ID

1422

Beschrijving

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

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=BFD57010-EDCC-3516-E034-0003BA12F5E7

Trefwoorden

  1. 27-08-12 27-08-12 -
  2. 14-07-17 14-07-17 - Martin Dugas
Geüploaded op

27 augustus 2012

DOI

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Licentie

Creative Commons BY-NC 3.0

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Colorectal Cancer NCT00077233 Registration - CALGB: HOSPITALIZATION FORM - 2170963v3.0

No Instruction available.

  1. StudyEvent: CALGB: HOSPITALIZATION FORM
    1. No Instruction available.
Ccrr Module For Calgb: Hospitalization Form
Beschrijving

Ccrr Module For Calgb: Hospitalization Form

Patient Initials
Beschrijving

PatientInitials

Datatype

text

Patient Hospital No.
Beschrijving

PatientHospitalNo.

Datatype

text

Institution/Affiliate
Beschrijving

Institution/Affiliate

Datatype

text

Participating Group
Beschrijving

ParticipatingGroup

Datatype

text

Participating Group Protocol No.
Beschrijving

ParticipatingGroupProtocolNo.

Datatype

text

Participating Group Patient ID
Beschrijving

ParticipatingGroupPatientID

Datatype

text

CALGB Study No.
Beschrijving

CALGBStudyNo.

Datatype

text

CALGB Patient ID
Beschrijving

CALGBPatientID

Datatype

text

Hospital admit date
Beschrijving

Hospitaladmitdate

Datatype

text

Hospital discharge date
Beschrijving

Hospitaldischargedate

Datatype

text

Reason for hospitalization
Beschrijving

Reasonforhospitalization

Datatype

text

Other, specify
Beschrijving

Other,specify

Datatype

text

Completed by
Beschrijving

Completedby

Datatype

text

Date from originally completed
Beschrijving

Datefromoriginallycompleted

Datatype

text

Similar models

No Instruction available.

  1. StudyEvent: CALGB: HOSPITALIZATION FORM
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Ccrr Module For Calgb: Hospitalization Form
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
Item
Reason for hospitalization
text
Code List
Reason for hospitalization
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

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