The Pharmacogenomic Submission and Quality Assurance Form, a CDE-compliant CALGB CRF to be used on CALGB protocols. NCT00770809 Paclitaxel and Trastuzumab With or Without Lapatinib in Treating Patients With Stage II or Stage III Breast Cancer That Can Be Removed by Surgery Source Form: NCI FormBuilder:

  1. 8/27/12 8/27/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
  3. 6/18/15 6/18/15 -
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June 18, 2015

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Creative Commons BY-NC 3.0 Legacy
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CALGB: Pharmacogenomic Submission and Quality Assurance Form NCT00770809

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. If data are amended, circle amended items and check the "Yes" box.

Are data amended
Patient demographics
Biopsy and Cytology Specimens
Does specimen accompany this form
Specify reason (If no,)
Biopsy and Cytology Specimens collection
Was blood sample collected in an EDTA Vacutainer tube (purple top)
Was blood sample stored either at 4 degrees C or frozen within 24 hours of collection
Was blood sample shipped to the PCO on a cold pack
Biopsy and Cytology Specimens shipment

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