performed Date

Datatype

date

Alias
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ObjectClass
C25367
NCI Thesaurus ValueDomain
C25367
NCI Thesaurus Property
C38000
UMLS CUI-1
C2985720
Time Test Completed (hh:mm)
Beschrijving

Patient Complete Vital Signs Physical Examination Time

Datatype

time

Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C20989
NCI Thesaurus Property
C25250
NCI Metathesaurus Property
C0518766
NCI Thesaurus ValueDomain
C25207
UMLS CUI-1
C2825565
Vital Signs
Beschrijving

Vital Signs

Height (cm in)
Beschrijving

Patient Height Measurement

Datatype

float

Maateenheden
  • cm
Alias
NCI Thesaurus ValueDomain
C25209
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25347
UMLS CUI-1
C0005890
cm
Weight (kg lb)
Beschrijving

Patient Weight Measurement

Datatype

float

Maateenheden
  • Kg
Alias
NCI Thesaurus ValueDomain
C25209
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25208
UMLS CUI-1
C0005910
Kg
Body Surface Area (m^2)
Beschrijving

Person Body Surface Area Value

Datatype

float

Maateenheden
  • m2
Alias
NCI Thesaurus ObjectClass
C25190
NCI Thesaurus ValueDomain
C25712
NCI Thesaurus Property
C25157
UMLS CUI-1
C0005902
m2
Blood Pressure (mmHg)
Beschrijving

Blood Systolic Pressure Measurement

Datatype

integer

Maateenheden
  • mmHg
Alias
NCI Thesaurus ValueDomain
C25209
NCI Thesaurus Property
C25214
NCI Thesaurus ObjectClass
C25298
UMLS CUI-1
C0871470
mmHg
Blood pressure (mmHg)
Beschrijving

Diastolic Blood Pressure Evaluation Measurement

Datatype

integer

Maateenheden
  • mmHg
Alias
NCI Thesaurus ValueDomain
C25209
NCI Thesaurus Property
C25214
NCI Thesaurus ObjectClass
C25299
UMLS CUI-1
C0428883
mmHg
Heart Rate (beats/min)
Beschrijving

Patient Vital Signs Heart Rate Physical Examination Value

Datatype

integer

Maateenheden
  • beats/min
Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C20989
NCI Thesaurus Property
C49672
NCI Thesaurus Property
C49677
NCI Thesaurus ValueDomain
C25712
UMLS CUI-1
C0018810
beats/min
Respiratory Rate (/min)
Beschrijving

Person Vital Signs Respiratory Rate Physical Examination Value

Datatype

integer

Maateenheden
  • /min
Alias
NCI Thesaurus ObjectClass
C25190
NCI Thesaurus Property
C20989
NCI Thesaurus Property
C49672
NCI Thesaurus Property
C49678
NCI Thesaurus ValueDomain
C25712
UMLS CUI-1
C0231832
/min
Body Temperature (C F)
Beschrijving

Person Vital Signs Temperature Physical Examination Value

Datatype

float

Maateenheden
  • °C
Alias
NCI Thesaurus ObjectClass
C25190
NCI Thesaurus Property
C20989
NCI Thesaurus Property
C25206
NCI Thesaurus Property
C49672
NCI Thesaurus ValueDomain
C25712
UMLS CUI-1
C0005903
°C
Karnofsky Performance Status (%)
Beschrijving

Karnofsky Performance Status Score

Datatype

integer

Maateenheden
  • %
Alias
NCI Thesaurus Property
C25367
NCI Thesaurus ObjectClass
C20641
NCI Thesaurus ValueDomain
C25338
UMLS CUI-1
C0206065
Footer Module
Beschrijving

Footer Module

Comments
Beschrijving

Research Comments Text

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25704
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
UMLS CUI-1
C0947611
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Similar models

No Instruction available.

