Description:

CALGB 90601 Registration Worksheet Gemcitabine Hydrochloride and Cisplatin With or Without Bevacizumab in Treating Patients With Advanced Urinary Tract Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=653F1390-699C-B455-E040-BB89AD4361B9

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=653F1390-699C-B455-E040-BB89AD4361B9

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Versions (3) ▾
  1. 12/18/14
  2. 1/9/15
  3. 1/9/15
Uploaded on:

January 9, 2015

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License:
Creative Commons BY-NC 3.0 Legacy
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Bladder Cancer NCT00942331 Registration - CALGB 90601 Registration Worksheet - 2848728v1.0

No Instruction available.

  1. StudyEvent: CALGB 90601 Registration Worksheet
    1. No Instruction available.
Header Module
Protocol Administration
Patient Demographics/pre-treatment Characteristics
Gender
Race (Mark all that apply)
Ethnicity (Mark one)
Patient Demographics/pre-treatment Characteristics2
Performance Status (ECOG/Zubrod scale)
cm
Kg
m2
Method of Payment (USA only Mark one)
Patient Demographics/pre-treatment Characteristics3
Certification Of Eligibility And Protocol Design
In the opinion of the investigator, is the patient eligible?
Protocol Design
Presence of visceral metastasis
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 specimen use for genetic research relating to the study treatment
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).
My doctor or someone from CALGB may contact me in the future to ask me to take part in more research
Prior Cancer Therapies
Other Prior Therapy
Prior therapy type
Registration Information