Description:

SOUTHWEST ONCOLOGY GROUP NOTICE OF DEATH NCT00070564 Adjuvant Doxorubicin, Cyclophosphamide, and Paclitaxel in Treating Patients With Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A678BEDB-9FFF-50A6-E034-0003BA0B1A09

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A678BEDB-9FFF-50A6-E034-0003BA0B1A09

Keywords:
Versions (3) ▾
  1. 8/26/12
  2. 1/9/15
  3. 7/5/15
Uploaded on:

July 5, 2015

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License:
Creative Commons BY-NC 3.0 Legacy
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SOUTHWEST ONCOLOGY GROUP NOTICE OF DEATH NCT00070564

Instructions: Answer all questions and explain any blank fields or blank dates in the Notes section. Place an X in appropriate boxes. Circle AMENDED items in red.

Header
Date of death
Causes Of Death
If cancer was the primary cause or if cancer possibly or definitely contributed to death, and the patient had had multiple tumor types, specify those which were causes of death
Non-cancer and non-treatment related causes (select one)
Non-cancer and non-treatment related causes (select one)
Non-cancer and non-treatment related causes (select one)
Autopsy done?
Death information obtained from (select all that apply)
COMMENTS
Ccrr Module For Southwest Oncology Group Notice Of Death

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