ID
801
Descripción
CALGB: 40101 TREATMENT SUMMARY SUBSET FORM Four Versus Six Cycles of Cyclophosphamide/Doxorubicin or Paclitaxel in Adjuvant Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A46C8094-22BA-26B0-E034-080020C9C0E0
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Versiones (2)
- 26/8/12 26/8/12 -
- 24/4/15 24/4/15 - Martin Dugas
Subido en
26 de agosto de 2012
DOI
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Licencia
Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT00041119 Treatment - CALGB: 40101 TREATMENT SUMMARY SUBSET FORM - 2037407v3.0
INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice. Print text in capital letters. Avoid contact with the edges of the boxes. Circle amended items and check "Amended data" box to the right. If submitting by mail, retain a copy for your records and send the original to the CALGB Statistical Center, Data Operations. If faxing, use an original form for maximum clarity in transmission and fax to 919-416-4990. If submitting electronically, click the Send button when you have completed the PDF version of the form.
Descripción
Unnamed2
Descripción
Patient'sName
Tipo de datos
text
Descripción
ParticipatingGroup
Tipo de datos
text
Alias
- NCI Thesaurus ObjectClass
- C17005
- UMLS 2011AA ObjectClass
- C1257890
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
Descripción
PatientHospitalNumber
Tipo de datos
text
Descripción
ParticipatingGroupProtocolNo.
Tipo de datos
text
Descripción
MainMemberInstitution/Adjunct
Tipo de datos
text
Descripción
ParticipatingGroupPatientNo.
Tipo de datos
text
Descripción
Unnamed3
Descripción
Unnamed4
Descripción
Totaldosageforthiscycle,Doxorubicin
Tipo de datos
text
Descripción
Totaldosageforthiscycle,Cyclophosphamide
Tipo de datos
text
Descripción
Totaldosageforthiscycle,Paclitaxel
Tipo de datos
text
Descripción
Doseadjustments
Tipo de datos
text
Descripción
Reasonforadjustment
Tipo de datos
text
Descripción
Specify(reasonforadjustment)
Tipo de datos
text
Descripción
Unnamed5
Descripción
Ccrr Module For Calgb: 40101 Treatment Summary Subset Form
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INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice. Print text in capital letters. Avoid contact with the edges of the boxes. Circle amended items and check "Amended data" box to the right. If submitting by mail, retain a copy for your records and send the original to the CALGB Statistical Center, Data Operations. If faxing, use an original form for maximum clarity in transmission and fax to 919-416-4990. If submitting electronically, click the Send button when you have completed the PDF version of the form.
C1705108 (UMLS 2011AA)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C0237753 (UMLS 2011AA ValueDomain)
C0392756 (UMLS 2011AA)
C0205394 (UMLS 2011AA)