ID
9194
Descripción
CALGB: 10201 Treatment FORM Daunorubicin and Cytarabine With or Without Oblimersen in Treating Older Patients With Previously Untreated Acute Myeloid Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AD83D624-B33F-3003-E034-0003BA12F5E7
Link
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Versiones (2)
- 19/9/12 19/9/12 -
- 9/1/15 9/1/15 - Martin Dugas
Subido en
9 de enero de 2015
DOI
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Licencia
Creative Commons BY-NC 3.0 Legacy
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Leukemia NCT00085124 Treatment - CALGB: 10201 Treatment FORM - 2031608v3.0
Instructions: Complete and submit thie form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice. Print text in capital letters. Avoid contact with the edges of the boxes. Cirlce amended items and check "Amended data" box to teh right. If submitting by mail, retain a copy for your records and send the original form for mazimum clarity in transmission and fax to 919-416-4990. If submistting electronically, click the Send button when you have completed the PDF version of the form.
Descripción
Treatment Phase Information
Descripción
Leukemia Treatment Plan
Descripción
ProtocolTreatmentInd
Tipo de datos
boolean
Descripción
TreatmentFirstDoseBeginDate
Tipo de datos
date
Descripción
TotalCourseNumber
Tipo de datos
float
Descripción
TreatmentLastDoseEndDate
Tipo de datos
date
Descripción
AgentTotalDose
Tipo de datos
float
Descripción
AgentTotalDose
Tipo de datos
float
Descripción
AgentTotalDose
Tipo de datos
float
Descripción
OffTreatmentReason
Tipo de datos
text
Descripción
OffTreatmentReason,Other
Tipo de datos
text
Descripción
DoseModification(Change)
Tipo de datos
text
Descripción
DoseModificationReason
Tipo de datos
text
Descripción
CompletedBy
Tipo de datos
text
Descripción
Ccrr Module For Calgb: 10201 Treatment Form
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Instructions: Complete and submit thie form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice. Print text in capital letters. Avoid contact with the edges of the boxes. Cirlce amended items and check "Amended data" box to teh right. If submitting by mail, retain a copy for your records and send the original form for mazimum clarity in transmission and fax to 919-416-4990. If submistting electronically, click the Send button when you have completed the PDF version of the form.
C1511726 (UMLS 2011AA ObjectClass)
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C1691222 (UMLS 2011AA Property)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C0205394 (UMLS 2011AA)
C1298908 (UMLS 2011AA)