Information:
Error:
ID
9403
Description
PATHOLOGY SUBMISSION REPORT Quality Of Life Companion Study For JMA27 (NCIC-MA.27): A Randomized Phase III Trial Of Exemestane Versus Anastrozole With Or Without Celecoxib In Postmenopausal Women With Receptor Positive Primary Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=ABE248E1-B493-53AD-E034-0003BA12F5E7
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Keywords
Versions (2)
- 8/26/12 8/26/12 -
- 1/9/15 1/9/15 - Martin Dugas
Uploaded on
January 9, 2015
DOI
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License
Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT00090974 Transmittal - PATHOLOGY SUBMISSION REPORT - 2059549v3.0
To be submitted with Form 1 - Eligibility Checklist and Initial Evaluation within 6 weeks of randomization
- StudyEvent: PATHOLOGY SUBMISSION REPORT
Similar models
To be submitted with Form 1 - Eligibility Checklist and Initial Evaluation within 6 weeks of randomization
- StudyEvent: PATHOLOGY SUBMISSION REPORT
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
PatientStudyID,CoordinatingGroup
Item
Patient Study ID, Coordinating Group (NCIC CTG Patient Serial Number)
text
Patient Initials
Item
Patient Initials (first - middle - last)
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
PatientMedicalRecordNumber
Item
Patient Medical Record Number
text
InvestigatorName
Item
Investigator Name
text
InstitutionName
Item
Institution Name
text
RegisteredInvestigator
Item
Registered Investigator (NCI Investigator #)
text
SpecimenCollectionDate
Item
Specimen Collection Date - Pathology (yyyy mmm dd)
date
AddressPathologyInstitutionName
Item
Pathology Institution Name (at which the pathology specimens are held)
text
AddressPathologyDepartment
Item
Address: Dept./Building
text
AddressPathologyStreet
Item
Street name and Number
text
Address,City
Item
City
text
AddressPathologyProvince
Item
State/Province
text
AddressPathologyCountry
Item
Country
text
AddressPathologyPostalCode
Item
Postal Code
text
PathologistName,Reviewing
Item
Reviewing Pathologist (Diagnosing Pathologists)
text
SpecimenID
Item
Specimen ID number (Pathology accession number #)
float
Comments
Item
COMMENTS
text
InvestigatorSignature
Item
Investigator Signature
text
C25678 (NCI Thesaurus Property)
C1519316 (UMLS 2011AA Property)
C17089 (NCI Thesaurus ObjectClass)
C0035173 (UMLS 2011AA ObjectClass)
C1519316 (UMLS 2011AA Property)
C17089 (NCI Thesaurus ObjectClass)
C0035173 (UMLS 2011AA ObjectClass)
PersonCompletingForm,LastName
Item
Person Completing Form, Last Name
text
PersonCompletingForm,FirstName
Item
Person Completing Form, First Name
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C0027361 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
FormCompletionDate,Original
Item
Form Completion Date, Original (yyyy mmm dd)
date