Header
Patient Initials
text
Patient ID NSABP
Institution Name
Affiliate Name
Person Completing Form Last Name
Person Completing Form First Name
Person Completing Form Phone
Data amended
boolean
Unnamed2
Agent Start Date
date
DoseEndDate
Number of Doses, Total
float
TreatmentDiscontinuedType
Other,specify(reasontreatmentended)
AdverseEventEndTreatmentType
Unnamed3
Research Comments