INSTRUCTIONS: All of the information on this Registration Worksheet and the Protocol Eligibility Section must be answered appropriately for a patient to be considered eligible for registration. This Registration Worksheet must be entirely filled out and referred to during the registration. Do NOT submit this worksheet as part of the patient data

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Header module
Clinical Study Protocol Amendment Activation Date
Item
Activation Date (MM DD YYYY)
date
C25164 (NCI Thesaurus ValueDomain)
C25320 (NCI Thesaurus ObjectClass)
C64382 (NCI Thesaurus Property)
C41200 (NCI Thesaurus Property-2)
C1515882 (UMLS CUI-1)
Data Amended Last Date
Item
Last Amended Date (MM DD YYYY)
date
C25164 (NCI Thesaurus ValueDomain)
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)
C25551 (NCI Thesaurus ValueDomain-2)
C0011008 (UMLS CUI-1)
C1517741 (UMLS CUI-2)
Registration status
Item
Registration Step
text
C25337 (NCI Thesaurus ValueDomain)
C25646 (NCI Thesaurus ObjectClass)
C16154 (NCI Thesaurus Property)
C16154 (NCI Thesaurus ValueDomain-2)
C0585727 (UMLS CUI-1)
Item Group
Swog Patient Id
Patient Southwest Oncology GroupIdentifier Number
Item
SWOG Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C25364 (NCI Thesaurus Property)
C25699 (NCI Thesaurus Property-2)
C1519429 (UMLS CUI-1)
C3259154 (UMLS CUI-2)
Registrar Southwest Oncology Group Identifier Number
Item
Registrar's SWOG Roster ID Number
text
C25337 (NCI Thesaurus ValueDomain)
C25364 (NCI Thesaurus Property)
C25699 (NCI Thesaurus Property-2)
C25357 (NCI Thesaurus ObjectClass)
C0600091 (UMLS CUI-1)
C1519429 (UMLS CUI-2)
Southwest Oncology Group Investigator Identifie rNumber
Item
SWOG Investigator Number
float
C25337 (NCI Thesaurus ValueDomain)
C25364 (NCI Thesaurus Property)
C25699 (NCI Thesaurus ObjectClass)
C17089 (NCI Thesaurus ObjectClass-2)
C0600091 (UMLS CUI-1)
C1519429 (UMLS CUI-2)
Southwes Oncology Group Treating Institution Identifier Number
Item
SWOG Treating Institution Number
float
C25699 (NCI Thesaurus ObjectClass)
C25705 (NCI Thesaurus ObjectClass-2)
C41206 (NCI Thesaurus ObjectClass-3)
C25364 (NCI Thesaurus Property)
C25337 (NCI Thesaurus ValueDomain)
C1519429 (UMLS CUI-1)
C1522326 (UMLS CUI-2)
C0600091 (UMLS CUI-3)
Item Group
Stratification Questions
Item
Neoadjuvant chemotherapy
text
C25320 (NCI Thesaurus ObjectClass)
C15632 (NCI Thesaurus Property)
C15665 (NCI Thesaurus Property-2)
C25689 (NCI Thesaurus Property-3)
C25162 (NCI Thesaurus ValueDomain)
C0600558 (UMLS CUI-1)
C3665472 (UMLS CUI-2)
CL.1
Code List
Neoadjuvant chemotherapy
CL Item
Cisplatin Based (1)
C0008838 (UMLS CUI-1)
C0178499 (UMLS CUI-2)
CL Item
Carboplatin Based (2)
C0079083 (UMLS CUI-1)
C0178499 (UMLS CUI-2)
CL Item
Other (3)
C17649 (NCI Thesaurus)
C0205394 (UMLS CUI-1)
CL Item
None (4)
C41132 (NCI Thesaurus)
C0549184 (UMLS CUI-1)
Item
Clinical stage
text
C15206 (NCI Thesaurus ObjectClass)
C4912 (NCI Thesaurus Property)
C16899 (NCI Thesaurus Property-2)
C25689 (NCI Thesaurus Property-3)
C25162 (NCI Thesaurus ValueDomain)
C0699885 (UMLS CUI-1)
C1300072 (UMLS CUI-2)
Clinical Study Stage Bladder Carcinoma
Code List
Clinical stage
CL Item
T2 (1)
CL Item
T3 Or T4a (2)
Item
Zubrod performance status
text
C25162 (NCI Thesaurus ValueDomain)
C25400 (NCI Thesaurus ObjectClass)
C25689 (NCI Thesaurus Property)
C3714786 (UMLS CUI-1)
Zubrod Performance Status
Code List
Zubrod performance status
CL Item
0-1 (1)
CL Item
2 (2)
Item Group
Patient Eligibility
Eligibility Determination
Item
Has the SWOG Registration Worksheet been completed entirely and is the patient eligible according to the current version of protocol section 5.0?
boolean
C16960 (NCI Thesaurus ObjectClass)
C25699 (NCI Thesaurus ObjectClass-2)
C25646 (NCI Thesaurus Property)
C25171 (NCI Thesaurus Property-2)
C38147 (NCI Thesaurus ValueDomain)
C1519429 (UMLS CUI-1)
C0013893 (UMLS CUI-2)
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