Other info and relevant events Maturity Level: 2 - Ready for Review

Progressive number of relevant event (1=first; 2= second; 3 = third; ?). In this field must be reported the ordinal number of relevant event to be described.

Progressive number of diagnosis (1=first; 2= second; 3 = third; ?).
In this field must be reported the ordinal number of the tumor diagnosis in which other info or relevant events occurred

Progressive number of relevant event (1=first; 2= second; 3 = third; ?). In this field must be reported the ordinal number of relevant event to be described.

Important toxicity during treatment �

Answwer 'YES' OR 'NO' if non haematologic severe or life threatening (CTCAE grade 3 or 4) toxicity occurred during treatment. Please note that febrile neutropenia events are not considered as 'severe' unless infection had severly affected important organs (e.g osteomyelitis, pneumonia) 1 => Yes 2 => No -9922 => NK

Number of toxicity

Date (dd/mm/yyyy) of the event. If the date is unkown or partially missed insert the year at the best of your knowledge.

Please describe any significant event (e.g. admission to the intensive care for a metabolic problem, seizures, severe toxic complication) occurring during therapy that might have fully recovered or be still remaining or with sequelae

Please specify if the event is resolved or not

Please specify if hypogonadal occured during therapy

Please specify if growth hormon deficiency occured during therapy

Please specify if hydrocephalus occured during therapy

Please specify if chronic viral hepatitis occured during therapy

Please specify if sinusoidal obstruction syndrome occured during therapy

Please report if at least one central venous line (catheter) was positioned

Report if the CVC is still in place or was removed

Report where (in which vein) the CVC was positioned

Catheter-related thrombosis

Report if there was a catheter-related thrombosis due to a central venous catheter.

Specify the details of the catheter-related thrombosis, including the location (vessel and laterality), treatment and status at the end of cancer treatment.

Transfusion �

Please state if at least one blood (any component) transfusion was made

Please report the date of the last transfusion given. If the date is unkown or partially missed insert the year at the best of your knowledge.

Please specify if patient recieved 10 or more than 10 trasfusions during therapy

Please state if any procedure was performed for fertility preservation

If fertility preservation was performed,please describe it

If fertility preservation was performed, describe with details of the institution where either sperm or ovarian tissue/oocytes have been stored

Report here if any other treatment (not included in the chemotherapy, surgery or radiotherapy sections) was adminstered to the survivor

Discharge letter

Other info and relevant events Maturity Level: 2 - Ready for Review

Progressive number of relevant event (1=first; 2= second; 3 = third; ?). In this field must be reported the ordinal number of relevant event to be described.

Progressive number of diagnosis (1=first; 2= second; 3 = third; ?).
In this field must be reported the ordinal number of the tumor diagnosis in which other info or relevant events occurred

Progressive number of relevant event (1=first; 2= second; 3 = third; ?). In this field must be reported the ordinal number of relevant event to be described.

Important toxicity during treatment �

Answwer 'YES' OR 'NO' if non haematologic severe or life threatening (CTCAE grade 3 or 4) toxicity occurred during treatment. Please note that febrile neutropenia events are not considered as 'severe' unless infection had severly affected important organs (e.g osteomyelitis, pneumonia) 1 => Yes 2 => No -9922 => NK

Number of toxicity

Date (dd/mm/yyyy) of the event. If the date is unkown or partially missed insert the year at the best of your knowledge.

Please describe any significant event (e.g. admission to the intensive care for a metabolic problem, seizures, severe toxic complication) occurring during therapy that might have fully recovered or be still remaining or with sequelae

Please specify if the event is resolved or not

Please specify if hypogonadal occured during therapy

Please specify if growth hormon deficiency occured during therapy

Please specify if hydrocephalus occured during therapy

Please specify if chronic viral hepatitis occured during therapy

Please specify if sinusoidal obstruction syndrome occured during therapy

Please report if at least one central venous line (catheter) was positioned

Report if the CVC is still in place or was removed

Report where (in which vein) the CVC was positioned

Catheter-related thrombosis

Report if there was a catheter-related thrombosis due to a central venous catheter.

Specify the details of the catheter-related thrombosis, including the location (vessel and laterality), treatment and status at the end of cancer treatment.

Transfusion �

Please state if at least one blood (any component) transfusion was made

Please report the date of the last transfusion given. If the date is unkown or partially missed insert the year at the best of your knowledge.

Please specify if patient recieved 10 or more than 10 trasfusions during therapy

Please state if any procedure was performed for fertility preservation

If fertility preservation was performed,please describe it

If fertility preservation was performed, describe with details of the institution where either sperm or ovarian tissue/oocytes have been stored

Report here if any other treatment (not included in the chemotherapy, surgery or radiotherapy sections) was adminstered to the survivor

Discharge letter

Other info and relevant events Maturity Level: 2 - Ready for Review

Progressive number of relevant event (1=first; 2= second; 3 = third; ?). In this field must be reported the ordinal number of relevant event to be described.

Progressive number of diagnosis (1=first; 2= second; 3 = third; ?).
In this field must be reported the ordinal number of the tumor diagnosis in which other info or relevant events occurred

Progressive number of relevant event (1=first; 2= second; 3 = third; ?). In this field must be reported the ordinal number of relevant event to be described.

Important toxicity during treatment �

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

• value @ url

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Answwer 'YES' OR 'NO' if non haematologic severe or life threatening (CTCAE grade 3 or 4) toxicity occurred during treatment. Please note that febrile neutropenia events are not considered as 'severe' unless infection had severly affected important organs (e.g osteomyelitis, pneumonia) 1 => Yes 2 => No -9922 => NK

Number of toxicity

Date (dd/mm/yyyy) of the event. If the date is unkown or partially missed insert the year at the best of your knowledge.

Please describe any significant event (e.g. admission to the intensive care for a metabolic problem, seizures, severe toxic complication) occurring during therapy that might have fully recovered or be still remaining or with sequelae

Please specify if the event is resolved or not

Please specify if hypogonadal occured during therapy

Please specify if growth hormon deficiency occured during therapy

Please specify if hydrocephalus occured during therapy

Please specify if chronic viral hepatitis occured during therapy

Please specify if sinusoidal obstruction syndrome occured during therapy

Please report if at least one central venous line (catheter) was positioned

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

• value @ url

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Report if the CVC is still in place or was removed

Report where (in which vein) the CVC was positioned

Catheter-related thrombosis

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

• value @ url

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Report if there was a catheter-related thrombosis due to a central venous catheter.

Specify the details of the catheter-related thrombosis, including the location (vessel and laterality), treatment and status at the end of cancer treatment.

Transfusion �

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

• value @ url

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Please state if at least one blood (any component) transfusion was made

Please report the date of the last transfusion given. If the date is unkown or partially missed insert the year at the best of your knowledge.

Please specify if patient recieved 10 or more than 10 trasfusions during therapy

Please state if any procedure was performed for fertility preservation

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

• value @ url

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

If fertility preservation was performed,please describe it

If fertility preservation was performed, describe with details of the institution where either sperm or ovarian tissue/oocytes have been stored

Report here if any other treatment (not included in the chemotherapy, surgery or radiotherapy sections) was adminstered to the survivor

Discharge letter