ID
10181
Beschrijving
CALGB: 49907 ADJUVANT TREATMENT SUMMARY FORM; All Patients 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=A50D76F4-2138-330D-E034-080020C9C0E0
Link
Trefwoorden
Versies (2)
- 26-08-12 26-08-12 -
- 22-04-15 22-04-15 - Martin Dugas
Geüploaded op
22 april 2015
DOI
Voor een aanvraag inloggen.
Licentie
Creative Commons BY-NC 3.0 Legacy
Model Commentaren :
Hier kunt u commentaar leveren op het model. U kunt de tekstballonnen bij de itemgroepen en items gebruiken om er specifiek commentaar op te geven.
Itemgroep Commentaren voor :
Item Commentaren voor :
U moet ingelogd zijn om formulieren te downloaden. AUB inloggen of schrijf u gratis in.
Breast Cancer ADJUVANT TREATMENT CALGB 49907 NCT00024102
INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice. Print text in capital letters. Avoid contact with the edges of the boxes. Circle amended items and check "Amended data" box to the right. If submitting by mail, retain a copy for your records and send the original to the CALGB Data Management Center. If faxing, use an original form for maximum clarity in transmission and fax to 919-416-4990. If submitting electronically, click the Send button when you have completed the PDF version of the form.
Beschrijving
Treatment Cycle Information
Beschrijving
TotalDoseofDrugsforCycle1
Datatype
float
Maateenheden
- mg
Alias
- UMLS CUI-1
- C2986497
Beschrijving
Agent Name
Datatype
text
Alias
- UMLS CUI-1
- C0450442
Beschrijving
ReasonTreatmentEnded
Datatype
text
Beschrijving
Other,specify(reasontreatmentended)
Datatype
text
Beschrijving
Werethereanydosemodificationsoradditions/omissionstoprotocoltreatment?
Datatype
text
Alias
- UMLS CUI-1
- C1707811
Beschrijving
Wereanyoptionalprotocoltherapiesgiven?
Datatype
boolean
Beschrijving
optionalprotocoltherapyname(s)
Datatype
text
Beschrijving
Wasanyconcurrentnon-protocoltherapygivenduringprotocoltreatment?
Datatype
boolean
Alias
- UMLS CUI-1
- C1518384
- UMLS CUI-2
- C0087111
Beschrijving
indicate below (concurrent non-protocol therapy given during protocol treatment) (mark all that apply with an X)
Datatype
text
Alias
- UMLS CUI-1
- C1518384
- UMLS CUI-2
- C0087111
Similar models
INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice. Print text in capital letters. Avoid contact with the edges of the boxes. Circle amended items and check "Amended data" box to the right. If submitting by mail, retain a copy for your records and send the original to the CALGB Data Management Center. If faxing, use an original form for maximum clarity in transmission and fax to 919-416-4990. If submitting electronically, click the Send button when you have completed the PDF version of the form.
C0011008 (UMLS 2011AA ValueDomain)
C15368 (NCI Thesaurus ObjectClass)
C42651 (NCI Thesaurus ObjectClass-2)
C0442711 (UMLS 2011AA ObjectClass)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C1705108 (UMLS 2011AA)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C0011008 (UMLS 2011AA ValueDomain)
C25509 (NCI Thesaurus ValueDomain-2)
C1279901 (UMLS 2011AA ValueDomain-2)
C0010583 (UMLS CUI-1)
C0025677 (UMLS CUI-1)
C0016360 (UMLS CUI-1)
C0671970 (UMLS CUI-1)
C1298908 (UMLS 2011AA)
C0087111 (UMLS CUI-2)
C0087111 (UMLS CUI-2)