The Pharmacogenomic Submission and Quality Assurance Form, a CDE-compliant CALGB CRF to be used on CALGB protocols NCT00265850 . Cetuximab and/or Bevacizumab Combined With Combination Chemotherapy in Treating Patients With Metastatic Colorectal Cancer Source Form: NCI FormBuilder:


Versions (3) ▾
  1. 8/27/12
  2. 1/9/15
  3. 6/18/15
Uploaded on:

June 18, 2015

No DOI assigned. To request one please log in.
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.

CALGB: 80405 Pharmacogenomic Submission and Quality Assurance Form NCT00265850

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
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

Similar models