ID
4703
Beschrijving
CALGB: 49903 ADVANCED TREATMENT SUMMARY FORM; All Patients Trastuzumab With or Without Tamoxifen in Treating Women With Progressive Stage IV Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A73D1CA4-8ADF-4761-E034-0003BA0B1A09
Link
Trefwoorden
Versies (2)
- 26-08-12 26-08-12 -
- 20-03-14 20-03-14 - Martin Dugas
Geüploaded op
20 maart 2014
DOI
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Licentie
Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT00053339 Treatment - CALGB: 49903 ADVANCED TREATMENT SUMMARY FORM; All Patients - 2054479v3.0
INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice. Print text in capital letters. Avoid contact with the edges of the boxes. Circle amended items and check "Amended data" box to the right. If submitting by mail, retain a copy for your records and send the original to the CALGB Data Management Center. If faxing, use an original form for maximum clarity in transmission and fax to 919-416-4990. If submitting electronically, click the Send button when you have completed the PDF version of the form.
Beschrijving
IDs
Beschrijving
Patient Name
Datatype
string
Alias
- UMLS CUI
- C1299487
Beschrijving
ParticipatingGroup
Datatype
text
Alias
- NCI Thesaurus ObjectClass
- C17005
- UMLS 2011AA ObjectClass
- C1257890
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
Beschrijving
PatientHospitalNumber
Datatype
text
Beschrijving
ParticipatingGroupProtocolNo.
Datatype
text
Beschrijving
AffiliateName
Datatype
text
Beschrijving
ParticipatingGroupPatientID
Datatype
text
Beschrijving
Treatment Cycle Information
Beschrijving
Drug dose
Datatype
float
Alias
- UMLS CUI
- C0678766
Beschrijving
Agent
Datatype
string
Alias
- UMLS CUI
- C0450442
Beschrijving
OffTreatmentReason
Datatype
string
Alias
- UMLS CUI
- CL436968
Beschrijving
OffTreatmentReason,Other
Datatype
string
Alias
- UMLS CUI
- CL436968
Beschrijving
Treatment Schedule - Systemic Therapy
Beschrijving
Treatment Schedule - Other Therapy
Beschrijving
OptionalProtocolTherapyInd
Datatype
string
Alias
- UMLS CUI
- C1707479
Beschrijving
OptionalProtocolTherapyName
Datatype
string
Alias
- UMLS CUI
- C1707479
Beschrijving
ConcurrentNon-ProtocolTherapyInd
Datatype
string
Alias
- UMLS CUI
- C1707479
Beschrijving
Concomitant Therapy
Datatype
string
Alias
- UMLS CUI
- C1707479
Beschrijving
Comments
Beschrijving
Signature
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INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice. Print text in capital letters. Avoid contact with the edges of the boxes. Circle amended items and check "Amended data" box to the right. If submitting by mail, retain a copy for your records and send the original to the CALGB Data Management Center. If faxing, use an original form for maximum clarity in transmission and fax to 919-416-4990. If submitting electronically, click the Send button when you have completed the PDF version of the form.
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
C1705108 (UMLS 2011AA)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C0205394 (UMLS 2011AA)
C1298908 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0027361 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)