Description:

CALGB: Secondary Malignancy Form 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=A73D10AA-19A6-4733-E034-0003BA0B1A09

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A73D10AA-19A6-4733-E034-0003BA0B1A09

Keywords:
Versions (2) ▾
  1. 8/26/12
  2. 3/20/14
Uploaded on:

March 20, 2014

DOI:
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License:
Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT00053339 Follow-Up - CALGB: Secondary Malignancy Form - 2029264v3.0

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. Do not leave any entries blank. Enter -1 to indicate that an answer in unknown, unobtainable, not applicable, or not done. Retain a copy for your records and submit ORIGINAL to the CALGB Data Management Center.

Amended data?
Has FDA Form 3500 (MEDWATCH) or NCI/CTEP Secondary AML/MDS Form been sent to Central Office?

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