Description:

NCI Cooperative Group Treatment by Cycle Form-CALGB-90104 Combination Chemotherapy in Treating Patients With Bladder Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A9C01F91-F376-264F-E034-0003BA12F5E7

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A9C01F91-F376-264F-E034-0003BA12F5E7

Keywords:

Clinical Trial

Treatment Form

Urinary Bladder Neoplasms

8/26/12 8/26/12 -
11/28/14 11/28/14 - Martin Dugas

Uploaded on:

November 28, 2014

DOI:

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License :

Creative Commons BY-NC 3.0 Legacy

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Bladder Cancer NCT00014534 Treatment - NCI Cooperative Group Treatment by Cycle Form-CALGB-90104 - 2056083v3.0

Details

No Instruction available.

1 forms

StudyEvent: NCI Cooperative Group Treatment by Cycle Form-CALGB-90104
1. No Instruction available.

Mskcc 00-138; Calgb-90104; Ecog

Coordinating Group Protocol Number

Coordinating Group Code

Protocol Title

Patient Study ID, Coordinating Group

Patient Study ID, Participating Group

Participating Group Code

Institution Name

Affiliate

Patient Last Name (initials acceptable)

Patient First Name (initials acceptable)

Patient Middle Name (initials acceptable)

Form Administration

Person Completing Form, Last Name

Person Completing Form, First Name

Are data amended?

Yes

Treatment Cycles

Current Cycle Number

Cycle Start Date

Chemotherapy Agent Name

Agent Start Date

Agent End Date

Agent Admin Route

Agent Total Dose (per day)

Agent Dose Level

Agent Dose Units

Ccrr Module For Nci Cooperative Group Treatment By Cycle Form-calgb-90104

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