ID
8935
Beschreibung
NSABP PROTOCOL B-39: REGISTRATION FORM - B-39 Form A Radiation Therapy in Treating Women Who Have Undergone Surgery For Ductal Carcinoma In Situ or Stage I or Stage II Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=E6E4EDBC-FF93-23A2-E034-0003BA3F9857
Link
Stichworte
Versionen (3)
- 26.08.12 26.08.12 -
- 09.01.15 09.01.15 - Martin Dugas
- 03.07.15 03.07.15 -
Hochgeladen am
9. Januar 2015
DOI
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Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT00103181 Registration - NSABP PROTOCOL B-39: REGISTRATION FORM - B-39 Form A - 2295070v3.0
Provide the code number of the credentialed facility where the patient will receive her radiation treatment.
- StudyEvent: NSABP PROTOCOL B-39: REGISTRATION FORM - B-39 Form A
Beschreibung
Unnamed2
Beschreibung
Birth Date
Datentyp
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C0421451
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus ValueDomain-2
- C25367
- NCI Thesaurus Property
- C25155
Beschreibung
Social Security Number
Datentyp
float
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS CUI-1
- C1301821
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25686
Beschreibung
Unnamed3
Beschreibung
Racial Group
Datentyp
text
Alias
- NCI Thesaurus ValueDomain
- C25372
- UMLS CUI-1
- C0034510
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C17049
Beschreibung
PatientPaymentType
Datentyp
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C25371
- UMLS 2011AA Property
- C0680264
Beschreibung
PatientEthnicityCategory
Datentyp
text
Alias
- NCI Thesaurus ValueDomain
- C25372
- UMLS 2011AA ValueDomain
- C0683312
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C29933
Beschreibung
PatientAddressCountryCode
Datentyp
text
Alias
- NCI Thesaurus ValueDomain
- C25162
- UMLS 2011AA ValueDomain
- C0805701
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C25407
- UMLS 2011AA Property
- C1442065
Beschreibung
OtherPatientAddressCountrySpecify
Datentyp
text
Alias
- NCI Thesaurus ObjectClass
- C17649
- UMLS 2011AA ObjectClass
- C0205394
- NCI Thesaurus ObjectClass-2
- C16960
- UMLS 2011AA ObjectClass-2
- C0030705
- NCI Thesaurus Property
- C25407
- UMLS 2011AA Property
- C1442065
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
- NCI Thesaurus ValueDomain-2
- C25464
- UMLS 2011AA ValueDomain-2
- C0454664
Beschreibung
PatientAddressPostalCode
Datentyp
text
Alias
- NCI Thesaurus ValueDomain
- C25162
- UMLS 2011AA ValueDomain
- C0805701
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C25407
- UMLS 2011AA Property
- C1442065
Beschreibung
PatientMalignantNeoplasmConsentInd-2
Datentyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C9305
- UMLS 2011AA Property
- C0006826
- NCI Thesaurus Property-2
- C25460
- UMLS 2011AA Property-2
- C1511481
Beschreibung
PatientOtherDiseaseorDisorderClinicalStudyConsentInd-2
Datentyp
boolean
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C17649
- UMLS 2011AA Property
- C0205394
- NCI Thesaurus Property-2
- C2991
- UMLS 2011AA Property-2
- C0012634
- NCI Thesaurus Property-3
- C15206
- UMLS 2011AA Property-3
- C0008972
- NCI Thesaurus Property-4
- C25460
- UMLS 2011AA Property-4
- C1511481
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Beschreibung
PatientContactConsentInd-2
Datentyp
boolean
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C67527
- UMLS 2011AA Property
- C0016884
- NCI Thesaurus Property-2
- C25460
- UMLS 2011AA Property-2
- C1511481
- NCI Thesaurus Property-3
- C16452
- UMLS 2011AA Property-3
- C0009452
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Beschreibung
Patient Height
Datentyp
float
Maßeinheiten
- cm
Alias
- NCI Thesaurus ValueDomain
- C25209
- UMLS CUI-1
- C0489786
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25347
Beschreibung
Patient Weight
Datentyp
float
Maßeinheiten
- Kg
Alias
- NCI Thesaurus ValueDomain
- C25209
- UMLS CUI-1
- C0005910
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25208
Beschreibung
BreastDiseaseStageStatus
Datentyp
text
Alias
- NCI Thesaurus ObjectClass
- C12971
- UMLS 2011AA ObjectClass
- C0006141
- NCI Thesaurus ObjectClass-2
- C2991
- UMLS 2011AA ObjectClass-2
- C0012634
- NCI Thesaurus ValueDomain
- C25688
- UMLS 2011AA ValueDomain
- C0449438
- NCI Thesaurus Property
- C25365
- UMLS 2011AA Property
- C0678257
Beschreibung
PatientMenopauseStatus
Datentyp
text
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C3231
- UMLS 2011AA Property
- C0025320
- NCI Thesaurus ValueDomain
- C25688
- UMLS 2011AA ValueDomain
- C0449438
Beschreibung
PersonHormoneReceptorStatus
Datentyp
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus ValueDomain
- C25688
- UMLS 2011AA ValueDomain
- C0449438
- NCI Thesaurus Property
