Description:

Southwest Oncology Group S0931 Tumor Specimen Processing Form (Form #55588) Everolimus in Treating Patients With Kidney Cancer Who Have Undergone Surgery Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=7E26DCC6-D28C-5564-E040-BB89AD433E24

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=7E26DCC6-D28C-5564-E040-BB89AD433E24

Keywords:

Laboratories

Clinical Trial

Kidney Neoplasms

Versions (2) ▾

9/19/12
1/9/15

Uploaded on:

January 9, 2015

DOI:

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License:

Creative Commons BY-NC 3.0 Legacy

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Kidney Cancer NCT01120249 Lab - Southwest Oncology Group S0931 Tumor Specimen Processing Form (Form #55588) - 3000274v1.0

Details

Instructions: SWOG institutions, please submit this form within 7 days of registration. All dates are MONTH, DAY, YEAR. Explain any blank fields or blank dates in the Comments section. Place an X in appropriate boxes. Circle AMENDED items in red and write AMENDED across top of form

StudyEvent: Southwest Oncology Group S0931 Tumor Specimen Processing Form (Form #55588)
1. Instructions: SWOG institutions, please submit this form within 7 days of registration. All dates are MONTH, DAY, YEAR. Explain any blank fields or blank dates in the Comments section. Place an X in appropriate boxes. Circle AMENDED items in red and write AMENDED across top of form

Header

SWOG Patient ID

SWOG Study No.

Registration Step

Patient Initials (L, F M)

Institution/Affiliate

Physician

Participating Group Name

Participating Group Study No.

Participating Group Patient ID

Tumor Specimen Processing

Surgery Date (MM DD YYYY)

Date of tissue fixation (MM DD YYYY)

Elapsed time from surgical clamp of blood supply to fixation (min)

Mark an 'X' if unknown

Was the fixation performed within 20 minutes of the surgical clamp of blood supply (If the exact minutes are unknown,)

No (no)

Unknown (unknown)

Yes (yes)

Specimen Fixative

Formalin (Formalin)

Other (Other)

Other, specify

Duration of fixation (hrs)

Comments

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