Header
PatientBirthDate
date
HospitalPatientIdentifierNumber
text
InstitutionName
InstitutionIdentifierNumber
RegisteredInvestigatorName
Disease Recurrence
AssessmentPerformedDate
MetastasisDiagnosisDate
Loco-regional Recurrence
BreastCarcinomaLocal-RegionalRecurrentDiseaseAnatomicSite
AssessmentMethodType
AssessmentMethodSpecify
Distant Metastasis
BreastMalignantNeoplasmMetastaticInvolvementSite
MalignantNeoplasmMetastaticInvolvementSpecify
Comments
InvestigatorSignatureDate
InvestigatorSignatureText