Protocol Administration
IRB Approval Date
date
InformedConsentFormSignedDate
date
Treatment Begin Date
date
PatientSignedDischargeMedicalRecordDate
date
InstitutionContactPersonName
text
ContactPersonTelephoneNumber
text
ContactPersonFaxNumber
text
Patient Demographics/pre-treatment Characteristics
Patient Initials
text
Patient Birth Date
date
PatientPersonSocialSecurityNumber
text
Medical Record Number
text
Gender
text
Racial Group
text
Ethnic Group
text
Patient Demographics/pre-treatment Characteristics2
ECOG Performance Status
text
PatientPaymentType
text
Patient Demographics/pre-treatment Characteristics3
DiseaseDescriptionText
text
PatientAddressPostalCode
text
Country of current residence
text
Certification Of Eligibility And Protocol Design
Protocol Design
ClinicalResearchAssociateResponsiblePersonName
text
ClinicalResearchAssociatePersonTelephoneNumber
text
ClinicalResearchAssociatePersonEmailAddressText
text
Registration Information
PatientRegistrationDate
date
Trial subject ID CALGB
text
Trial subject ID Participating Group
text
RegisteringPersonIdentifierSignatureName
text