ID
10264
Beskrivning
CALGB: TRACKING FORM (TISSUE BLOCKS) Comparison of Combination Chemotherapy Regimens in Treating Older Women Who Have Undergone Surgery for Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A50D4607-D11F-30F7-E034-080020C9C0E0
Länk
Nyckelord
Versioner (4)
- 2012-08-26 2012-08-26 -
- 2015-05-22 2015-05-22 -
- 2015-06-03 2015-06-03 -
- 2015-06-03 2015-06-03 -
Uppladdad den
22 maj 2015
DOI
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Licens
Creative Commons BY-NC 3.0 Legacy
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CALGB: TRACKING FORM (TISSUE BLOCKS)
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.
Beskrivning
Patient clinical trial data
Beskrivning
Patient'sName
Datatyp
text
Beskrivning
ParticipatingGroup
Datatyp
text
Alias
- NCI Thesaurus ObjectClass
- C17005
- UMLS 2011AA ObjectClass
- C1257890
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
Beskrivning
PatientHospitalNumber
Datatyp
text
Beskrivning
ParticipatingGroupProtocolNo.
Datatyp
text
Beskrivning
MainMemberInstitution/Adjunct
Datatyp
text
Beskrivning
ParticipatingGroupPatientNo.
Datatyp
text
Beskrivning
pathology/biopsy status
Beskrivning
Dotissueblock/slidesaccompanythisform?
Datatyp
text
Beskrivning
specifyreason(specimenwillnotbesubmitted)
Datatyp
text
Beskrivning
Ispatientenrolledinacorrelativesciencestudy?
Datatyp
text
Beskrivning
correlativestudynumber(s)
Datatyp
text
Beskrivning
SurgicalProcedureDate
Datatyp
text
Beskrivning
Dateblocksandpathologyreportssubmitted
Datatyp
text
Beskrivning
Tissuepathology
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus ObjectClass
- C12801
- UMLS 2011AA ObjectClass
- C0040300
- NCI Thesaurus Property
- C25683
- UMLS 2011AA Property
- C0449416
- NCI Thesaurus ObjectClass
- C18189
- UMLS 2011AA ObjectClass
- C0030664
Beskrivning
Methodofextraction
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus Property
- C16847
- UMLS 2011AA Property
- C0449851
- NCI Thesaurus Property
- C15329
- UMLS 2011AA Property
- C0543467
- NCI Thesaurus ObjectClass
- C19157
- UMLS 2011AA ObjectClass
- C0370003
Beskrivning
Pathology/accessionnumber
Datatyp
text
Beskrivning
PersonSpecimenSubmittedName
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS 2011AA ValueDomain
- C1547383
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C19157
- UMLS 2011AA Property
- C0370003
- NCI Thesaurus Property
- C25695
- UMLS 2011AA Property
- C1515023
Beskrivning
PhoneNo.
Datatyp
text
Beskrivning
Ccrr Module For Calgb: Tracking Form (tissue Blocks)
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.
C1705108 (UMLS 2011AA)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0332307 (UMLS 2011AA ValueDomain)
C12801 (NCI Thesaurus ObjectClass)
C0040300 (UMLS 2011AA ObjectClass)
C25683 (NCI Thesaurus Property)
C0449416 (UMLS 2011AA Property)
C18189 (NCI Thesaurus ObjectClass)
C0030664 (UMLS 2011AA ObjectClass)
C0027627 (UMLS 2011AA)
C0332307 (UMLS 2011AA ValueDomain)
C16847 (NCI Thesaurus Property)
C0449851 (UMLS 2011AA Property)
C15329 (NCI Thesaurus Property)
C0543467 (UMLS 2011AA Property)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C0005558 (UMLS 2011AA)
C0024881 (UMLS 2011AA)
C0184913 (UMLS 2011AA)
C0024885 (UMLS 2011AA)
C1547383 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C19157 (NCI Thesaurus Property)
C0370003 (UMLS 2011AA Property)
C25695 (NCI Thesaurus Property)
C1515023 (UMLS 2011AA Property)