- C28154
- UMLS 2011AA Property
- C0019929
- NCI Thesaurus Property-2
- C25365
- UMLS 2011AA Property-2
- C0678257
Beschreibung
PatientChemotherapyIntentReceiveInd-2
Datentyp
boolean
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus ObjectClass-2
- C15632
- UMLS 2011AA ObjectClass-2
- C0392920
- NCI Thesaurus Property
- C25639
- UMLS 2011AA Property
- C1514756
- NCI Thesaurus Property-2
- C25725
- UMLS 2011AA Property-2
- C1283828
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Beschreibung
Certification Of Eligibility:
Beschreibung
Unnamed4
Beschreibung
RadiologyLabIdentifierNumber
Datentyp
float
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
- NCI Thesaurus ObjectClass
- C17059
- UMLS 2011AA ObjectClass
- C0034599
- NCI Thesaurus ObjectClass-2
- C37984
- UMLS 2011AA ObjectClass-2
- C0022877
Beschreibung
PhysicianInvestigatorIdentifierNumber
Datentyp
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
- NCI Thesaurus ObjectClass
- C25741
- UMLS 2011AA ObjectClass
- C0031831
- NCI Thesaurus ObjectClass-2
- C17089
- UMLS 2011AA ObjectClass-2
- C0035173
Beschreibung
PhysicianInvestigatorIdentifierNumber
Datentyp
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
- NCI Thesaurus ObjectClass
- C25741
- UMLS 2011AA ObjectClass
- C0031831
- NCI Thesaurus ObjectClass-2
- C17089
- UMLS 2011AA ObjectClass-2
- C0035173
Beschreibung
InvestigatorName
Datentyp
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS 2011AA ValueDomain
- C1547383
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
- NCI Thesaurus ObjectClass
- C17089
- UMLS 2011AA ObjectClass
- C0035173
Beschreibung
InvestigatorName
Datentyp
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS 2011AA ValueDomain
- C1547383
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
- NCI Thesaurus ObjectClass
- C17089
- UMLS 2011AA ObjectClass
- C0035173
Beschreibung
PartialBreastRadiationTherapyAdministeredPartialBreastRTType
Datentyp
text
Alias
- NCI Thesaurus ObjectClass
- C12971
- UMLS 2011AA ObjectClass
- C0006141
- NCI Thesaurus ObjectClass-2
- C25378
- UMLS 2011AA ObjectClass-2
- C0728938
- NCI Thesaurus Property
- C15313
- UMLS 2011AA Property
- C1522449
- NCI Thesaurus Property-2
- C25382
- UMLS 2011AA Property-2
- C1521801
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
Beschreibung
PartialBreastRadiationTherapyAdministeredPartialBreastRTType
Datentyp
text
Alias
- NCI Thesaurus ObjectClass
- C12971
- UMLS 2011AA ObjectClass
- C0006141
- NCI Thesaurus ObjectClass-2
- C25378
- UMLS 2011AA ObjectClass-2
- C0728938
- NCI Thesaurus Property
- C15313
- UMLS 2011AA Property
- C1522449
- NCI Thesaurus Property-2
- C25382
- UMLS 2011AA Property-2
- C1521801
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
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Provide the code number of the credentialed facility where the patient will receive her radiation treatment.
- StudyEvent: NSABP PROTOCOL B-39: REGISTRATION FORM - B-39 Form A
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
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C25686 (NCI Thesaurus Property)
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C0018717 (UMLS 2011AA)
C0205394 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C0683312 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C29933 (NCI Thesaurus Property)
C1518424 (UMLS 2011AA)
C0805701 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
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C17649 (NCI Thesaurus Property)
C0205394 (UMLS 2011AA Property)
C2991 (NCI Thesaurus Property-2)
C0012634 (UMLS 2011AA Property-2)
C15206 (NCI Thesaurus Property-3)
C0008972 (UMLS 2011AA Property-3)
C25460 (NCI Thesaurus Property-4)
C1511481 (UMLS 2011AA Property-4)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C0030705 (UMLS 2011AA ObjectClass)
C67527 (NCI Thesaurus Property)
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C25460 (NCI Thesaurus Property-2)
C1511481 (UMLS 2011AA Property-2)
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C0489786 (UMLS CUI-1)
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C0005910 (UMLS CUI-1)
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C0006141 (UMLS 2011AA ObjectClass)
C2991 (NCI Thesaurus ObjectClass-2)
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C0449438 (UMLS 2011AA ValueDomain)
C0232970 (UMLS 2011AA)
C15421 (NCI Thesaurus-3)
C0232970 (UMLS 2011AA-4)
C15421 (NCI Thesaurus-5)
C0232970 (UMLS 2011AA-6)
C0279752 (UMLS 2011AA)
C0027361 (UMLS 2011AA ObjectClass)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
C28154 (NCI Thesaurus Property)
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C25365 (NCI Thesaurus Property-2)
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