Description:

Bilateral Surgery Form (Form 24-BC) Brain Function in Premenopausal Women Receiving Tamoxifen With or Without Ovarian Function Suppression for Early-Stage Breast Cancer on Clinical Trial IBCSG-2402 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=01617880-D901-0B38-E044-0003BA3F9857

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=01617880-D901-0B38-E044-0003BA3F9857

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Versions (2) ▾
  1. 8/26/12
  2. 1/9/15
Uploaded on:

January 9, 2015

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License:
Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT00659373 Pathology - Bilateral Surgery Form (Form 24-BC) - 2408466v1.0

SURGERY FORM (Form 24-C) Instructions: This form is to be completed and submitted one month after final surgery. Mark your selection with an ?X? in the appropriate box(es). Use minus one (-1) to indicate that an answer is unknown, unobtainable, or not done.

Ccrr Module For Surgery Form (form 24-c)
This form is being completed for
Type (LTM = less than mastectomy)
PATHOLOGICAL FINDINGS (CCRR MODULE FOR Surgery Form Form 24-C)
Was sentinel node biopsy performed? (CCRR MODULE FOR Surgery Form Form 24-C)
Was axillary dissection performed? (CCRR MODULE FOR Surgery Form Form 24-C)

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