NIH | National Cancer Institute | NCI Wiki  
Long NameLost to Follow-Up NCI Standard Template
DefinitionThe collection of CDEs used in the Lost to Follow-Up module.
ContextcaBIG
Protocol Long NameNCI Standard Template Forms
WorkflowDRAFT NEW
TypeCRF
Public ID3860190
Version1.0
Module Long NameModule InstructionsQuestionCDECDE Public IDCDE VersionValue Domain Data TypeValue Domain Unit of MeasureDisplay FormatValid ValueForm Value Meaning TextForm Value Meaning Desc.
Mandatory Lost to Follow-Up QuestionsThese items must be included when this data is collected for reporting.
Investigator AttestationInvestigator Withdrawal by Subject Lost To Follow-up Confirmation Yes No Indicator38290141.0CHARACTER
YesYesThe affirmative response to a question or activity.
NoNoThe non-affirmative response to a question.
Conditional Lost to Follow-Up QuestionsThere are business rules to indicate situations under which these elements should be used on a case report form.
Are you reporting the Participant Lost to Follow Up?Patient Reported Lost To Follow-up Yes No Indicator38290531.0CHARACTER
YesYesThe affirmative response to a question or activity.
NoNoThe non-affirmative response to a question.
Date Study Participant Declared Lost to Follow-UpPatient Lost Follow-up Date35213371.0DATEMM/DD/YYYY
Optional Lost to 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.
Study participant lost to follow-up approvedPatient Lost Institutional Review Board Approval Follow-up Yes No Indicator36130781.0CHARACTER
YesYesThe affirmative response to a question or activity.
NoNoThe non-affirmative response to a question.
Are you rescinding the lost to follow up notificationPatient Cancel Lost Follow-up Yes No Indicator37874131.0CHARACTER
YesYesThe affirmative response to a question or activity.
NoNoThe non-affirmative response to a question.
Date Lost to Follow Up is rescindedPatient Cancel Lost Follow-up Date37874141.0DATEMM/DD/YYYY