ID
6183
Descrição
CALGB: 49907 CAPECITABINE DRUG SUPPLY RECORD FORM Comparison of Combination Chemotherapy Regimens in Treating Older Women Who Have Undergone Surgery for Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A50CE624-6F5F-37E3-E034-080020C9C0E0
Link
Palavras-chave
Versões (2)
- 19/04/2012 19/04/2012 -
- 16/12/2014 16/12/2014 - Martin Dugas
Transferido a
16 de dezembro de 2014
DOI
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Licença
Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT00024102 Transmittal - CALGB 49907 CAPECITABINE DRUG SUPPLY RECORD FORM 2044684_v3_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 Statistical Center, Data Operations. 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.
Descrição
Medication
Alias
- UMLS CUI-1
- C0013227
Descrição
Dailycapecitabinedose
Tipo de dados
double
Descrição
Numberof500mgtabletsprescribedtobetakeneachday
Tipo de dados
double
Descrição
Numberof500mgtabletsissued
Tipo de dados
double
Descrição
Dateandtimetheelectronicdevicewasplacedonthevial
Tipo de dados
text
Descrição
Nameofthepersonwhofilledthevial
Tipo de dados
text
Descrição
DateandTimepillcountwasdone
Tipo de dados
text
Descrição
Howmany500mgtabletsreturned
Tipo de dados
double
Descrição
Dateandtimetheelectronicdevicewasremovedfromthevial
Tipo de dados
text
Descrição
Nameofthepersonwhoperformedthereturnpillcount
Tipo de dados
text
Descrição
CompletedBy
Tipo de dados
text
Descrição
DateCompleted
Tipo de dados
date
Similar models
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 Statistical Center, Data Operations. 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.
C0011008 (UMLS 2011AA ValueDomain)
C1705108 (UMLS 2011AA)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)