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Informations:
Erreur:
ID
752
Description
SOUTHWEST ONCOLOGY GROUP SPECIMEN SUBMISSION FORM Adjuvant Doxorubicin, Cyclophosphamide, and Paclitaxel in Treating Patients With Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A678B75B-66D7-50A2-E034-0003BA0B1A09
Lien
Mots-clés
Versions (3)
- 26/08/2012 26/08/2012 -
- 09/01/2015 09/01/2015 - Martin Dugas
- 22/03/2015 22/03/2015 - Martin Dugas
Téléchargé le
26 août 2012
DOI
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Licence
Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT00070564 Pathology - SOUTHWEST ONCOLOGY GROUP SPECIMEN SUBMISSION FORM - 2046468v3.0
No Instruction available.
- StudyEvent: SOUTHWEST ONCOLOGY GROUP SPECIMEN SUBMISSION FORM
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- StudyEvent: SOUTHWEST ONCOLOGY GROUP SPECIMEN SUBMISSION FORM
Name
Type
Description | Question | Decode (Coded Value)
Type de données
Alias
SWOGPatientID
Item
SWOG Patient No.
text
SWOGStudyNo.
Item
TREATMENT STUDY NO.
text
RegType
Item
Reg Type
text
PatientInitialsName
Item
Patient Initials (L, F, M)
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25536 (NCI Thesaurus Property)
C1555582 (UMLS 2011AA Property)
C1547383 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25536 (NCI Thesaurus Property)
C1555582 (UMLS 2011AA Property)
Disease
Item
Disease
text
MainMemberInstitution/Affiliate
Item
Institution/Member
text
RegisteredInvestigator
Item
Physician
text
ContactPersonatInstitution
Item
Contact Person at Institution
text
C21541 (NCI Thesaurus ObjectClass)
C0018704 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25461 (NCI Thesaurus ObjectClass)
C0337611 (UMLS 2011AA ObjectClass)
C0018704 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25461 (NCI Thesaurus ObjectClass)
C0337611 (UMLS 2011AA ObjectClass)
PhoneNumber
Item
Telephone No. (Groups other than SWOG)
double
ParticipatingGroupName
Item
Group Name
text
Particip.GroupProtocolNumber
Item
Study No.
double
PatientStudyID,ParticipatingGroup
Item
Pt. No.
text
CL Item
Tubes Of Blood (Tubes of blood)
CL Item
Tubes Of Bone Marrow (Tubes of bone marrow)
CL Item
Tubes Of Serum (Tubes of serum)
CL Item
Tissue, Specify Site(s) (Tissue, specify site(s))
CL Item
Slides, Type And Number (Slides, type and number)
CL Item
Karyotype(s), Number (Karyotype(s), number)
CL Item
Other, Specify (Other, specify)
SpecimenSite
Item
Tissue, specify site(s)
text
CL Item
Fresh (fresh)
CL Item
Frozen (frozen)
CL267638 (NCI Metathesaurus)
CL Item
Fixed (paraffin embedded)
Slides,typeandnumber
Item
Slides, type and number
text
KaryotypeCount
Item
Karyotype(s), number
double
SpecimenCellSource,Other
Item
Other, specify
text
SpecimenCollectionDate
Item
Date specimen collected (month, day, year)
date
SpecimenCollectionTime
Item
Time specimen collected (Check all that apply)
date
CL Item
Prestudy Specimen (Prestudy specimen)
CL Item
Complete Remission/response Specimen (Complete remission/response specimen)
CL Item
Relapse/recurrence Specimen (Relapse/recurrence specimen)
CL Item
Other Specimen, Specify (Other specimen, specify)
Otherspecimen,specify
Item
Other specimen, specify
text
SWOGStudyNo.
Item
TREATMENT STUDY NO.
text
PersonCompletingForm,LastName
Item
By
text
FormCompletionDate,Original
Item
Date
date
Comments
Item
Notes from central laboratory
text
Centrallaboratoryidentificationnumber
Item
Central laboratory identification number
text
SpecimenReceivedDate
Item
Date specimen received
date
SpecimenReceivedTime
Item
Time specimen received
date
CL Item
Useable (usable as received)
CL Item
not usable as received; adequate submission (not usable as received; adequate submission)
CL Item
not usable as received; inadequate submission (not usable as received; inadequate submission)
CL Item
Damaged Or Unusable (Damaged or unusable)
CL Item
No Specimen Received (No specimen received)
PersonCompletingForm,LastName
Item
By
text
FormCompletionDate,Original
Item
Date
date
Comments
Item
Notes from central laboratory
text