NIH | National Cancer Institute | NCI Wiki  
Long NameFollow-Up NCI Standard Template
DefinitionThe collection of CDEs used in the Survival/Death Follow-up module.
ContextcaBIG
Protocol Long NameNCI Standard Template Forms
WorkflowDRAFT NEW
TypeCRF
Public ID3859494
Version1.0
Module Long NameModule InstructionsQuestionCDECDE Public IDCDE VersionValue Domain Data TypeValue Domain Unit of MeasureDisplay FormatValid ValueForm Value Meaning TextForm Value Meaning Desc.
Conditional Follow-up QuestionsThere are business rules to indicate situations under which these elements should be used on a case report form.
Date of contactFollow-up Contact Date23909271.0DATEDD/MON/YYYY
Date of Last Contact or DeathPatient Last Contact Date64.0DATEMM/DD/YYYY
Optional Follow-Up QuestionsThere is no requirement for inclusion of these elements on the case report form. If the design and scientific questions posed in the study dictate the need to collect this type of data, these elements should be included.
Contact TypeMedia Communication Contact Means of Contact Type20064735.0ALPHANUMERIC
EmailE-mailE-mail is short for "electronic mail" and refers to composing, sending, and receiving messages over electronic communication systems. Most e-mail systems use the Internet.
Home CellHome Mobile TelephoneA person's permanent place of residence.: Mobile communications system that uses a combination of radio wave transmission and conventional telephone switching to permit telephone communication to and from mobile users within a specified area.
Home emailHome E-mailA person's permanent place of residence.: E-mail is short for "electronic mail" and refers to composing, sending, and receiving messages over electronic communication systems. Most e-mail systems use the Internet.
Home faxHome Fax NumberA person's permanent place of residence.: A telephone number that is used for identifying a destination fax machine in a telephone network.
Home mailHome Postal AddressA person's permanent place of residence.: A physical location used by a person or organization for the purpose of receiving postal mail deliveries.
Home phoneHome Telephone NumberA person's permanent place of residence.: A telephone number is a sequence of decimal digits (0-9) that is used for identifying a destination telephone line or other device in a telephone network. In the US this is a ten digit number resembling "123-456-7890".
In PersonPersonal Attribute AppearanceThe distinguishing qualities or prominent aspects of an individual person.: The outward or visible aspect of a person or thing.
PagerPagerA small wireless radio receiver designed to be carried by a person, to give an indication when activated by the reception of a radio signal containing its specific code, and to display a short messages in a text-only format.
Phone CallTelephone Number CallA telephone number is a sequence of decimal digits (0-9) that is used for identifying a destination telephone line or other device in a telephone network. In the US this is a ten digit number resembling "123-456-7890".: Send a message or attempt to reach someone by radio, phone, etc.
Regular MailRegular Postal AddressCustomary, usual, or at fixed intervals; conforming to a standard or pattern.: A physical location used by a person or organization for the purpose of receiving postal mail deliveries.
UnknownUnknownNot known, not observed, not recorded, or refused.
Work CellWork Mobile TelephoneExertion or effort directed to produce or accomplish something.: Mobile communications system that uses a combination of radio wave transmission and conventional telephone switching to permit telephone communication to and from mobile users within a specified area.
Work emailWork E-mailExertion or effort directed to produce or accomplish something.: E-mail is short for "electronic mail" and refers to composing, sending, and receiving messages over electronic communication systems. Most e-mail systems use the Internet.
Work faxWork Fax NumberExertion or effort directed to produce or accomplish something.: A telephone number that is used for identifying a destination fax machine in a telephone network.
Work mailWork Postal AddressExertion or effort directed to produce or accomplish something.: A physical location used by a person or organization for the purpose of receiving postal mail deliveries.
Work phoneWork Telephone NumberExertion or effort directed to produce or accomplish something.: A telephone number is a sequence of decimal digits (0-9) that is used for identifying a destination telephone line or other device in a telephone network. In the US this is a ten digit number resembling "123-456-7890".
