Protocol Administration
ProtocolIRBApprovedDate
date
InformedConsentFormSignedDate
date
TreatmentProjectedBeginDate
date
PatientSignedDischargeMedicalRecordDate
date
InstitutionContactPersonName
text
ContactPersonTelephoneNumber
text
ContactPersonFaxNumber
text
Patient Demographics/pre-treatment Characteristics
PatientInitialsName
text
PatientBirthDate
date
PatientPersonSocialSecurityNumber
text
PatientMedicalRecordNumber
text
PatientGenderCategory
text
Patient Demographics/pre-treatment Characteristics2
PatientRaceCategory
text
PatientEthnicGroupCategory
text
PerformanceStatusAssessmentEasternCooperativeOncologyGroupScale
text
PatientHeightMeasurement
double
PatientWeightMeasurement
double
PersonBodySurfaceAreaValue
double
PatientPaymentType
text
Patient Demographics/pre-treatment Characteristics3
DiseaseDescriptionText
text
PatientAddressPostalCode
text
PatientAddressCountryName
text
Certification Of Eligibility And Protocol Design
PatientEligibilityIndicator
text
Protocol Design
HepatitisDescriptionStatus
text
DiseaseInvolvementType
text
ProtocolTreatmentArmAssignmentType
text
Protocol Design
PersonDiagnosticImagingCurrentClinicalTrialConsentIndicator
text
TissueSpecimenMalignantNeoplasmRelatedResearchConsentInd-3
text
BloodSpecimenRelatedGeneticResearchConsentInd-2
text
PersonSpecimenMalignantNeoplasmResearchConsentInd-2
text
BloodTissueSpecimenOtherDiseasesandDisordersResearchConsentInd-3
text
PatientContactConsentInd-3
text
Registration Information
PatientCALGBIdentifierNumber
text
PatientRegistrationDate
date
PatientParticipatingIdentifierNumber
text
RegisteringPersonIdentifierSignatureName
text
Notes:
ClinicalResearchAssociateResponsiblePersonName
text
ClinicalResearchAssociatePersonEmailAddressText
text
ClinicalResearchAssociatePersonTelephoneNumber
text