Description:

CALGB 90104 Registration Worksheet-Rev Combination Chemotherapy in Treating Patients With Bladder Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=BE1B0F83-6C73-6D73-E034-0003BA12F5E7

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=BE1B0F83-6C73-6D73-E034-0003BA12F5E7

Keywords:
Versions (3) ▾
  1. 8/26/12
  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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Bladder Cancer NCT00014534 Registration - CALGB 90104 Registration Worksheet-Rev - 2169333v3.0

No Instruction available.

  1. StudyEvent: CALGB 90104 Registration Worksheet-Rev
    1. No Instruction available.
Initial Patient Consent For Specimen Use
Patient?s Initial Consent given for specimen use for research on the patient?s cancer?
Patient?s Initial Consent given for specien use for research unrelated to the patient?s cancer?
Patient?s Initial Consent given for further contact regarding specimen?
Ccrr Module For Calgb 90104 Registration Worksheet-rev
Gender
Race
cm
Kg
Method of Payment
T status
Lymph node involvement (check one)