Description:

A0 Form - 1014 Ph II 3D-CRT Recurrent Breast Form Radiation Therapy in Treating Women With Locally Recurrent Breast Cancer Previously Treated With Repeat Breast-Preserving Surgery Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=8876AA44-3947-792F-E040-BB89AD434A3F

Link:
https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=8876AA44-3947-792F-E040-BB89AD434A3F
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Versions (3)
  1. 12/15/14 12/15/14 - Martin Dugas
  2. 1/9/15 1/9/15 - Martin Dugas
  3. 9/17/21 9/17/21 -
Uploaded on:

September 17, 2021

DOI:
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License :
Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT01082211 Demographic - A0 Form - 1014 Ph II 3D-CRT Recurrent Breast Form - 3107774v1.0

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1 forms  
  1. StudyEvent: A0 Form - 1014 Ph II 3D-CRT Recurrent Breast Form
    1. No Instruction available.
Module 1
Has the eligibility checklist been completed
In the opinion of the investigator, is the patient eligible?
Race
3 more items in the detailed view.
Any care at VA or military hospital
Have you obtained the patient's consent for his or her tissue to be used for research to learn about, prevent or treat cancer?
Have you obtained the patient's consent for his or her blood to be kept for use in research to learn about, prevent, treat, or cure cancer?
Have you obtained the patient's consent for his or her tissue to be kept for use research about other health problems (for example: causes of diabetes, Alzheimer's disease, and heart disease)?
Have you obtained the patient's consent for his or her blood to be kept for use research about other health problems (for example: causes of diabetes, Alzheimer's disease, and heart disease)?
Have you obtained the patient's consent for allow someone from this institution to contact him or her in the future to ask him or her to take part in more research
Patient has consented to participate in the cosmesis study
If no, provide reason
Patient has consented to take part in the circulating tumor cell portion of the trial
If no, provide reason
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