Unnamed2
Patient'sName
text
ParticipatingGroup
text
PatientHospitalNumber
text
ParticipatingGroupProtocolNo.
text
MainMemberInstitution/Affiliate
text
ParticipatingGroupPatientID
text
Patient'sVitalStatus
text
DeathReason
text
DeathReason,Specify
text
Notice Of Progression/relapse
DiseaseRelapseProgressionInd-3
text
Dateprogressiveorrecurrentdiseasediagnosed
text
Site(s)ofprogression/relapse
text
Other,specify(sitesofprogression)
text
ProgressionSite,LymphNodes
text
Stat Use Only
Notice Of New Primary
Hasanewprimarycancerormyelodysplasticsyndrome(MDS)beendiagnosedthathasnotbeenpreviouslyreported?
text
NewPrimaryCancerDate
date
NewPrimarySite
text
CompletedBy
text
DateCompleted
date
Ccrr Module For Calgb: 80101 Follow-up/relapse Form