Description:

PACCT1 Registration Worksheet (step 1) Hormone Therapy With or Without Combination Chemotherapy in Treating Women Who Have Undergone Surgery for Node-Negative Breast Cancer (The TAILORx Trial) Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=519E7791-5644-1478-E044-0003BA3F9857

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=519E7791-5644-1478-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 NCT00310180 Eligibility - PACCT1 Registration Worksheet (step 1) - 2764542v1.0

No Instruction available.

  1. StudyEvent: PACCT1 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
Was an Oncotype DX assay performed
I agree my tissue will be submitted for research.
I agree to provide additional blood for research.
My specimens may be kept for research about other health problems (for example: causes of diabetes, Alzheimer's disease, and heart disease)
Someone may contact me in the future to ask me to allow other uses of my specimens.
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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