ID
10613
Description
CALGB: ADJUVANT RADIOTHERAPY REPORT 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=A50C8257-093C-33B9-E034-080020C9C0E0
Lien
Mots-clés
Versions (3)
- 26/08/2012 26/08/2012 -
- 22/05/2015 22/05/2015 -
- 03/06/2015 03/06/2015 -
Téléchargé le
3 juin 2015
DOI
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Licence
Creative Commons BY-NC 3.0 Legacy
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CALGB: ADJUVANT RADIOTHERAPY REPORT 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.
Description
Patient clinical trial data
Description
Patient'sName
Type de données
text
Description
ParticipatingGroup
Type de données
text
Alias
- NCI Thesaurus ObjectClass
- C17005
- UMLS 2011AA ObjectClass
- C1257890
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
Description
PatientHospitalNumber
Type de données
text
Description
ParticipatingGroupProtocolNo.
Type de données
text
Description
MainMemberInstitution/Adjunct
Type de données
text
Description
ParticipatingGroupPatientNo.
Type de données
text
Description
Radiation Treatment
Description
Hasthepatientreceivedadjuvanttherapy?
Type de données
text
Description
AdjuvantRTBeginDate
Type de données
date
Description
AdjuvantRTEndDate
Type de données
date
Description
Natureofradiotherapy
Type de données
text
Description
CompletedBy
Type de données
text
Description
DateCompleted
Type de données
date
Description
Ccrr Module For Calgb: Adjuvant Radiotherapy Report Form
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)