ID

6934

Descrizione

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

collegamento

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

Keywords

  1. 26/08/12 26/08/12 -
  2. 08/01/15 08/01/15 - Martin Dugas
Caricato su

8 gennaio 2015

DOI

Per favore, per richiedere un accesso.

Licenza

Creative Commons BY-NC 3.0 Legacy

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Bladder Cancer NCT00014534 Toxicity - NCI Cooperative Group Toxicity Form (CALGB-90104) - 2056157v3.0

No Instruction available.

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

Mskcc 00-138; Calgb 90104; Ecog

Coordinating Group Protocol Number
Descrizione

CoordinatingGroupProtocolNumber

Tipo di dati

text

Coordinating Group Code
Descrizione

CoordinatingGroupCode

Tipo di dati

text

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

Protocol Title

Tipo di dati

text

Alias
NCI Thesaurus ObjectClass
C25320
UMLS CUI-1
C2986303
NCI Thesaurus Property
C42774
Patient Study ID, Coordinating Group
Descrizione

PatientStudyID,CoordinatingGroup

Tipo di dati

text

Patient Study ID, Participating Group
Descrizione

PatientStudyID,ParticipatingGroup

Tipo di dati

text

Participating Group Code
Descrizione

ParticipatingGroupCode

Tipo di dati

text

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

InstitutionName

Tipo di dati

text

Affiliate
Descrizione

AffiliateName

Tipo di dati

text

Patient Last Name (initials acceptable)
Descrizione

PatientName,Last

Tipo di dati

text

Patient First Name (initials acceptable)
Descrizione

PatientName,First

Tipo di dati

text

Patient Middle Name (initials acceptable)
Descrizione

PatientName,Middle

Tipo di dati

text

Form Administration
Descrizione

Form Administration

Person Completing Form, Last Name
Descrizione

PersonCompletingForm,LastName

Tipo di dati

text

Person Completing Form, First Name
Descrizione

PersonCompletingForm,FirstName

Tipo di dati

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)
Descrizione

AmendedDataInd

Tipo di dati

boolean

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

Adverse Events

CTC Adverse Event Term
Descrizione

CTCAdverseEventTerm

Tipo di dati

text

Adverse Event Reporting From Date
Descrizione

CTCAdverseEventReportBeginDate

Tipo di dati

date

Adverse Event Reporting To Date
Descrizione

CTCAdverseEventReportEndDate

Tipo di dati

date

CTC Adverse Event Grade
Descrizione

CTCAdverseEventGrade

Tipo di dati

text

CTC Adverse Event Attribution Code
Descrizione

CTCAdverseEventAttributionCode

Tipo di dati

text

Treatment?
Descrizione

ProtocolTreatmentInd

Tipo di dati

boolean

SAE filed?
Descrizione

SAEfiled?

Tipo di dati

boolean

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

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

Similar models

No Instruction available.

  1. StudyEvent: NCI Cooperative Group Toxicity Form (CALGB-90104)
    1. No Instruction available.
Name
genere
Description | Question | Decode (Coded Value)
Tipo di dati
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)
Protocol Title
Item
Protocol Title
text
C25320 (NCI Thesaurus ObjectClass)
C2986303 (UMLS CUI-1)
C42774 (NCI Thesaurus 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)
AmendedDataInd
Item
Are data amended? (If data are amended, please circle in red when using paper form)
boolean
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
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
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)
ProtocolTreatmentInd
Item
Treatment?
boolean
SAEfiled?
Item
SAE filed?
boolean
Item Group
Ccrr Module For Nci Cooperative Group Toxicity Form (calgb-90104)

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