Bladder/urothelial: Form Administration
PersonCompletingForm,LastName
text
PersonCompletingForm,FirstName
text
AmendedDataInd
text
To Record Data On Treatment Of Patient Using Chemotherapy Agents. Full Block Name On Form: Bladder/urothelial: Treatment Schedule - Chemotherapy
TreatmentFirstDoseBeginDate
date
TreatmentLastDoseEndDate
date
AgentInitialDose
text
AgentDoseUnits
text
AgentName
text
Bladder/urothelial: Treatment Schedule - Radiation Therapy
RTType
text
RTOtherType
text
RTTotalDose,Pelvis
text
RTTotalDose,Prostate
text
RTBeginDate
date
RTEndDate
date
RTInterruptionsInd
text
RTInterruptionsReason
text
Bladder/urothelial: Treatment Schedule - Surgery
ProtocolSurgeryDate
date
ProtocolSurgeryType
text
SurgicalTreatmentCompleted
text
SurgicalTreatmentModificationReason
text
Bladder/urothelial: Off-treatment & Modifications
OffTreatmentReason
text
OffTreatmentReason,Other
text
DoseModification(Change)
text
DoseModificationReason
text
Bladder/urothelial: Treatment Schedule - Non-protocol Therapy
Non-ProtocolTherapyInd,DuringProtocol
text
Non-ProtocolChemotherapyInd
text
Non-ProtocolRTInd
text
Non-protocolSurgeryPerformedInd-3
text
Non-ProtocolTherapyType
text
Non-ProtocolTherapyType
text
Non-ProtocolTherapyType
text
OtherNon-ProtocolTherapyInd
text
OtherNon-ProtocolTherapyName
text
Allows Documentation Of Any Additional Cooments