Tracking Information
InstitutionName
text
TreatingPhysician
text
PatientMedicalRecordNumber
text
PatientBirthDate
date
PatientSocialSecurityNumber
double
PatientAddress,PostalCode
double
PatientAddress,Country
text
Demographic Information
PatientRace
text
PatientEthnicity
text
PaymentMethod
text
PatientPaymentSpecify
text
PatientHeight
double
PatientWeight
double
PerformanceStatus
text
PriorCancerInd
text
PriorCancerType
text
PriorCancerDiagnosisDate
date
Comments
Footer Module
ParticipatingGroupCode
text
ParticipatingGroupProtocolNumber
double
PatientParticipatingIdentifierNumber
text
Ccrr Module For Gog Registration Form