Race
Racial Group
text
Person Completing Form, Last Name
PatientPaymentType
text
Ethnic Group
text
PatientAddressCountryCode
text
Country of current residence
text
PatientAddressPostalCode
text
Receptor Status
ERLevelTumorStatus
text
PgRStatusType
text
Treatment
BreastNeoplasmNuclearGradeCategory
text
HormoneTherapyPlanAdministrationInd-2
boolean
Patient Characteristics
Patient Height
float
Patient Weight
float
Unnamed4
InformedConsentFormSignedDate
date
Permission to contact Patient
boolean
PatientPHIConsentIndicator
text
Eligibility for trial
boolean
SpecimenNationalSurgicalAdjuvantBreastandBowelProjectCentralLaboratoryIdentifierNumber
text
Determination Of Pre-entry Menopausal Status
BilateralOophorectomyPerformedInd-2
boolean
MensesEndOccurrenceInd-3
boolean
HysterectomyAdvancedReproductionAgePerformedInd-2
boolean
HysterectomyFluorescenceinsituHybridizationPerformedInd-2
boolean
PatientPostMenopauseIndicator
boolean
LastMenstrualCycleOnsetDate
date
Footer Module
Person Completing Form
text
Date Form Completed
date
Patient ID NSABP
text