Description:

AMC-046 Off-Protocol Treatment Summary Form (F05) Cidofovir in Treating HIV-Infected Patients With High-Grade Squamous Intraepithelial Lesions of the Skin Near the Anus Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=7D8985E5-2F13-08A5-E040-BB89AD434A3B

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=7D8985E5-2F13-08A5-E040-BB89AD434A3B

Keywords:

Clinical Trial

Off-Treatment

Anus Neoplasms

Versions (2) ▾

8/26/12
1/8/15

Uploaded on:

January 8, 2015

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License:

Creative Commons BY-NC 3.0 Legacy

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Anal Cancer NCT00550589 Off Treatment - AMC-046 Off-Protocol Treatment Summary Form (F05) - 2989512v1.0

Details

Please submit this form if the subject has completed study treatment or discontinued study treatment prematurely. Note: Submission of this form DOES NOT mean the subject is necessarily off study. Please check the protocol for any post treatment follow-up requirements

StudyEvent: AMC-046 Off-Protocol Treatment Summary Form (F05)
1. Please submit this form if the subject has completed study treatment or discontinued study treatment prematurely. Note: Submission of this form DOES NOT mean the subject is necessarily off study. Please check the protocol for any post treatment follow-up requirements

Ccrr Module For Off Protocol Treatment Summary - Rf05b

Last Date (any modality of) protocol therapy was given (mm/dd/yyyy)

Reason Treatment Ended (select the primary reason)

Treatment Completed Per Protocol Criteria (Treatment completed per protocol criteria)

Disease Progression, Relapse During Active Treatment (Disease progression, relapse during active treatment)

Adverse Event/side Effects/complications (Adverse Event/Side Effects/Complications)

Death On Study (Death on study)

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