Description:

Southwest Oncology Group S0910 Registration Worksheet Form Epratuzumab, Cytarabine, and Clofarabine in Treating Patients With Relapsed or Refractory Acute Lymphoblastic Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=8A5A6B07-2599-04D8-E040-BB89AD435E5E

Link:
https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=8A5A6B07-2599-04D8-E040-BB89AD435E5E
Keywords:
  1. 9/19/12 9/19/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
Uploaded on:

January 9, 2015

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Creative Commons BY-NC 3.0 Legacy
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Leukemia NCT00945815 Registration - Southwest Oncology Group S0910 Registration Worksheet Form - 3116464v1.0

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
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
I agree to have my specimens submitted for MRD Testing.
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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