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ID
1422
Description
CALGB: HOSPITALIZATION FORM Fluorouracil and Leucovorin Plus Either Irinotecan or Oxaliplatin With or Without Cetuximab in Treating Patients With Previously Untreated Metastatic Adenocarcinoma of the Colon or Rectum Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=BFD57010-EDCC-3516-E034-0003BA12F5E7
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Versions (2)
- 8/27/12 8/27/12 -
- 7/14/17 7/14/17 - Martin Dugas
Uploaded on
August 27, 2012
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License
Creative Commons BY-NC 3.0
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Colorectal Cancer NCT00077233 Registration - CALGB: HOSPITALIZATION FORM - 2170963v3.0
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- StudyEvent: CALGB: HOSPITALIZATION FORM
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- StudyEvent: CALGB: HOSPITALIZATION FORM
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
PatientInitials
Item
Patient Initials
text
PatientHospitalNo.
Item
Patient Hospital No.
text
Institution/Affiliate
Item
Institution/Affiliate
text
ParticipatingGroup
Item
Participating Group
text
ParticipatingGroupProtocolNo.
Item
Participating Group Protocol No.
text
ParticipatingGroupPatientID
Item
Participating Group Patient ID
text
CALGBStudyNo.
Item
CALGB Study No.
text
CALGBPatientID
Item
CALGB Patient ID
text
Hospitaladmitdate
Item
Hospital admit date
text
Hospitaldischargedate
Item
Hospital discharge date
text
CL Item
Treatment of disease related complications (Treatment of disease related complications)
CL Item
Treatment of complications related to protocol therapy (Treatment of complications related to protocol therapy)
CL Item
Non-study indication (Non-study indication)
CL Item
Other, specify (Other, specify)
Other,specify
Item
Other, specify
text
Completedby
Item
Completed by
text
Datefromoriginallycompleted
Item
Date from originally completed
text