Quality of Life Cover Sheet GOG-0204 Comparison of Four Combination Chemotherapy Regimens Using Cisplatin in Treating Patients With Stage IVB, Recurrent, or Persistent Cancer of the Cervix Source Form: NCI FormBuilder:


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January 9, 2015

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Cervical Cancer NCT00064077 Quality of Life - Quality of Life Cover Sheet GOG-0204 - 2079938v3.0

GOG Form QCS204.doc (11/12/2002)

  1. StudyEvent: Quality of Life Cover Sheet GOG-0204
    1. GOG Form QCS204.doc (11/12/2002)
Module 1
Scheduled time to obtain Quality of Life Questionnaire and cover sheet
Module 2
Was QoL Questionnaire completed?
Please indicate reason (If no, check one)
Where was questionnaire administered (If yes,)
Module 3
If questionnaire was completed, did patient require assistance
Module 4
Ccrr Module For Quality Of Life Cover Sheet Gog-0204

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