ID

6934

Beschrijving

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

Link

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

Trefwoorden

  1. 26-08-12 26-08-12 -
  2. 08-01-15 08-01-15 - Martin Dugas
Geüploaded op

8 januari 2015

DOI

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Licentie

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
Beschrijving

Mskcc 00-138; Calgb 90104; Ecog

Coordinating Group Protocol Number
Beschrijving

CoordinatingGroupProtocolNumber

Datatype

text

Coordinating Group Code
Beschrijving

CoordinatingGroupCode

Datatype

text

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

Protocol Title

Datatype

text

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

PatientStudyID,CoordinatingGroup

Datatype

text

Patient Study ID, Participating Group
Beschrijving

PatientStudyID,ParticipatingGroup

Datatype

text

Participating Group Code
Beschrijving

ParticipatingGroupCode

Datatype

text

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

InstitutionName

Datatype

text

Affiliate
Beschrijving

AffiliateName

Datatype

text

Patient Last Name (initials acceptable)
Beschrijving

PatientName,Last

Datatype

text

Patient First Name (initials acceptable)
Beschrijving

PatientName,First

Datatype

text

Patient Middle Name (initials acceptable)
Beschrijving

PatientName,Middle

Datatype

text

Form Administration
Beschrijving

Form Administration

Person Completing Form, Last Name
Beschrijving

PersonCompletingForm,LastName

Datatype

text

Person Completing Form, First Name
Beschrijving

PersonCompletingForm,FirstName

Datatype

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)
Beschrijving

AmendedDataInd

Datatype

boolean

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

Adverse Events

CTC Adverse Event Term
Beschrijving

CTCAdverseEventTerm

Datatype

text

Adverse Event Reporting From Date
Beschrijving

CTCAdverseEventReportBeginDate

Datatype

date

Adverse Event Reporting To Date
Beschrijving

CTCAdverseEventReportEndDate

Datatype

date

CTC Adverse Event Grade
Beschrijving

CTCAdverseEventGrade

Datatype

text

CTC Adverse Event Attribution Code
Beschrijving

CTCAdverseEventAttributionCode

Datatype

text

Treatment?
Beschrijving

ProtocolTreatmentInd

Datatype

boolean

SAE filed?
Beschrijving

SAEfiled?

Datatype

boolean

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

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
Type
Description | Question | Decode (Coded Value)
Datatype
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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