ID
10237
Descripción
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
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Versiones (2)
- 26/8/12 26/8/12 -
- 20/5/15 20/5/15 - Martin Dugas
Subido en
20 de mayo de 2015
DOI
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Licencia
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.
Descripción
Drug Supply
Descripción
Dailycapecitabinedose
Tipo de datos
float
Descripción
Numberof500mgtabletsprescribedtobetakeneachday
Tipo de datos
float
Descripción
Numberof500mgtabletsissued
Tipo de datos
float
Descripción
Dateandtimetheelectronicdevicewasplacedonthevial
Tipo de datos
text
Descripción
Nameofthepersonwhofilledthevial
Tipo de datos
text
Descripción
DateandTimepillcountwasdone
Tipo de datos
text
Descripción
Howmany500mgtabletsreturned
Tipo de datos
float
Descripción
Dateandtimetheelectronicdevicewasremovedfromthevial
Tipo de datos
text
Descripción
Nameofthepersonwhoperformedthereturnpillcount
Tipo de datos
text
Descripción
CompletedBy
Tipo de datos
text
Descripción
DateCompleted
Tipo de datos
date
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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)