ID

690

Description

CALGB: ORIENTATION-MEMORY-CONCENTRATION TEST 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=A50D6435-FF10-3254-E034-080020C9C0E0

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A50D6435-FF10-3254-E034-080020C9C0E0

Keywords

  1. 8/26/12 8/26/12 -
  2. 3/18/15 3/18/15 - Martin Dugas
Uploaded on

August 26, 2012

DOI

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License

Creative Commons BY-NC 3.0 Legacy

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Breast Cancer NCT00024102 Quality of Life - CALGB: ORIENTATION-MEMORY-CONCENTRATION TEST FORM - 2042573v3.0

Scoring: Score 1 for each incorrect response; maximum weight score=28.

  1. StudyEvent: CALGB: ORIENTATION-MEMORY-CONCENTRATION TEST FORM
    1. Scoring: Score 1 for each incorrect response; maximum weight score=28.
Unnamed1
Description

Unnamed1

CALGB Form
Description

CALGBForm

Data type

text

CALGB Study No
Description

CALGBStudyNo

Data type

text

CALGB Patient ID
Description

CALGBPatientID

Data type

text

Date Completed (M)
Description

DateCompleted

Data type

date

Amended data?
Description

Amendeddata?

Data type

text

Unnamed2
Description

Unnamed2

Patient's Name
Description

Patient'sName

Data type

text

Participating Group
Description

ParticipatingGroup

Data type

text

Alias
NCI Thesaurus ObjectClass
C17005
UMLS 2011AA ObjectClass
C1257890
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Patient Hospital Number
Description

PatientHospitalNumber

Data type

text

Participating Group Protocol No.
Description

ParticipatingGroupProtocolNo.

Data type

text

Main Member Institution/Adjunct
Description

MainMemberInstitution/Adjunct

Data type

text

Participating Group Patient No.
Description

ParticipatingGroupPatientNo.

Data type

text

Unnamed3
Description

Unnamed3

Completed By (Print or Type Name)
Description

CompletedBy

Data type

text

Assessment Number (1.)
Description

AssessmentNumber

Data type

double

Unnamed4
Description

Unnamed4

What year is it now? (Patient's Response)
Description

Whatyearisitnow?

Data type

double

Score (Weight)
Description

PerQuestionScore

Data type

double

Score (Weight)
Description

PerQuestionScore

Data type

double

Score (Weight)
Description

PerQuestionScore

Data type

double

Score (Weight)
Description

PerQuestionScore

Data type

double

Score (Weight)
Description

PerQuestionScore

Data type

double

Score (Weight)
Description

PerQuestionScore

Data type

double

Final Score
Description

WeightedScore

Data type

double

Final Score
Description

WeightedScore

Data type

double

Final Score
Description

WeightedScore

Data type

double

Final Score
Description

WeightedScore

Data type

double

Final Score
Description

WeightedScore

Data type

double

Final Score
Description

WeightedScore

Data type

double

What month is it now? (Patient's Response)
Description

Whatmonthisitnow?

Data type

double

About what time is it? ([within 1 hour])
Description

Aboutwhattimeisit?

Data type

text

Unnamed5
Description

Unnamed5

TOTAL SCORE
Description

TOTALSCORE

Data type

double

Ccrr Module For Calgb: Orientation-memory-concentration Test Form
Description

Ccrr Module For Calgb: Orientation-memory-concentration Test Form

Similar models

Scoring: Score 1 for each incorrect response; maximum weight score=28.

  1. StudyEvent: CALGB: ORIENTATION-MEMORY-CONCENTRATION TEST FORM
    1. Scoring: Score 1 for each incorrect response; maximum weight score=28.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Unnamed1
CALGBForm
Item
CALGB Form
text
CALGBStudyNo
Item
CALGB Study No
text
CALGBPatientID
Item
CALGB Patient ID
text
DateCompleted
Item
Date Completed (M)
date
Item
Amended data?
text
Code List
Amended data?
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item Group
Unnamed2
Patient'sName
Item
Patient's Name
text
ParticipatingGroup
Item
Participating Group
text
C17005 (NCI Thesaurus ObjectClass)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
PatientHospitalNumber
Item
Patient Hospital Number
text
ParticipatingGroupProtocolNo.
Item
Participating Group Protocol No.
text
MainMemberInstitution/Adjunct
Item
Main Member Institution/Adjunct
text
ParticipatingGroupPatientNo.
Item
Participating Group Patient No.
text
Item Group
Unnamed3
CompletedBy
Item
Completed By (Print or Type Name)
text
AssessmentNumber
Item
Assessment Number (1.)
double
Item Group
Unnamed4
Whatyearisitnow?
Item
What year is it now? (Patient's Response)
double
PerQuestionScore
Item
Score (Weight)
double
PerQuestionScore
Item
Score (Weight)
double
PerQuestionScore
Item
Score (Weight)
double
PerQuestionScore
Item
Score (Weight)
double
PerQuestionScore
Item
Score (Weight)
double
PerQuestionScore
Item
Score (Weight)
double
WeightedScore
Item
Final Score
double
WeightedScore
Item
Final Score
double
WeightedScore
Item
Final Score
double
WeightedScore
Item
Final Score
double
WeightedScore
Item
Final Score
double
WeightedScore
Item
Final Score
double
Whatmonthisitnow?
Item
What month is it now? (Patient's Response)
double
Aboutwhattimeisit?
Item
About what time is it? ([within 1 hour])
text
Item Group
Unnamed5
TOTALSCORE
Item
TOTAL SCORE
double
Item Group
Ccrr Module For Calgb: Orientation-memory-concentration Test Form

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