ID

574

Beskrivning

NCI Cooperative Group Toxicity 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=A9BEFBAB-CF40-25AD-E034-0003BA12F5E7

Länk

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A9BEFBAB-CF40-25AD-E034-0003BA12F5E7

Nyckelord

Versioner (2)
  1. 2012-08-26 2012-08-26 -
  2. 2015-01-08 2015-01-08 - Martin Dugas
Uppladdad den

26 augusti 2012

DOI

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Licens

Creative Commons BY-NC 3.0 Legacy
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Bladder Cancer NCT00014534 Toxicity - NCI Cooperative Group Toxicity Form (CALGB-90104) - 2056157v3.0

Engelsk

No Instruction available.

1 Formulär  
  1. StudyEvent: NCI Cooperative Group Toxicity Form (CALGB-90104)
    1. No Instruction available.
Mskcc 00-138; Calgb 90104; Ecog
Beskrivning

Mskcc 00-138; Calgb 90104; Ecog

Coordinating Group Protocol Number
Beskrivning

CoordinatingGroupProtocolNumber

Datatyp

text

Coordinating Group Code
Beskrivning

CoordinatingGroupCode

Datatyp

text

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

ProtocolTitle

Datatyp

text

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

PatientStudyID,CoordinatingGroup

Datatyp

text

Patient Study ID, Participating Group
Beskrivning

PatientStudyID,ParticipatingGroup

Datatyp

text

Participating Group Code
Beskrivning

ParticipatingGroupCode

Datatyp

text

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

InstitutionName

Datatyp

text

Affiliate
Beskrivning

AffiliateName

Datatyp

text

Patient Last Name (initials acceptable)
Beskrivning

PatientName,Last

Datatyp

text

Patient First Name (initials acceptable)
Beskrivning

PatientName,First

Datatyp

text

Patient Middle Name (initials acceptable)
Beskrivning

PatientName,Middle

Datatyp

text

Form Administration
Beskrivning

Form Administration

Person Completing Form, Last Name
Beskrivning

PersonCompletingForm,LastName

Datatyp

text

Person Completing Form, First Name
Beskrivning

PersonCompletingForm,FirstName

Datatyp

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Are data amended? (If data are amended, please circle in red when using paper form)
Beskrivning

AmendedDataInd

Datatyp

text

Alias
NCI Thesaurus ObjectClass
C25474
UMLS 2011AA ObjectClass
C1511726
NCI Thesaurus Property
C25416
UMLS 2011AA Property
C1691222
Adverse Events
Beskrivning

Adverse Events

CTC Adverse Event Term
Beskrivning

CTCAdverseEventTerm

Datatyp

text

Adverse Event Reporting From Date
Beskrivning

CTCAdverseEventReportBeginDate

Datatyp

date

Adverse Event Reporting To Date
Beskrivning

CTCAdverseEventReportEndDate

Datatyp

date

CTC Adverse Event Grade
Beskrivning

CTCAdverseEventGrade

Datatyp

text

CTC Adverse Event Attribution Code
Beskrivning

CTCAdverseEventAttributionCode

Datatyp

text

Treatment?
Beskrivning

ProtocolTreatmentInd

Datatyp

text

SAE filed?
Beskrivning

SAEfiled?

Datatyp

text

Ccrr Module For Nci Cooperative Group Toxicity Form (calgb-90104)
Beskrivning

Ccrr Module For Nci Cooperative Group Toxicity Form (calgb-90104)

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Similar models

No Instruction available.

1 Formulär
  1. StudyEvent: NCI Cooperative Group Toxicity Form (CALGB-90104)
    1. No Instruction available.
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
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? (If data are amended, please circle in red when using paper form)
text
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
CL.1
Code List
Are data amended? (If data are amended, please circle in red when using paper form)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item Group
Adverse Events
CTCAdverseEventTerm
Item
CTC Adverse Event Term
text
CTCAdverseEventReportBeginDate
Item
Adverse Event Reporting From Date
date
CTCAdverseEventReportEndDate
Item
Adverse Event Reporting To Date
date
CTCAdverseEventGrade
Item
CTC Adverse Event Grade
text
Item
CTC Adverse Event Attribution Code
text
CL.2
Code List
CTC Adverse Event Attribution Code
CL Item
Unrelated (unrelated)
C25328 (NCI Thesaurus)
C0445356 (UMLS 2011AA)
CL Item
Unlikely (unlikely)
CL Item
Possibly (possibly)
CL Item
Probably (probably)
CL Item
Definitely (definitely)
Item
Treatment?
text
CL.3
Code List
Treatment?
CL Item
Null (yes)
CL Item
Null (no)
Item
SAE filed?
text
CL.4
Code List
SAE filed?
CL Item
Yes (yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (no)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item Group
Ccrr Module For Nci Cooperative Group Toxicity Form (calgb-90104)
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