Ccrr Module For Calgb 90202: Prostate Specific Antigen Form
PatientInitialsName
text
PatientMedicalRecordNumber
text
CombinedInstitutionName
text
ParticipatingGroupName
text
ProtocolParticipatingIdentifierNumber
text
PatientParticipatingIdentifierNumber
text
Patient Description
CancerInitialDiagnosisDate
date
MedDRACode
double
FirstAbnormalBoneMarrowPriorMyelodysplasticSyndromeFindingDate
date
PatientAgeValue
double
Leukemia Classification (who/fab)
DiseaseDiagnosisHematopoieticType
text
DiseaseDiagnosisHematopoieticSpecify
text
LeukemiaFrench-American-BritishClassificationCategory
text
LeukemiaFrench-American-BritishClassificationSpecify
text
Clinical Onset Of Aml
ClinicalEtiologyAcuteMyeloidLeukemiaDiagnosisType
text
PriorTherapyMDSLeukemiaAdministeredInd-2
text
PriorChemotherapyMyelodysplasticSyndromeAdministeredInd-2
text
HydroxyureaAgentAdministeredDayCount
double
Extramedullary Disease Involvement
DiseaseExtramedullaryInvolvementSite
text
DiseaseExtramedullaryInvolvementOtherSite
text
LaboratoryProcedureAuerRodsOutcomeStatus
text
AssessmentMethodText
text
Organ Involvement
SplenomegalyPalpationDocumentedInd
text
SplenomegalyImageDocumentedInd
text
HepatomegalyPalpationDocumentedInd
text
HepatomegalyImageDocumentedInd
text
LymphadenopathyPalpationDocumentedInd
text
LymphadenopathyImageDocumentedInd
text
Current Symptoms
InfectionSeverityType
text
AdverseEventHemorrhageSymptomStatus
text
Lab Data At Study Entry
ChestX-RayResultType
text
ChestX-rayResultAbnormalSpecify
text
ChestX-RayAssessmentDate
date
HepaticBilirubinLabValue
double
HepaticBilirubinLabUpperLimitNormalValue
double
CardiacEvaluationDiagnosticProcedure
text
AbnormalElectrocardiographyAdverseEventPresentSpecify
text
DiagnosticElectrocardiogramPerformedDate
date
HeartLVEFTestPercentageValue
double
LeftVentricularEjectionFractionAssessmentType
text
Overall Response
ResponsiblePersonName
text
FormCompleteDate
date