ID

10304

Description

Southwest Oncology Group Registration Form Step 2 (S0303) Combination Chemotherapy and Bevacizumab in Treating Patients With Locally Advanced, Metastatic, or Recurrent Colorectal Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=ECDF9D42-18FA-2B72-E034-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=ECDF9D42-18FA-2B72-E034-0003BA3F9857

Keywords

  1. 8/27/12 8/27/12 -
  2. 5/23/15 5/23/15 -
  3. 6/3/15 6/3/15 -
  4. 6/3/15 6/3/15 -
Uploaded on

May 23, 2015

DOI

To request one please log in.

License

Creative Commons BY-NC 3.0 Legacy

Model comments :

You can comment on the data model here. Via the speech bubbles at the itemgroups and items you can add comments to those specificially.

Itemgroup comments for :

Item comments for :

In order to download data models you must be logged in. Please log in or register for free.

Southwest Oncology Group Registration Form Step 2 (S0303)

No Instruction available.

  1. StudyEvent: Southwest Oncology Group Registration Form Step 2 (S0303)
    1. No Instruction available.
SWOG clinical trial data
Description

SWOG clinical trial data

SWOG Study No.
Description

SWOGStudyNo.

Data type

text

Registration Step
Description

RegistrationStep

Data type

text

Activation Date
Description

ActivationDate

Data type

text

Last Amended Date
Description

LastAmendedDate

Data type

text

Patient's Name
Description

Patient'sName

Data type

text

SWOG Patient ID
Description

SWOGPatientID

Data type

text

Other Group Patient Number
Description

OtherGroupPatientNumber

Data type

text

Participating Group/Protocol Number
Description

ParticipatingGroup/ProtocolNumber

Data type

text

Further registration details
Description

Further registration details

Caller's SWOG Roster ID
Description

Caller'sSWOGRosterID

Data type

text

SWOG Investigator Number
Description

SWOGInvestigatorNumber

Data type

text

Other Group Investigator Name
Description

OtherGroupInvestigatorName

Data type

text

Other Group Investigator Number
Description

OtherGroupInvestigatorNumber

Data type

text

SWOG Treating Institution Number
Description

SWOGTreatingInstitutionNumber

Data type

text

Other Group Institution Name
Description

OtherGroupInstitutionName

Data type

text

Other Group Institution Number
Description

OtherGroupInstitutionNumber

Data type

text

NCI Investigator Number
Description

NCIInvestigatorNumber

Data type

text

Projected Start Date of Treatment
Description

ProjectedStartDateofTreatment

Data type

text

Date that the patient was reconsented to the open-label bevacizumab phase of the study
Description

Datethatthepatientwasreconsentedtotheopen-labelbevacizumabphaseofthestudy

Data type

text

Original TXPREPID from Step 1
Description

OriginalTXPREPIDfromStep1

Data type

text

Similar models

No Instruction available.

  1. StudyEvent: Southwest Oncology Group Registration Form Step 2 (S0303)
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
SWOG clinical trial data
SWOGStudyNo.
Item
SWOG Study No.
text
RegistrationStep
Item
Registration Step
text
ActivationDate
Item
Activation Date
text
LastAmendedDate
Item
Last Amended Date
text
Patient'sName
Item
Patient's Name
text
SWOGPatientID
Item
SWOG Patient ID
text
OtherGroupPatientNumber
Item
Other Group Patient Number
text
ParticipatingGroup/ProtocolNumber
Item
Participating Group/Protocol Number
text
Item Group
Further registration details
Caller'sSWOGRosterID
Item
Caller's SWOG Roster ID
text
SWOGInvestigatorNumber
Item
SWOG Investigator Number
text
OtherGroupInvestigatorName
Item
Other Group Investigator Name
text
OtherGroupInvestigatorNumber
Item
Other Group Investigator Number
text
SWOGTreatingInstitutionNumber
Item
SWOG Treating Institution Number
text
OtherGroupInstitutionName
Item
Other Group Institution Name
text
OtherGroupInstitutionNumber
Item
Other Group Institution Number
text
NCIInvestigatorNumber
Item
NCI Investigator Number
text
ProjectedStartDateofTreatment
Item
Projected Start Date of Treatment
text
Datethatthepatientwasreconsentedtotheopen-labelbevacizumabphaseofthestudy
Item
Date that the patient was reconsented to the open-label bevacizumab phase of the study
text
OriginalTXPREPIDfromStep1
Item
Original TXPREPID from Step 1
text

Please use this form for feedback, questions and suggestions for improvements.

Fields marked with * are required.

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial