ID

765

Beschreibung

CALGB: TRACKING FORM (TISSUE BLOCKS) Four Versus Six Cycles of Cyclophosphamide/Doxorubicin or Paclitaxel in Adjuvant Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A4CFD446-0ADA-6A9F-E034-080020C9C0E0

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A4CFD446-0ADA-6A9F-E034-080020C9C0E0

Stichworte

  1. 26.08.12 26.08.12 -
  2. 08.07.15 08.07.15 -
  3. 08.07.15 08.07.15 -
Hochgeladen am

26. August 2012

DOI

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Lizenz

Creative Commons BY-NC 3.0 Legacy

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Breast Cancer NCT00041119 Pathology - CALGB: TRACKING FORM (TISSUE BLOCKS) - 2038962v3.0

No samples should be submitted without an accompanying form. If a specimen will not be submitted, specify the reason below and submit the form as stated above.

Unnamed1
Beschreibung

Unnamed1

CALGB Form
Beschreibung

CALGBForm

Datentyp

text

CALGB Study No
Beschreibung

CALGBStudyNo

Datentyp

text

CALGB Patient ID
Beschreibung

CALGBPatientID

Datentyp

text

Amended data?
Beschreibung

Amendeddata?

Datentyp

text

Unnamed2
Beschreibung

Unnamed2

Patient's Name
Beschreibung

Patient'sName

Datentyp

text

Participating Group
Beschreibung

ParticipatingGroup

Datentyp

text

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

PatientHospitalNumber

Datentyp

text

Participating Group Protocol No.
Beschreibung

ParticipatingGroupProtocolNo.

Datentyp

text

Main Member Institution/Adjunct
Beschreibung

MainMemberInstitution/Adjunct

Datentyp

text

Participating Group Patient No.
Beschreibung

ParticipatingGroupPatientNo.

Datentyp

text

Unnamed3
Beschreibung

Unnamed3

Do tissue block/slides accompany this form? (If No,)
Beschreibung

Dotissueblock/slidesaccompanythisform?

Datentyp

text

specify reason (specimen will not be submitted)
Beschreibung

specifyreason(specimenwillnotbesubmitted)

Datentyp

text

Is patient enrolled in a correlative science study? (If Yes, give the)
Beschreibung

Ispatientenrolledinacorrelativesciencestudy?

Datentyp

text

correlative study number(s)
Beschreibung

correlativestudynumber(s)

Datentyp

text

Surgical Procedure Date (M)
Beschreibung

SurgicalProcedureDate

Datentyp

text

Date blocks and pathology reports submitted (M)
Beschreibung

Dateblocksandpathologyreportssubmitted

Datentyp

text

Tissue pathology (mark one with an X)
Beschreibung

Tissuepathology

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C12801
UMLS 2011AA ObjectClass
C0040300
NCI Thesaurus Property
C25683
UMLS 2011AA Property
C0449416
NCI Thesaurus ObjectClass
C18189
UMLS 2011AA ObjectClass
C0030664
Method of extraction (mark one with an X)
Beschreibung

Methodofextraction

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus Property
C16847
UMLS 2011AA Property
C0449851
NCI Thesaurus Property
C15329
UMLS 2011AA Property
C0543467
NCI Thesaurus ObjectClass
C19157
UMLS 2011AA ObjectClass
C0370003
Pathology/accession number
Beschreibung

Pathology/accessionnumber

Datentyp

text

Submitted By (Last Name)
Beschreibung

PersonSpecimenSubmittedName

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C19157
UMLS 2011AA Property
C0370003
NCI Thesaurus Property
C25695
UMLS 2011AA Property
C1515023
Phone No.
Beschreibung

PhoneNo.

Datentyp

text

Ccrr Module For Calgb: Tracking Form (tissue Blocks)
Beschreibung

Ccrr Module For Calgb: Tracking Form (tissue Blocks)

Ähnliche Modelle

No samples should be submitted without an accompanying form. If a specimen will not be submitted, specify the reason below and submit the form as stated above.

Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Unnamed1
CALGBForm
Item
CALGB Form
text
CALGBStudyNo
Item
CALGB Study No
text
CALGBPatientID
Item
CALGB Patient ID
text
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
Item
Do tissue block/slides accompany this form? (If No,)
text
Code List
Do tissue block/slides accompany this form? (If No,)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
specifyreason(specimenwillnotbesubmitted)
Item
specify reason (specimen will not be submitted)
text
Item
Is patient enrolled in a correlative science study? (If Yes, give the)
text
Code List
Is patient enrolled in a correlative science study? (If Yes, give the)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
correlativestudynumber(s)
Item
correlative study number(s)
text
SurgicalProcedureDate
Item
Surgical Procedure Date (M)
text
Dateblocksandpathologyreportssubmitted
Item
Date blocks and pathology reports submitted (M)
text
Item
Tissue pathology (mark one with an X)
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C12801 (NCI Thesaurus ObjectClass)
C0040300 (UMLS 2011AA ObjectClass)
C25683 (NCI Thesaurus Property)
C0449416 (UMLS 2011AA Property)
C18189 (NCI Thesaurus ObjectClass)
C0030664 (UMLS 2011AA ObjectClass)
Code List
Tissue pathology (mark one with an X)
CL Item
Primary Tumor (Primary tumor)
CL Item
Recurrent Tumor (Recurrent tumor)
CL Item
Lymph Node Metastasis (Lymph node metastasis)
CL Item
Non-malignant Tissue (Non-malignant tissue)
CL Item
Metastasis (Metastasis)
C19151 (NCI Thesaurus)
C0027627 (UMLS 2011AA)
CL Item
Uninvolved Node (Uninvolved node)
Item
Method of extraction (mark one with an X)
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C16847 (NCI Thesaurus Property)
C0449851 (UMLS 2011AA Property)
C15329 (NCI Thesaurus Property)
C0543467 (UMLS 2011AA Property)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
Code List
Method of extraction (mark one with an X)
CL Item
Biopsy (Biopsy)
C15189 (NCI Thesaurus)
C0005558 (UMLS 2011AA)
CL Item
Axillary Dissection (Axillary dissection)
CL Item
Mastectomy (Mastectomy)
C15277 (NCI Thesaurus)
C0024881 (UMLS 2011AA)
CL Item
Re-excision (Re-excision)
C48600 (NCI Thesaurus)
C0184913 (UMLS 2011AA)
CL Item
General Surgery, Nos (General surgery, NOS)
CL Item
Sentinel Node Dissection (Sentinel node dissection)
CL Item
Lumpectomy (Lumpectomy)
C15755 (NCI Thesaurus)
C0024885 (UMLS 2011AA)
Pathology/accessionnumber
Item
Pathology/accession number
text
PersonSpecimenSubmittedName
Item
Submitted By (Last Name)
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C19157 (NCI Thesaurus Property)
C0370003 (UMLS 2011AA Property)
C25695 (NCI Thesaurus Property)
C1515023 (UMLS 2011AA Property)
PhoneNo.
Item
Phone No.
text
Item Group
Ccrr Module For Calgb: Tracking Form (tissue Blocks)

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