ID
10487
Descrição
CALGB: CHANGES IN FUNCTION FORM NCT00024102 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=A50D6975-F5AD-3262-E034-080020C9C0E0 NCT00024102
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Versões (3)
- 18/12/2014 18/12/2014 - Martin Dugas
- 02/06/2015 02/06/2015 -
- 03/06/2015 03/06/2015 -
Transferido a
3 de junho de 2015
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Creative Commons BY-NC 3.0 Legacy
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CALGB: CHANGES IN FUNCTION FORM NCT00024102
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.
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Assessment data
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Patient status assessment
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Hasyourphysicalconditiongotten
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Hasyouremotionalstategotten
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Hasyourabilitytoenjoyyoursociallifegotten
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Hasyouroverallqualityoflifegotten
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Ccrr Module For Calgb: Changes In Function Form
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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 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.
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C1705108 (UMLS 2011AA)