ID
10637
Descripción
CALGB: 49907 ADJUVANT TREATMENT SUMMARY FORM; Subset of Patients 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=A50CEAE3-8E50-387D-E034-080020C9C0E0
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Versiones (4)
- 26/8/12 26/8/12 -
- 22/5/15 22/5/15 -
- 3/6/15 3/6/15 -
- 3/6/15 3/6/15 -
Subido en
3 de junio de 2015
DOI
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Licencia
Creative Commons BY-NC 3.0 Legacy
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CALGB: 49907 ADJUVANT TREATMENT SUMMARY FORM; Subset of Patients 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.
Descripción
Patient demographics
Descripción
Patient'sName
Tipo de datos
text
Descripción
ParticipatingGroup
Tipo de datos
text
Alias
- NCI Thesaurus ObjectClass
- C17005
- UMLS 2011AA ObjectClass
- C1257890
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
Descripción
PatientHospitalNumber
Tipo de datos
text
Descripción
ParticipatingGroupProtocolNo.
Tipo de datos
text
Descripción
MainMemberInstitution/Adjunct
Tipo de datos
text
Descripción
ParticipatingGroupPatientNo.
Tipo de datos
text
Descripción
Treatment Cycle Information
Descripción
Comments
Descripción
Ccrr Module For Calgb: 49907 Adjuvant Treatment Summary Form; Subset Of Patients
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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.
C1705108 (UMLS 2011AA)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C0010583 (UMLS 2011AA)
C0025677 (UMLS 2011AA)
C0016360 (UMLS 2011AA)
C0671970 (UMLS 2011AA)
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