What is the source of the information gathered during contact regarding the participant?Participant Contact Information Source Type38289621.0CHARACTER
Adjudication CommitteeAdjudication CommitteeAn external committee whose purpose is to evaluate study data and decide whether a study endpoint or other criterion has been met.
AutopsyAutopsyAutopsy; an examination and dissection of a dead body to determine cause of death or the changes produced by disease.
Cancer RegistrarCancer RegistrarA tumor composed of atypical neoplastic, often pleomorphic cells that invade other tissues. Malignant neoplasms usually metastasize to distant anatomic sites and may recur after excision. The most common malignant neoplasms are carcinomas (adenocarcinomas or squamous cell carcinomas), Hodgkin's and non-Hodgkin's lymphomas, leukemias, melanomas, and sarcomas. -- 2004: Registrar; someone responsible for keeping records.
CRAClinical Research AssociatePerson employed by a study sponsor or Contract Research Organization to monitor a clinical study at all participating sites. (from centerwatch.com glossary)
Death CertificateDeath CertificateThe cessation of life.: A document earned by a person indicating that the person has specific knowledge, skills, or abilities in the view of a certifying body. Similarly, a document indicating that a product or process is suitable or in working order for a specific purpose.
FamilyFamilyFamily; a domestic group, or a number of domestic groups linked through descent (demonstrated or stipulated) from a common ancestor, marriage, or adoption.
HospiceHospiceAn establishment that provides palliative and supportive care for terminally ill patients and their families via physical, psychological, social and other forms of care
Medical RecordMedical RecordA chronological written account of a patient's examination and treatment that includes the patient's medical history and complaints, the physician's physical findings, the results of diagnostic tests and procedures, and medications and therapeutic procedures. (dictionary.com)
ObituariesObituaryA published record of a person's death that usually includes a brief biography and details of the funeral arrangements.
Outside medical personnel (Nurse, Physician)External Medical PersonnelHappening or arising or located outside or beyond some limits, or especially, some surface.: Medical; relating to the study or practice of medicine.: Persons employed in any field.
ParticipantParticipantSomeone who takes part in an activity.
Site medical personnel (Nurse, Physician)Study Site Medical PersonnelA facilty in which study/protocol activities are conducted.: Medical; relating to the study or practice of medicine.: Persons employed in any field.
SSDISocial Security Death IndexA publically-accessible database derived from the Social Security Administration's (SSA) Death Master File Extract. It includes a listing of the vital statistics of a majority of decedents reported to the SSA since 1962.
Select all that apply to this follow-up period and submit the specified formsPatient Information Current Follow-up Collected Status31100541.0CHARACTER
FoundPresentBeing or existing in a specified place or at the specified time.
LostLost To Follow-upThe loss or lack of continuation of follow-up after a study has officially closed. See Follow-up.
Not able to obtain any additional informationNot able to obtain any additional informationNot able to obtain any additional information
Not ApplicableNot ApplicableDetermination of a value is not relevant in the current context.
Other, specifyOther, specifyDifferent than the one(s) previously specified or mentioned.: Be specific about something; define clearly.: Named locations of, or within, the body.
Contact TimePerson Contact Time25068261.0TIMETIME (HR(24):MN)
Were you able to obtain any information about the patient since the last reportPatient Information Current Follow-up Collected Ind-224883041.0CHARACTER
YesYesThe affirmative response to a question or activity.
NoNoThe non-affirmative response to a question.
Was the patient hospitalized for any treatment related complications in this report period?Patient Treatment Related Hospitalization Ind-322233731.0CHARACTER
YesYesThe affirmative response to a question or activity.
NoNoThe non-affirmative response to a question.
UnknownUnknownNot known, not observed, not recorded, or refused.
Date of hospital admissionHospital Admission Date648423.0DATEMM/DD/YYYY
Hospital Discharge DateHospital Discharge Date20038383.0DATEMM/DD/YYYY
Describe HospitalizationHospitalization Description Reason20038414.0CHARACTER
Days in ICUHospital Intensive Care Unit Admission Day Count21827371.0NUMBER
CommentsResearch Comments Text7975.0CHARACTER