Protocol Administration
ProtocolIRBApprovedDate
date
InformedConsentFormSignedDate
date
TreatmentProjectedBeginDate
date
PatientSignedDischargeMedicalRecordDate
date
InstitutionContactPersonName
text
ResponsiblePersonPhoneNumber
text
ResponsiblePersonFaxNumber
text
Patient Demographics/pre-treatment Characteristics
PatientInitialsName
text
PatientBirthDate
date
PatientPersonSocialSecurityNumber
text
PatientMedicalRecordNumber
text
PatientGenderCategory
text
PatientRaceCategory
text
PatientEthnicGroupCategory
text
Patient Demographics/pre-treatment Characteristics2
PatientAddressPostalCode
text
PatientAddressCountryName
text
Certification Of Eligibility And Protocol Design
PatientEligibilityIndicator
text
PatientQualityofLifeConsentInd-2
text
Initial Patient Consent For Specimen Use
SpecimenResearchConsentRelatedInd-3
text
BloodTissueSpecimenOtherDiseasesandDisordersResearchConsentInd-3
text
PatientContactConsentInd-3
text
Registration Information
PatientRegistrationDate
date
PatientCALGBIdentifierNumber
text
PatientParticipatingIdentifierNumber
text
RegisteringPersonIdentifierSignatureName
text