ID
6183
Descrizione
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
collegamento
Keywords
versioni (2)
- 19/04/12 19/04/12 -
- 16/12/14 16/12/14 - Martin Dugas
Caricato su
16 dicembre 2014
DOI
Per favore, per richiedere un accesso.
Licenza
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.
Descrizione
Medication
Alias
- UMLS CUI-1
- C0013227
Descrizione
Dailycapecitabinedose
Tipo di dati
double
Descrizione
Numberof500mgtabletsprescribedtobetakeneachday
Tipo di dati
double
Descrizione
Numberof500mgtabletsissued
Tipo di dati
double
Descrizione
Dateandtimetheelectronicdevicewasplacedonthevial
Tipo di dati
text
Descrizione
Nameofthepersonwhofilledthevial
Tipo di dati
text
Descrizione
DateandTimepillcountwasdone
Tipo di dati
text
Descrizione
Howmany500mgtabletsreturned
Tipo di dati
double
Descrizione
Dateandtimetheelectronicdevicewasremovedfromthevial
Tipo di dati
text
Descrizione
Nameofthepersonwhoperformedthereturnpillcount
Tipo di dati
text
Descrizione
CompletedBy
Tipo di dati
text
Descrizione
DateCompleted
Tipo di dati
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)