Header
Patient ID NSABP
text
Patient Initials
Treatment Group
Radiation Therapy Start Date
date
ProtocolTherapyMonthCompleteDate
PatientHospitalizationInd-2
boolean
Adverse Events
AdverseEventCommonTerminologyforAdverseEventsVersion4TermName
AdverseEventSeverityGrade
Other Aes
Comments
Research Comments
Footer
Person Completing Form
Date Form Completed