Description:

AMC-052 HPV On-Study Form NCT00513526 Human Papillomavirus Vaccine Therapy in Treating Men With HIV-1 Infection Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=3950D614-2D59-3AAB-E044-0003BA3F9857

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=3950D614-2D59-3AAB-E044-0003BA3F9857

Keywords:
Versions (4) ▾
  1. 9/19/12
  2. 8/11/14
  3. 6/2/15
  4. 6/3/15
Uploaded on:

June 3, 2015

DOI:
No DOI assigned. 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.

AMC-052 HPV On-Study Form NCT00513526

No Instruction available.

  1. StudyEvent: AMC-052 HPV On-Study Form
    1. No Instruction available.
HIV status
CDC HIV Risk Group
Prior Systemic Chemotherapy
Has the patient received radiation therapy?
Condyloma
History of anal, perianal, or genital condyloma (If yes check all that apply)
History of penile or genital condyloma
History of perianal condyloma
History of intraanal condlyoma
Anal cytology/biopsy
Anal cytology performed (prior to screening to AMC052)
Anal cytology result (if yes)
Anal or perianal biopsy performed (prior to screening to AMC052)
Most severe anal biopsy result
Footer module
Smoked at least 100 cigarettes (5 packs) during lifetime
Document type

Similar models