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ID
2730
Description
Concomitant Medications Excluding Antiretroviral Therapy - RF09 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=CCE1D9E3-15E5-4307-E034-0003BA12F5E7
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Versions (2)
- 9/19/12 9/19/12 -
- 8/29/17 8/29/17 -
Uploaded on
September 19, 2012
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License
Creative Commons BY-NC 3.0 Legacy
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Sarcoma, Kaposi xxx Treatment - Concomitant Medications Excluding Antiretroviral Therapy - RF09 - 2266246v3.0
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- StudyEvent: Concomitant Medications Excluding Antiretroviral Therapy - RF09
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- StudyEvent: Concomitant Medications Excluding Antiretroviral Therapy - RF09
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Ccrr Module For Concomitant Medications Excluding Antiretroviral Therapy - Rf09
PatientInitials
Item
Patient Initials
text
Study#
Item
Study#
text
Site#
Item
Site#
text
ID#
Item
ID#
text
Cycle#
Item
Cycle #
text
Firstdayofcycle
Item
First day of cycle
text
Item
During this cycle, has the subject started or stopped any medications?
text
CL Item
Yes (Yes)
CL Item
No (No)
Medication(GenericNameOnly)
Item
Medication (Generic Name Only)
text
ACTGDrugCode
Item
ACTG Drug Code
text
Amount
Item
Amount
text
Units
Item
Units
text
Frequency(perday)
Item
Frequency (per day)
text
CL Item
Yes (Yes)
CL Item
No (No)
DateStarted
Item
Date Started
text
CL Item
Yes (Yes)
CL Item
No (No)
DateStopped
Item
Date Stopped
text