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Prostate Cancer Research and Education Foundation

Free MultiGraph Medical Graphing Service

MultiGraph Data Input Form
(Many thanks to Don Cooley for developing the first version of this form.)

There are six sections to this form:

Identification
Clinical Data
Numerical Data
Single-date Events
Items with a Start and Stop
Notes


Hint: Be sure not hit the Enter key until all your data is entered. However, if you hit the Enter key by mistake, hit your browser Back key and continue entering data.  Hit Submit when you are done.  If there is incorrect or missing data in your submission, you will have a chance to fix it when you get an update.

Identification
Name  
Address  
Line2  
City  
State/Province  
Zip postcode  
Country  
Dayphone  
Evephone  
Fax  
Email  
Dateofbirth  
Diagnosisdate  
     
 
Select the date format you will use if your dates are all numbers. If you use formats such as 18-Jan-00, Feb 15, 1999, the format selection does not matter. Back to Top
 
Clinical Data
 
Height   inches
Weight   pounds
Prostate Volume   g or cc
Gleason   n+n=n
Clinicalstage  
Ploidy   Diploid, Aneuploid, or ...
Partin   nn,nn,nn,nn
Partin II   nn,nn,nn,nn
Narayan   nn,nn,nn,nn
     
 

Numerical Data

This is a table in which you will enter the numerical data you want graphed. Typical items are PSA, PSA2, Testo (Testosterone), PAP, AlkPhos. In the first row enter the names of the variables. PSA has already been entered for the first variable. If your lab report shows "<" for less than some value, do not put a space between the symbol and the number. Back to Top
         
      Other Variable Names (no_spaces)
  Date PSA
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12
13.
14.
15.
16.
17.
18
19
20
21.
22.
23.
               
 
Single-date events
 
This is the section in which you will enter the event-type information. Enter the date of the event, select its type, and then a short name up to seven characters with no spaces. If the event is a Diagnostic that has a result that can be classified as "Positive" (disease found) or "Negative" (problem not found, or questionable, make the appropriate selection.

Example of Diagnostic Names: include DRE (digital rectal exam), Biopsy, MRI, CTScan, BScan (Bone Scan), and ProstSc (ProstaScint).

Items with a Start and Stop.

Example of other Event Names: might include: Fall, Death (in family), and might even be something good that happened. Back to Top

 
  Date Type Name (no_spaces) Result (for Diagnostics only)
1.
  If there is more information about this event, select Details: or Report: and add the info below:
 
         
  Date Type Name (no_spaces) Result (for Diagnostics only)
2.
  If there is more information about this event, select Details: or Report: and add the info below:
 
         
  Date Type Name (no_spaces) Result (for Diagnostics only)
3.
  If there is more information about this event, select Details: or Report: and add the info below:
 
         
  Date Type Name (no_spaces) Result (for Diagnostics only)
4.
  If there is more information about this event, select Details: or Report: and add the info below:
 
         
  Date Type Name (no_spaces) Result (for Diagnostics only)
5.
  If there is more information about this event, select Details: or Report: and add the info below:
 
         
  Date Type Name (no_spaces) Result (for Diagnostics only)
6.
  If there is more information about this event, select Details: or Report: and add the info below:
 
         
  Date Type Name (no_spaces) Result (for Diagnostics only)
7.
  If there is more information about this event, select Details: or Report: and add the info below:
 
         
  Date Type Name (no_spaces) Result (for Diagnostics only)
8.
  If there is more information about this event, select Details: or Report: and add the info below:
 
         
  Date Type Name (no_spaces) Result (for Diagnostics only)
9.
  If there is more information about this event, select Details: or Report: and add the info below:
 
         
  Date Type Name (no_spaces) Result (for Diagnostics only)
10.
  If there is more information about this event, select Details: or Report: and add the info below:
 
         
  Date Type Name (no_spaces) Result (for Diagnostics only)
11.
  If there is more information about this event, select Details: or Report: and add the info below:
 
         
  Date Type Name (no_spaces) Result (for Diagnostics only)
12.
  If there is more information about this event, select Details: or Report: and add the info below:
 
         
  Date Type Name (no_spaces) Result (for Diagnostics only)
13.
  If there is more information about this event, select Details: or Report: and add the info below:
 
         
  Date Type Name (no_spaces) Result (for Diagnostics only)
14.
  If there is more information about this event, select Details: or Report: and add the info below:
 
         
  Date Type Name (no_spaces) Result (for Diagnostics only)
15.
  If there is more information about this event, select Details: or Report: and add the info below:
 
         
  Date Type Name (no_spaces) Result (for Diagnostics only)
16.
  If there is more information about this event, select Details: or Report: and add the info below:
 
         
 
Items with a Start and Stop
Here you enter items like treatments or life style changes that have a start date, and may have a stop date. Examples of this include: Lupron, Zoladex, Flutamide, Casodex, Proscar, PC-Spes, LowFat, Exercise, Meditation, and XBRT (External beam radiation series). The name should be no longer than about 12 characters and may not include spaces. If the item has not been stopped, you can leave it blank or enter "Continuing" (without the quotes). Back to Top
  Date Start Date Stop Name (no_spaces) Description
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
 
Notes

Here you can add any other information you want included in the report that will be returned to you by email. Back to Top

 
 
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