Description:

E5103 Registration Worksheet (step 2) Doxorubicin, Cyclophosphamide, and Paclitaxel With or Without Bevacizumab in Treating Patients With Lymph Node-Positive or High-Risk, Lymph Node-Negative Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=4C815F91-A867-3175-E044-0003BA3F9857

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=4C815F91-A867-3175-E044-0003BA3F9857

Keywords:
Versions (3) ▾
  1. 8/26/12
  2. 1/9/15
  3. 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 NCT00433511 Eligibility - E5103 Registration Worksheet (step 2) - 2746746v1.0

No Instruction available.

  1. StudyEvent: E5103 Registration Worksheet (step 2)
    1. No Instruction available.
Eligibility
Has the eligibility checklist been completed
In the opinion of the investigator, is the patient eligible?
Did the patient receive treatment Arm C on step 1 of treatment?
Kg
Do you wish to use an express carrier to ship the drugs (at your expense)?
Name of express carrier
Patient Demographics / Pre-treatment Characteristics
Patient's Sex
Patient Race (check all that applyU.S. and Canada only)
Patient Ethnicity
Method of payment (check one)

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