2. Off Protocol Therapy
AgentEndDate
date
OffTreatmentReason
text
OffTreatmentReason,Other
text
CTCAdverseEventTerm
text
CTCAdverseEventCategory
text
CTCAdverseEventGrade
text
CTCAdverseEventAttributionCode
text
Ncic Ctg Use Only2
TreatmentEndDate
date
Offprotocoltherapycode
text
ProtocolViolation(PV)
text
Coord
text
PhysicianReviewInitials
text
Ncic Ctg Use Only
LoggedEntryInitials
text
LoggedEntryDate
date
CoordinatorReviewInitials
text
CoordinatorReviewDate
date
PhysicianReviewInitials
text
DataEntryInitials
text
DataVerificationInitials
text
Unnamed1
PatientStudyID,CoordinatingGroup
text
PatientInitialsName
text
3. Unblinding
4. Comments
5. Investigator Signature
InvestigatorSignature
text
PersonCompletingForm,LastName
text
FormCompletionDate,Original
date
Ccrr Module For Off Treatment Form