Description:

E1902 Registration Worksheet (step 1) Reduced-Intensity Regimen Before Donor Bone Marrow Transplant in Treating Patients With Myelodysplastic Syndromes Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=74FABE90-2003-D4A5-E040-BB89AD43500C

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=74FABE90-2003-D4A5-E040-BB89AD43500C

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Versions (2) ▾
  1. 5/25/12
  2. 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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Leukemia NCT00045305 Eligibility - E1902 Registration Worksheet (step 1) - 2950125v1.0

No Instruction available.

  1. StudyEvent: E1902 Registration Worksheet (step 1)
    1. No Instruction available.
Eligibility
Has the eligibility checklist been completed
In the opinion of the investigator, is the patient eligible?
Has written informed consent been obtained
Has HIPAA authorization been obtained
Has donor and/or parent/guardian given signed and dated informed consent as appropriate
Has HIPAA authorization been obtained
Have/will center complete QARC TBI benchmark prior to patients receiving TBI on this protocol
My specimens may be kept for use in research to learn about, prevent, treat, or cure cancer.
My specimens may be kept for use in research about other health problems (for example: diabetes, Alzheimer's disease, or heart disease).
Someone from this institution may contact me in the future to ask me to take part in more research.
Race
Patient's Race
Patient Demographics / Pre-treatment Characteristics
Patient's Sex
Patient Ethnicity
Method of payment (check one)
Country of residence