After you submit an Exam form, a confirmation message CTC Data Collection Menu - Polypand a link to the Polyp form appears. You can also access the form by clicking Polyp under Data Collection in the CTC Registry menu.


Complete this form if, and only if, a polyp of at least 10 millimeters was detected during the exam. Enter data only for polyps that equal or exceed 10 millimeters in size. Complete the form by selecting from among the options presented on the form and filling in the blank fields. Specific instructions for each field are as follows: 

 

Field Name

Description

Facility ID Number


Registry Case Number


Patient First Name


Patient Last Name


Exam Date

These fields are filled in automatically from the Case Registration form.

Polyp Size


Location


Morphology

Enter data for up to five polyps. Size must be equal to or greater than 10 millimeters. Select the appropriate responses for Location and Morphology for each polyp.

Follow-up, patient lost to follow-up

Select the check box if follow-up data could not be obtained.

Data of Reference Exam or Confirming Surgery


Did colonoscopy reach level of lesion?


Was polyp confirmed?

Date of Reference Exam is optional. It must not be earlier than the exam date. If it is entered, indicate whether each of the polyps was confirmed or not. A polyp is considered confirmed if the colonoscopy determines the location to be in the same segment or an adjacent segment, and the size to be within ±50%.

Name of Person Who Completed the Paper Form

Enter the name of the person who collected the data for this exam. If this name has not been previously entered in a case record, then enter the person’s first and last name. In the future, the name will appear in the drop-down list for this field. If the name has been previously entered, click the arrow and select it from the drop-down list.


Note: Please populate this field even if paper forms were not used; you may use the name of the person completing the on-line data submission

Name of person submitting form


Submission Date

These fields are filled in automatically.


Click Submit when the form is complete.


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