ID
6213
Beschreibung
CALGB: SOCIAL SUPPORT FORM Comparison of Combination Chemotherapy Regimens in Treating Older Women Who Have Undergone Surgery for Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A50BF99D-12AE-2D64-E034-080020C9C0E0
Link
Stichworte
Versionen (2)
- 18.12.14 18.12.14 - Martin Dugas
- 23.03.15 23.03.15 - Martin Dugas
Hochgeladen am
18. Dezember 2014
DOI
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Lizenz
Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT00024102 Quality of Life - CALGB: SOCIAL SUPPORT FORM - 2041863v3.0
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.
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Unnamed2
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Patient'sName
Datentyp
text
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ParticipatingGroup
Datentyp
text
Alias
- NCI Thesaurus ObjectClass
- C17005
- UMLS 2011AA ObjectClass
- C1257890
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
Beschreibung
PatientHospitalNumber
Datentyp
text
Beschreibung
ParticipatingGroupProtocolNo.
Datentyp
text
Beschreibung
MainMemberInstitution/Adjunct
Datentyp
text
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ParticipatingGroupPatientNo.
Datentyp
text
Beschreibung
Unnamed3
Beschreibung
Unnamed4
Beschreibung
Abouthowmanyclosefriendsandcloserelativesdoyouhavenow(peopleyoufeelateasewithandcantalktoaboutwhatisonyourmind)?
Datentyp
double
Beschreibung
Someonetohelpifyouwereconfinedtobed
Datentyp
text
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Someoneyoucancountontolistentoyouwhenyouneedtotalk
Datentyp
text
Beschreibung
Someonetogiveyougoodadviceaboutacrisis
Datentyp
text
Beschreibung
Someonetotakeyoutothedoctorifyouneededit
Datentyp
text
Beschreibung
Someonewhoshowsyouloveandaffection
Datentyp
text
Beschreibung
Someonetohaveagoodtimewith
Datentyp
text
Beschreibung
Unnamed5
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Unnamed6
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Someonetogiveyouinformationtohelpyouunderstandasituation
Datentyp
text
Beschreibung
Someonetoconfideinortalktoaboutyourselforyourproblems
Datentyp
text
Beschreibung
Someonewhohugsyou
Datentyp
text
Beschreibung
Someonetogettogetherwithforrelaxation
Datentyp
text
Beschreibung
Someonetoprepareyourmealsifyouwereunabletodoityourself
Datentyp
text
Beschreibung
Someonewhoseadviceyoureallywant
Datentyp
text
Beschreibung
Someonetodothingswithtohelpyougetyourmindoffthings
Datentyp
text
Beschreibung
Someonetohelpyouwithdailychoresifyouweresick
Datentyp
text
Beschreibung
Someonetoshareyourmostprivateworriesandfearswith
Datentyp
text
Beschreibung
Someonetoturntoforsuggestionsabouthowtodealwithapersonalproblem
Datentyp
text
Beschreibung
Someonetodosomethingenjoyablewith
Datentyp
text
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Someonewhounderstandsyourproblems
Datentyp
text
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Someonetoloveandmakeyoufeelwanted
Datentyp
text
Beschreibung
Ccrr Module For Calgb: Social Support Form
Ähnliche Modelle
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.
C1705108 (UMLS 2011AA)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)