ID

6934

Descrição

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

Palavras-chave

  1. 26/08/2012 26/08/2012 -
  2. 08/01/2015 08/01/2015 - Martin Dugas
Transferido a

8 de janeiro de 2015

DOI

Para um pedido faça login.

Licença

Creative Commons BY-NC 3.0 Legacy

Comentários do modelo :

Aqui pode comentar o modelo. Pode comentá-lo especificamente através dos balões de texto nos grupos de itens e itens.

Comentários do grupo de itens para :

Comentários do item para :

Para descarregar formulários, precisa de ter uma sessão iniciada. Por favor faça login ou registe-se gratuitamente.

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
Descrição

Mskcc 00-138; Calgb 90104; Ecog

Coordinating Group Protocol Number
Descrição

CoordinatingGroupProtocolNumber

Tipo de dados

text

Coordinating Group Code
Descrição

CoordinatingGroupCode

Tipo de dados

text

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

Protocol Title

Tipo de dados

text

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

PatientStudyID,CoordinatingGroup

Tipo de dados

text

Patient Study ID, Participating Group
Descrição

PatientStudyID,ParticipatingGroup

Tipo de dados

text

Participating Group Code
Descrição

ParticipatingGroupCode

Tipo de dados

text

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

InstitutionName

Tipo de dados

text

Affiliate
Descrição

AffiliateName

Tipo de dados

text

Patient Last Name (initials acceptable)
Descrição

PatientName,Last

Tipo de dados

text

Patient First Name (initials acceptable)
Descrição

PatientName,First

Tipo de dados

text

Patient Middle Name (initials acceptable)
Descrição

PatientName,Middle

Tipo de dados

text

Form Administration
Descrição

Form Administration

Person Completing Form, Last Name
Descrição

PersonCompletingForm,LastName

Tipo de dados

text

Person Completing Form, First Name
Descrição

PersonCompletingForm,FirstName

Tipo de dados

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)
Descrição

AmendedDataInd

Tipo de dados

boolean

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

Adverse Events

CTC Adverse Event Term
Descrição

CTCAdverseEventTerm

Tipo de dados

text

Adverse Event Reporting From Date
Descrição

CTCAdverseEventReportBeginDate

Tipo de dados

date

Adverse Event Reporting To Date
Descrição

CTCAdverseEventReportEndDate

Tipo de dados

date

CTC Adverse Event Grade
Descrição

CTCAdverseEventGrade

Tipo de dados

text

CTC Adverse Event Attribution Code
Descrição

CTCAdverseEventAttributionCode

Tipo de dados

text

Treatment?
Descrição

ProtocolTreatmentInd

Tipo de dados

boolean

SAE filed?
Descrição

SAEfiled?

Tipo de dados

boolean

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

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
Tipo
Description | Question | Decode (Coded Value)
Tipo de dados
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)

Use este formulário para feedback, perguntas e sugestões de aperfeiçoamento.

Campos marcados com * são obrigatórios.

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial