Protocol Administration
IRB Approval Date
date
InformedConsentFormSignedDate
date
PatientSignedDischargeMedicalRecordDate
date
InstitutionContactPersonName
text
ContactPersonTelephoneNumber
text
ContactPersonFaxNumber
text
Patient Demographics/pre-treatment Characteristics
Patient Initials
text
Patient Birth Date
date
PatientPersonSocialSecurityNumber
text
Medical Record Number
text
Gender
text
Racial Group
text
Ethnic Group
text
Patient Demographics/pre-treatment Characteristics3
DiseaseDescriptionText
text
DiseaseDescriptionStage
text
DiseasesandDisordersPathologyDescriptionText
text
PatientAddressPostalCode
text
Country of current residence
text
Certification Of Eligibility And Protocol Design
Protocol Design
TissueSpecimenMalignantNeoplasmRelatedResearchConsentInd-3
boolean
PersonSpecimenMalignantNeoplasmResearchConsentInd-2
boolean
BloodTissueSpecimenOtherDiseasesandDisordersResearchConsentInd-3
boolean
Permission to contact Patient
boolean
Registration Information
Trial subject ID CALGB
text
PatientRegistrationDate
date
Trial subject ID Participating Group
text
RegisteringPersonIdentifierSignatureName
text