Description:

E3204 Registration Worksheet (step 1) Bevacizumab, Radiation Therapy, and Combination Chemotherapy in Treating Patients Who Are Undergoing Surgery for Locally Advanced Nonmetastatic Rectal Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=74A5ACCC-D9EB-ED2D-E040-BB89AD4358DB

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=74A5ACCC-D9EB-ED2D-E040-BB89AD4358DB

Keywords:
Versions (3) ▾
  1. 8/27/12
  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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Colorectal Cancer NCT00321685 Eligibility - E3204 Registration Worksheet (step 1) - 2946577v1.0

No Instruction available.

  1. StudyEvent: E3204 Registration Worksheet (step 1)
    1. No Instruction available.
Eligibility
Has the eligibility checklist been completed
In the opinion of the investigator, is the patient eligible?
Has written informed consent been obtained
Has HIPAA authorization been obtained
Primary T stage
If an ECOG patient is to receive radiation therapy, will it be given at the registering institution
Race
Patient's Race
Patient Demographics / Pre-treatment Characteristics
Patient's Sex
Patient Ethnicity
Method of payment (check one)
Country of residence

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