Description:

SOUTHWEST ONCOLOGY GROUP FOLLOW-UP TUMOR ASSESSMENT FORM (S0307) Zoledronate, Clodronate, or Ibandronate in Treating Women Who Have Undergone Surgery for Stage I, Stage II, or Stage III Breast Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=DEB8F801-4279-2F2B-E034-0003BA12F5E7

Link:
https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=DEB8F801-4279-2F2B-E034-0003BA12F5E7
Keywords:
  1. 8/26/12 8/26/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
Uploaded on:

January 9, 2015

DOI:
To request one please log in.
License :
Creative Commons BY-NC 3.0 Legacy
Model comments :

You can comment on the data model here. Via the speech bubbles at the itemgroups and items you can add comments to those specificially.

Itemgroup comments for :

Item comments for :

In order to download data models you must be logged in. Please log in or register for free.

Breast Cancer NCT00127205 Follow-Up - SOUTHWEST ONCOLOGY GROUP FOLLOW-UP TUMOR ASSESSMENT FORM (S0307) - 2277562v3.0

No Instruction available.

  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP FOLLOW-UP TUMOR ASSESSMENT FORM (S0307)
    1. No Instruction available.
Header
Notice Of Progression - Adjuvant
Has the patient been diagnosed with opposite breast cancer since submission of last follow-up form?
Has the patient been diagnosed with first local-regional recurrence since submission of last follow-up form?
Site(s) of First Local-Regional Progression (select all that apply)
Has the patient been diagnosed with first distant recurrence/progression since submission of last follow-up form?
Site(s) of First Distant Progression
If the patient has been previously diagnosed with first distant recurrence/progression at a site other than bone, has the patient been diagnosed with a subsequent bone recurrence since submission of last follow-up form?
How was this progression information obtained?
How was this progression information obtained?
Has the patient had a fracture since submission of the last follow-up form?
indicate site (If yes,)
Was the fracture traumatic (from greater than standing height)?
Has the patient had osteonecrosis or osteomyelitis of the jaw since submission of the last follow-up form?
Comments

Similar models

Please use this form for feedback, questions and suggestions for improvements.

Fields marked with * are required.

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial