Protocol Administration
IRB Approval Date
date
InformedConsentFormSignedDate
date
Treatment Begin Date
date
PatientSignedDischargeMedicalRecordDate
date
InstitutionContactPersonName
text
ContactPersonTelephoneNumber
text
ContactPersonFaxNumber
text
Patient Demographics/pre-treatment Characteristics
Patient Initials
text
Patient Birth Date
date
PatientPersonSocialSecurityNumber
text
Medical Record Number
text
PatientGenderCategory
text
PatientRaceCategory
text
PatientEthnicGroupCategory
text
Patient Demographics/pre-treatment Characteristics2
ECOG Performance Status
text
Patient Height
float
Patient Weight
float
Body Surface Area
float
PatientPaymentType
text
DiseaseDescriptionText
text
BreastTumorStageGroupingStage
text
DiseasesandDisordersPathologyDescriptionText
text
PatientAddressPostalCode
text
PatientAddressCountryName
text
Certification Of Eligibility And Protocol Design
PatientEligibilityIndicator
boolean
Protocol Design
ClinicalStudyProtocolStratificationFactorsType
text
Protocol Treatment Arm
text
Initial Patient Consent For Specimen Use
SpecimenResearchConsentRelatedInd-3
boolean
SpecimenRelatedGeneticResearchConsentInd-2
boolean
PersonSpecimenMalignantNeoplasmResearchConsentInd-2
boolean
PatientOtherDiseaseorDisorderClinicalStudyConsentInd-2
boolean
PatientContactConsentInd-3
boolean
Tissue Procurement Kit
SpecimenSubmissionContactPersonIdentifierName
text
SpecimenSubmissionInstitutionName
text
SpecimenSubmissionInstitutionAddressText
text
SpecimenSubmissionContactPersonTelephoneNumber
text
SpecimenSubmissionContactPersonFaxNumber
text
SpecimenSubmissionContactPersonE-mailAddressText
text
Registration Information
PatientRegistrationDate
date
Trial subject ID CALGB
text
Trial subject ID Participating Group
text
RegisteringPersonIdentifierSignatureName
text