Description:

NSABP-B-47 Concomitant Medications Form (Form MED) A Randomized Phase III Trial of Adjuvant Therapy Comparing Chemotherapy Alone (Six Cycles of Docetaxel Plus Cyclophosphamide or Four Cycles of Doxorubicin Plus Cyclophosphamide Followed by Weekly Paclitaxel) to Chemotherapy Plus Trastuzumab in Women With Node- Positive or High-Risk Node-Negative HER2-Low Invasive Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=95D01C7E-6ACF-38AE-E040-BB89AD4351B3

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=95D01C7E-6ACF-38AE-E040-BB89AD4351B3

Keywords:
Versions (2) ▾
  1. 8/27/12
  2. 1/9/15
Uploaded on:

January 9, 2015

DOI:
No DOI assigned. To request one please log in.
License:
Creative Commons BY-NC 3.0 Legacy
Model comments:

You can comment on the data model here. Via the speech bubbles at the itemgroups and items you can add comments to those specificially.

Itemgroup comments for:

Item comments for:

In order to download data models you must be logged in. Please log in or register for free.

Breast Cancer NCT01275677 Treatment - NSABP-B-47 Concomitant Medications Form (Form MED) - 3162774v1.0

This paper worksheet may be completed to facilitate the entry of the information in NSABP Coordinator Online. Partially completed online forms may be saved in Coordinator Online. DO NOT SUBMIT THIS WORKSHEET VIA FAX OR MAIL

Header
Unnamed Module 1
Reporting Period
Concomitant Medication
Were concomitant medications used during this reporting period? (metformin, NSAIDs, beta blockers, ace inhibitors, ARBs, diabetes medication, or hypertension medication)
Metformin
Aspirin
Has the patient taken any other medications during this reporting period (If yes, report the names trade name or generic name of both over the counter and prescription medications the patient has taken since submission of the previous form. For the first time point, list all medications taken within 4 weeks of randomization. For patients taking more than 9 other medications, additional rows will be available for entry online. Do not report vitamins or herbal/dietary supplements on this form)
Footer

Similar models