Description:

E1305 Registration Worksheet (step 1) Chemotherapy With or Without Bevacizumab in Treating Patients With Recurrent or Metastatic Head and Neck Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=4D9A0B72-1D0D-5E28-E044-0003BA3F9857

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=4D9A0B72-1D0D-5E28-E044-0003BA3F9857

Keywords:
Versions (3) ▾
  1. 9/19/12
  2. 1/9/15
  3. 9/17/21
Uploaded on:

September 17, 2021

DOI:
No DOI assigned. To request one please log in.
License:
Creative Commons BY-NC 3.0 Legacy
Model comments:

You can comment on the data model here. Via the speech bubbles at the itemgroups and items you can add comments to those specificially.

Back to model comments
Itemgroup comments for:

Item comments for:

In order to download data models you must be logged in. Please log in or register for free.

Head and Neck Cancer NCT00588770 Eligibility - E1305 Registration Worksheet (step 1) - 2750715v1.0

Details

No Instruction available.

  1. StudyEvent: E1305 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
Planned Chemotherapy Regimen
ECOG Performance Status
Prior Radiation Therapy to head and neck
Weight Loss in Previous Six Months
I agree to participate in the laboratory research studies that are being done as part of this clinical trial.
My specimens may be kept for use in research to learn about, prevent, treat, or cure cancer.
My specimens may be kept for use in research about other health problems (for example: causes of diabetes, Alzheimer's disease, or heart disease). (for example: causes of diabetes, Alzheimer's disease, and heart disease)
Someone from this institution may contact me in the future to ask me to take part in more research.
Back to the top of the page 

Similar models