ID
681
Description
CALGB: BACKGROUND INFORMATION 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=A50BF263-C019-2D60-E034-080020C9C0E0
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Versions (2)
- 8/26/12 8/26/12 -
- 7/28/15 7/28/15 - Julian Varghese
Uploaded on
August 26, 2012
DOI
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License
Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT00024102 Demographic - CALGB: BACKGROUND INFORMATION FORM - 2038600v3.0
THANK YOU VERY MUCH FOR YOUR VOLUNTARY PARTICIPATION! PLEASE RETURN TO THE PERSON WHO HANDED YOU THIS FORM.
- StudyEvent: CALGB: BACKGROUND INFORMATION FORM
Description
Unnamed2
Description
Patient'sName
Data type
text
Description
ParticipatingGroup
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C17005
- UMLS 2011AA ObjectClass
- C1257890
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
Description
PatientHospitalNumber
Data type
text
Description
ParticipatingGroupProtocolNo.
Data type
text
Description
MainMemberInstitution/Adjunct
Data type
text
Description
ParticipatingGroupPatientNo.
Data type
text
Description
Unnamed3
Description
IfyoudonotwishtoansweranyofthefollowingquestionspleasemarkanXhere.
Data type
text
Description
Today'sDate
Data type
text
Description
Whatisthehighestgradeyoufinishedinschool?
Data type
text
Description
Whatisyourmaritalstatus?
Data type
text
Description
Withwhomdoyoulive?
Data type
text
Description
Otherrelative,specify(withwhomyoulive)
Data type
text
Description
Other,specify(withwhomyoulive)
Data type
text
Description
Whatisyourcurrentemploymentstatus?
Data type
text
Description
Other,specify(currentemploymentstatus)
Data type
text
Description
Ccrr Module For Calgb: Background Information Form
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THANK YOU VERY MUCH FOR YOUR VOLUNTARY PARTICIPATION! PLEASE RETURN TO THE PERSON WHO HANDED YOU THIS FORM.
- StudyEvent: CALGB: BACKGROUND INFORMATION FORM
C1705108 (UMLS 2011AA)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C0870649 (UMLS 2011AA)
C0086972 (UMLS 2011AA)
C0206275 (UMLS 2011AA)
C1880351 (UMLS 2011AA)