Description:

NSABP PROTOCOL C-08 ON-STUDY 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=DE27BCD2-EB22-2947-E034-0003BA12F5E7

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=DE27BCD2-EB22-2947-E034-0003BA12F5E7

Keywords:
Versions (3) ▾
  1. 8/11/14
  2. 1/9/15
  3. 7/5/15
Uploaded on:

July 5, 2015

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

NSABP PROTOCOL C-08 ON-STUDY FORM NCT00096278

Fax Form ON to 412-622-2111

  1. StudyEvent: NSABP PROTOCOL C-08 ON-STUDY FORM
    1. Fax Form ON to 412-622-2111
Header
Are data amended? (check box if yes, and circle amended items)
Tumor assessment
Are there Multiple Primary Tumors?
Location of Tumor (Select One for Each Primary Tumor)
cm
Was there bowel obstruction?
Was there tumor perforation?
type of perforation (If yes,)
Was tumor resected en bloc? ([Refer to C-08 Nurse/CRA Guidelines.])
Histologic Grade (differentiation)
All surgical margins of resection are negative for tumor
Which margin is involved? (mark all that apply)
Tnm Classification
T Stage, Pathological ([If multiple tumors, report on most advanced.])
N Stage, Pathological
Vascular assessment
Hypertension (1.)
Diabetes Mellitus (2.)
Previous vascular event (3.)
Previous vascular event
Smoking (4.)
Family history of cardiac disease (5.)

Similar models