Description:

E3F05 Registration Worksheet (step 0) Radiation Therapy With or Without Temozolomide in Treating Patients With Low-Grade Glioma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=6129B720-53B3-074C-E040-BB89AD436AFD

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=6129B720-53B3-074C-E040-BB89AD436AFD

Keywords:
Versions (3) ▾
  1. 12/18/14
  2. 1/9/15
  3. 1/9/15
Uploaded on:

January 9, 2015

DOI:
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License:
Creative Commons BY-NC 3.0 Legacy
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Brain and Central Nervous System Tumors NCT00978458 Eligibility - E3F05 Registration Worksheet (step 0) - 2828702v1.0

Details

No Instruction available.

  1. StudyEvent: E3F05 Registration Worksheet (step 0)
    1. No Instruction available.
Eligibility
Has the eligibility checklist been completed
In the opinion of the investigator, is the patient eligible?
Has written informed consent been obtained
Has HIPAA authorization been obtained
I agree to donate additional blood for research.
My specimens may be kept for use in research to learn about, prevent, treat, or cure cancer.
My specimens may be kept for research about other health problems (for example: causes of diabetes, Alzheimer's disease, and heart disease)
Someone may contact me in the future to ask me to allow other uses of my specimens.
Race
Race (check all that apply)
3 more items in the detailed view.
Patient Demographics / Pre-treatment Characteristics
Patient's Sex
Patient Ethnicity
Method of payment (check one)
8 more items in the detailed view.
Country of Residence (if not USA)
243 more items in the detailed view.
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