Description:

NSABP PROTOCOL C-08: HYPERTENSION STATUS FORM NCT00096278 Fluorouracil, Leucovorin, and Oxaliplatin With or Without Bevacizumab in Treating Patients Who Have Undergone Surgery for Stage II or Stage III Colon Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=D7FA15D7-81B4-61AD-E034-0003BA12F5E7

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=D7FA15D7-81B4-61AD-E034-0003BA12F5E7

Keywords:
Versions (3) ▾
  1. 8/27/12
  2. 1/9/15
  3. 6/9/15
Uploaded on:

June 9, 2015

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License:
Creative Commons BY-NC 3.0 Legacy
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NSABP PROTOCOL C-08: HYPERTENSION STATUS FORM NCT00096278

This form should be completed every 3 months while the patient is receiving protocol therapy, and every 6 months after the last dose of protocol therapy, for up to one year.

Header
Are data amended? (check box if yes, and circle amended items)
Blood pressure assessment
Time point of this assessment
Does the patient have hypertension requiring medication?
Has there been an addition of a new anti-hypertensive agent or a modification of an existing agent since the last HT form?
Specify the action(s) taken (select all that apply:)
Reason action(s) taken:
Unit

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