Z6051 Late Complications Form (LCF) Laparoscopic-Assisted Resection or Open Resection in Treating Patients With Stage IIA, Stage IIIA, or Stage IIIB Rectal Cancer Source Form: NCI FormBuilder:

  1. 8/27/12 8/27/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
Uploaded on:

January 9, 2015

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.

Colorectal Cancer NCT00726622 Toxicity - Z6051 Late Complications Form (LCF) - 2718039v1.0

No Instruction available.

  1. StudyEvent: Z6051 Late Complications Form (LCF)
    1. No Instruction available.
Header Module
Instruction Module
Was patient hospitalized during this reporting interval?
Has an Adverse Event Expedited Report been submitted?
Ae Module
CTC AE Attribution Code (see above)
Were any additional adverse events experienced by the patient
Other Ae Module
CTC AE Attribution Code (see above)

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