Description:

NCI COOPERATIVE GROUP Patient Information 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=A9BED937-4416-2507-E034-0003BA12F5E7

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A9BED937-4416-2507-E034-0003BA12F5E7

Keywords:
Versions (2) ▾
  1. 12/18/14
  2. 1/8/15
Uploaded on:

December 18, 2014

DOI:
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License:
Creative Commons BY-NC 3.0 Legacy
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NCI COOPERATIVE GROUP Patient Information FORM (CALGB-90104)

No Instruction available.

  1. StudyEvent: NCI COOPERATIVE GROUP Patient Information FORM (CALGB-90104
    1. No Instruction available.
Mskcc 00-138; Calgb-90104; Ecog
Protocol Administration
Patient Demographics / Pre-treatment Characteristics
Patient Gender
Patient Race/Ethnicity (check one)
Performance Status (check one)
Certification Of Eligibility
In the opinion of the investigator is the patient eligible?
Protocol Design
Primary Tumor Pathological Stage
Number of Nodes Involved By Tumor (check one)
Initial Patient Consent For Specimen Use
Patient?s Initial Consent given for specimen use for research on the patient?s cancer?
Patient?s Initial Consent given for specien use for research unrelated to the patient?s cancer?
Patient?s Initial Consent given for further contact regarding specimen?