Description:

Advanced Bladder/Urothelial Cancer - Follow-Up Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=99CD59C5-A976-3FA4-E034-080020C9C0E0

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=99CD59C5-A976-3FA4-E034-080020C9C0E0

Keywords:
Versions (3) ▾
  1. 9/19/12
  2. 1/9/15
  3. 1/9/15
Uploaded on:

January 9, 2015

DOI:
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License:
Creative Commons BY-NC 3.0 Legacy
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Follow-Up - Advanced Bladder/Urothelial Cancer - Follow-Up Form - 2019343v2.31

No Instruction available.

  1. StudyEvent: Advanced Bladder/Urothelial Cancer - Follow-Up Form
    1. No Instruction available.
Crf Header
Breast: Form Administration
Are data amended (If data are amended, please circle in red when using paper form)
Bladder/urothelial: Vital Status
Patient Vital Status
Primary Cause of Death (check one)
Bladder/urothelial: Disease Follow-up Status
Has the patient had a documented clinical assessment for this cancer? (since submission of the previous follow-up form)
Bladder/urothelial: Notice Of Progression
Has the patient been diagnosed with a local recurrence (non-nodal site) (that has not been previously reported)
Site of First Local Progression (s - mark all that apply)
Has the patient been diagnosed with a local-regional lymph node recurrence that has not been previously reported
Site of First Local-Regional Lymph Node Progression (s - mark all that apply)
Has the patient been diagnosed with a distant metastatic progression that has not been previously reported
Progression Site, First Distant
Bladder/urothelial: Notice Of New Primary
New Primary Cancer Ind
Bladder/urothelial: Long-term Toxicity
Late Adverse Event Ind
Late Adverse Event Term
Allows Documentation Of Any Additional Cooments

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