Form Administration
ProtocolIRBApprovedDate
date
InformedConsentFormSignedDate
date
ConsentFormSignedEndDate
date
TreatmentProjectedBeginDate
date
PatientRegistrationDate
date
PatientSignedDischargeMedicalRecordDate
date
FormCompleteDate
date
ResponsiblePersonLastName
text
ResponsiblePersonFirstName
text
ResponsiblePersonPhoneNumber
text
ResponsiblePersonFaxNumber
text
Patient Demographics / Pre-treatment Characteristics
PatientName
text
PatientBirthDate
date
PatientGenderCategory
text
PatientRaceCategory
text
PatientEthnicGroupCategory
text
PatientSSNNumber
double
PatientAddressPostalCode
text
PatientAddressCountryName
text
PatientHeightMeasurement
double
PatientWeightMeasurement
double
PatientBodySurfaceAreaMeasurement
double
PerformanceStatusAssessmentEasternCooperativeOncologyGroupScale
text
KarnofskyPerformanceStatusScore
text
PatientPaymentType
text
Certification Of Eligibility
PatientEligibilityIndicator
text
Protocol Design
StudyStratificationText
text
TreatmentArmNumber
text
TreatmentAssignmentCode
text
AgentNSC/GPIIdentifierNumber
text
AgentName
text
AgentAdministeredDose
double
AgentDoseUOM
text
Drug Administration Route
text
AgentAdministeredFrequency
text
TherapeuticAgentsAdministeredScheduleText
text
Initial Patient Consent For Specimen Use
SpecimenResearchConsentRelatedInd-3
text
BloodTissueSpecimenOtherDiseasesandDisordersResearchConsentInd-3
text
PatientContactConsentInd-3
text
SpecimenICFSignedDate
date