ID
10237
Description
CALGB: 49907 CAPECITABINE DRUG SUPPLY RECORD FORM 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=A50CE624-6F5F-37E3-E034-080020C9C0E0
Lien
Mots-clés
Versions (2)
- 26/08/2012 26/08/2012 -
- 20/05/2015 20/05/2015 - Martin Dugas
Téléchargé le
20 mai 2015
DOI
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Licence
Creative Commons BY-NC 3.0 Legacy
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Breast Cancer DRUG SUPPLY NCT00024102 CALGB 49907
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 Statistical Center, Data Operations. 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.
Description
Drug Supply
Description
Dailycapecitabinedose
Type de données
float
Description
Numberof500mgtabletsprescribedtobetakeneachday
Type de données
float
Description
Numberof500mgtabletsissued
Type de données
float
Description
Dateandtimetheelectronicdevicewasplacedonthevial
Type de données
text
Description
Nameofthepersonwhofilledthevial
Type de données
text
Description
DateandTimepillcountwasdone
Type de données
text
Description
Howmany500mgtabletsreturned
Type de données
float
Description
Dateandtimetheelectronicdevicewasremovedfromthevial
Type de données
text
Description
Nameofthepersonwhoperformedthereturnpillcount
Type de données
text
Description
CompletedBy
Type de données
text
Description
DateCompleted
Type de données
date
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 Statistical Center, Data Operations. 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)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)