ID
9194
Beschrijving
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
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Versies (2)
- 19-09-12 19-09-12 -
- 09-01-15 09-01-15 - Martin Dugas
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9 januari 2015
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Licentie
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.
Beschrijving
Treatment Phase Information
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Leukemia Treatment Plan
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ProtocolTreatmentInd
Datatype
boolean
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TreatmentFirstDoseBeginDate
Datatype
date
Beschrijving
TotalCourseNumber
Datatype
float
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TreatmentLastDoseEndDate
Datatype
date
Beschrijving
AgentTotalDose
Datatype
float
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AgentTotalDose
Datatype
float
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AgentTotalDose
Datatype
float
Beschrijving
OffTreatmentReason
Datatype
text
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OffTreatmentReason,Other
Datatype
text
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DoseModification(Change)
Datatype
text
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DoseModificationReason
Datatype
text
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CompletedBy
Datatype
text
Beschrijving
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)
C25416 (NCI Thesaurus Property)
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)
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