Information:
Error:
ID
10025
Description
Comparison of Combination Chemotherapy Regimens in Treating Older Women Who Have Undergone Surgery for Breast Cancer NCT00024102 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A50CFEAE-D13B-3952-E034-080020C9C0E0
Link
Keywords
Versions (2)
- 8/26/12 8/26/12 -
- 3/18/15 3/18/15 - Martin Dugas
Uploaded on
March 18, 2015
DOI
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License
Creative Commons BY-NC 3.0 Legacy
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Breast Cancer combination chemotherapies (NCT00024102)
PATIENT INSTRUCTIONS: Use this calendar as a reminder to take your medication. Be sure to mark an "x" in each box for each day that you take your pills, record the time you took them, and circle AM or PM.
- StudyEvent: CALGB: 49907 CYCLOPHOSPHAMIDE MEDICATION CALENDAR
Similar models
PATIENT INSTRUCTIONS: Use this calendar as a reminder to take your medication. Be sure to mark an "x" in each box for each day that you take your pills, record the time you took them, and circle AM or PM.
- StudyEvent: CALGB: 49907 CYCLOPHOSPHAMIDE MEDICATION CALENDAR
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
CALGBForm
Item
CALGB Form
text
CALGBStudyNo
Item
CALGB Study No
text
CALGBPatientID
Item
CALGB Patient ID
text
Amended data
Item
Amended data?
boolean
Patient'sName
Item
Patient's Name
text
CycleNumber
Item
Cycle number
text
Day1ofcycle
Item
Day 1 of cycle (M)
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
CompletedBy
Item
Completed By (Print or Type Name)
text
DateCompleted
Item
Date Completed (M)
date
DAYOFWEEK
Item
DAY OF WEEK
text
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10 (10)
CL Item
11 (11)
CL Item
12 (12)
CL Item
13 (13)
CL Item
14 (14)
TOOKPILLS
Item
TOOK PILLS
text
Tookpillstime
Item
Took pills time
text
CL Item
Am (AM)
CL Item
Pm (PM)
total number of pills
Item
TOTAL NUMBER OF DAYS PILLS TAKEN THIS CYCLE
integer