Description:

Southwest Oncology Group S0941 Registration Worksheet Form Sorafenib Tosylate and Erlotinib Hydrochloride in Treating Patients With Locally Advanced, Unresectable, or Metastatic Gallbladder Cancer or Cholangiocarcinoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=8229FCFE-E5C8-63E1-E040-BB89AD43798D

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=8229FCFE-E5C8-63E1-E040-BB89AD43798D

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Versions (2) ▾
  1. 9/19/12
  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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Extrahepatic Bile Duct Cancer NCT01093222 Registration - Southwest Oncology Group S0941 Registration Worksheet Form - 3028434v1.0

INSTRUCTIONS: All of the information on this Registration Worksheet and the Protocol Eligibility Section must be answered appropriately for a patient to be considered eligible for registration. This Registration Worksheet must be entirely filled out and referred to during the registration. Do NOT submit this worksheet as part of the patient data.

Header
Swog Patient Id
SWOG Patient ID Status
Demography
Unnamed2
Unnamed5
Unnamed4
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 may contact me in the future to ask me to allow other uses of my specimens.
I agree to allow my study doctor, or someone approved by my study doctor, to contact me regarding future research involving my participation in this study
Unnamed 7
Has the Southwest Oncology Group Registration Worksheet been completed entirely and is the patient eligible according to the current version of protocol section 5.0

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