ID
9229
Description
S0201 Observation Arm Assessment Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A93268F8-DF07-6139-E034-0003BA12F5E7
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Versions (2)
- 9/19/12 9/19/12 -
- 1/9/15 1/9/15 - Martin Dugas
Uploaded on
January 9, 2015
DOI
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License
Creative Commons BY-NC 3.0 Legacy
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Melanoma (Skin) null Toxicity - S0201 Observation Arm Assessment Form - 2055704v3.0
Instructions: Complete at the end of weeks 12, 27, 54, 81. All dates are MONTH, DAY, YEAR. Explain any blank fields or blank dates in a Comments section. Place an X in appropriate boxes. Circle AMENDED items
Description
Disease Status
Description
Adverse Events
Description
Weretoxicitiesassessedforthisreportinginterval?
Data type
boolean
Description
SymptomAssessmentDate
Data type
date
Description
Unnamed3
Data type
text
Description
CTCCode
Data type
text
Description
CTCAdverseEventTerm
Data type
text
Description
CTCAdverseEventGrade
Data type
text
Description
CTCAdverseEventTerm,Other
Data type
text
Description
Comments
Description
Ccrr Module For S0201 Observation Arm Assessment Form
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