ID
736
Beskrivning
CALGB: QOL ASSESSMENT SUMARY 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=A50D1BCF-4910-2EA3-E034-080020C9C0E0
Länk
Nyckelord
Versioner (3)
- 2012-08-26 2012-08-26 -
- 2015-07-08 2015-07-08 -
- 2015-07-08 2015-07-08 -
Uppladdad den
26 augusti 2012
DOI
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Licens
Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT00024102 Quality of Life - CALGB: QOL ASSESSMENT SUMARY FORM - 2037828v3.0
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.
Beskrivning
Unnamed2
Beskrivning
Patient'sName
Datatyp
text
Beskrivning
ParticipatingGroup
Datatyp
text
Alias
- NCI Thesaurus ObjectClass
- C17005
- UMLS 2011AA ObjectClass
- C1257890
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
Beskrivning
PatientHospitalNumber
Datatyp
text
Beskrivning
ParticipatingGroupProtocolNo.
Datatyp
text
Beskrivning
MainMemberInstitution/Adjunct
Datatyp
text
Beskrivning
ParticipatingGroupPatientNo.
Datatyp
text
Beskrivning
Unnamed3
Beskrivning
Unnamed4
Beskrivning
Methodofassessment
Datatyp
text
Beskrivning
datequestionnairewassenttopatient
Datatyp
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Beskrivning
Numberofattemptsmadetocontactpatientbytelephoneand/ormail
Datatyp
double
Beskrivning
Languageinwhichassessmentwasconducted
Datatyp
text
Beskrivning
Other,specify(languageinwhichassessmentwasconducted)
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
Beskrivning
Qualityoflifeassessment
Datatyp
text
Alias
- NCI Thesaurus ObjectClass
- C17047
- UMLS 2011AA ObjectClass
- C0518214
- NCI Thesaurus Property
- C25217
- UMLS 2011AA Property
- C1516048
Beskrivning
numberofQOLinstrument(s)completed
Datatyp
double
Beskrivning
Iftheassessmentwaspartiallycompletedornotdone,indicatereason(s)below
Datatyp
text
Beskrivning
Other,specify(reasonassessmentwaspartiallycompletedornotdone)
Datatyp
text
Beskrivning
Ccrr Module For Calgb: Qol Assessment Sumary Form
Similar models
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)
C0011008 (UMLS 2011AA ValueDomain)
C1556083 (UMLS 2011AA)
C1527021 (UMLS 2011AA ValueDomain)
C0518214 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)