1 Formulieren
  1. StudyEvent: AMC-045 Vital Signs Form (F20)
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Header Module
Visit Number
Item
Visit number
text
C25337 (NCI Thesaurus ValueDomain)
C16696 (NCI Thesaurus ObjectClass)
C25385 (NCI Thesaurus Property)
C1549755 (UMLS CUI-1)
Assessment Date
Item
Date of evaluation (mm/dd/yyyy)
date
C25164 (NCI Thesaurus ValueDomain)
C25367 (NCI Thesaurus ObjectClass)
C25367 (NCI Thesaurus ValueDomain)
C38000 (NCI Thesaurus Property)
C2985720 (UMLS CUI-1)
Time Test Given
Item
Time Test Completed (hh:mm)
time
C16960 (NCI Thesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C25250 (NCI Thesaurus Property)
C0518766 (NCI Metathesaurus Property)
C25207 (NCI Thesaurus ValueDomain)
C2825565 (UMLS CUI-1)
Item Group
Vital Signs
Height
Item
Height (cm in)
float
C25209 (NCI Thesaurus ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C25347 (NCI Thesaurus Property)
C0005890 (UMLS CUI-1)
Weight
Item
Weight (kg lb)
float
C25209 (NCI Thesaurus ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C25208 (NCI Thesaurus Property)
C0005910 (UMLS CUI-1)
Body surface
Item
Body Surface Area (m^2)
float
C25190 (NCI Thesaurus ObjectClass)
C25712 (NCI Thesaurus ValueDomain)
C25157 (NCI Thesaurus Property)
C0005902 (UMLS CUI-1)
Systolic blood pressure
Item
Blood Pressure (mmHg)
integer
C25209 (NCI Thesaurus ValueDomain)
C25214 (NCI Thesaurus Property)
C25298 (NCI Thesaurus ObjectClass)
C0871470 (UMLS CUI-1)
Diastolic blood pressure
Item
Blood pressure (mmHg)
integer
C25209 (NCI Thesaurus ValueDomain)
C25214 (NCI Thesaurus Property)
C25299 (NCI Thesaurus ObjectClass)
C0428883 (UMLS CUI-1)
Heart rate
Item
Heart Rate (beats/min)
integer
C16960 (NCI Thesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C49672 (NCI Thesaurus Property)
C49677 (NCI Thesaurus Property)
C25712 (NCI Thesaurus ValueDomain)
C0018810 (UMLS CUI-1)
Respiratory rate
Item
Respiratory Rate (/min)
integer
C25190 (NCI Thesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C49672 (NCI Thesaurus Property)
C49678 (NCI Thesaurus Property)
C25712 (NCI Thesaurus ValueDomain)
C0231832 (UMLS CUI-1)
Body Temperature
Item
Body Temperature (C F)
float
C25190 (NCI Thesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C25206 (NCI Thesaurus Property)
C49672 (NCI Thesaurus Property)
C25712 (NCI Thesaurus ValueDomain)
C0005903 (UMLS CUI-1)
Item
Karnofsky Performance Status (%)
integer
C25367 (NCI Thesaurus Property)
C20641 (NCI Thesaurus ObjectClass)
C25338 (NCI Thesaurus ValueDomain)
C0206065 (UMLS CUI-1)
CL.1
Code List
Karnofsky Performance Status (%)
CL Item
Dead (0)
CL Item
Moribund, Fatal Processes Progressing Rapidly (10)
CL Item
Normal, No Complaints, No Evidence Of Disease (100)
CL Item
Very Sick, Hospitalization Indicated. Death Not Imminent (20)
CL Item
Severely Disabled, Hospitalization Indicated. Death Not Imminent (30)
CL Item
Disabled, Requires Special Care And Assistance (40)
CL Item
Requires Considerable Assistance And Frequent Medical Care (50)
CL Item
Requires Occasional Assistance, But Is Able To Care For Most Of His/her Needs (60)
CL Item
Cares For Self, Unable To Carry On Normal Activity Or To Do Active Work (70)
CL Item
Normal Activity With Effort; Some Signs Or Symptoms Of Disease (80)
CL Item
Able To Carry On Normal Activity; Minor Signs Or Symptoms Of Disease (90)
Item Group
Footer Module
Comments
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0947611 (UMLS CUI-1)
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