Description:

S0927 REGISTRATION WORKSHEET Omega-3-Fatty Acid Supplements in Treating Muscle and Bone Pain and Stiffness in Patients With Stage I, Stage II, or Stage III Breast Cancer Receiving Hormone Therapy Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B1B9094A-B2F6-CBEC-E040-BB89AD435D64

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B1B9094A-B2F6-CBEC-E040-BB89AD435D64

Keywords:
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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Arthralgia NCT01385137 Registration - S0927 REGISTRATION WORKSHEET - 3303246v1.0

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
Stratification Question
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
I agree for my blood to be used in the additional studies.
Unnamed 7
Has the SWOG Registration Worksheet been completed entirely and is the patient eligible according to the current version of protocol section 5.0?