Description:

CALGB: LEUKEMIA TISSUE BANK SPECIMEN ROUTING FORM Leukemia NCT00085124 Pathology - CALGB: LEUKEMIA TISSUE BANK SPECIMEN ROUTING FORM - 2076722v3.0 Daunorubicin and Cytarabine With or Without Oblimersen in Treating Older Patients With Previously Untreated Acute Myeloid Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B229F365-AE89-5149-E034-0003BA12F5E7

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B229F365-AE89-5149-E034-0003BA12F5E7

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Versions (2) ▾
  1. 9/19/12
  2. 7/25/17
Uploaded on:

July 25, 2017

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License:
Creative Commons BY-NC 3.0
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Leukemia Daunorubicin and Cytarabine NCT00085124 CALGB

Instructions: This form is to be completed and submitted with each bone marrow or blood sample drawn for evaluation. Unless otherwise indicated use ?-1? to indicate that and answer is ?unknown,? ?unobtainable,? ?not applicable? or ?not done.? Make 2 copies, send original to reference laboratory with sample; send one copy to CALGB Statistical Center, Data Operations and keep a copy for your records.

Specimen information
Specimen Type
Diagnosis
Sample Period
Sample Extraction Method
Sample Preparation Method
Sample Container
Are the tubes labeled
Pathology Report Submitted to Data Management Center for this Sample Period
Lab Use Only
ml
Sample Storage
Sample Condition
Administrative Data
Amended data

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