Description:

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: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=136FE59E-9938-7353-E044-0003BA3F9857

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=136FE59E-9938-7353-E044-0003BA3F9857

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

June 18, 2015

DOI:
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License:
Creative Commons BY-NC 3.0 Legacy
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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.

Header
Are data amended
Patient demographics
Pathology/Biopsy
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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