Clinical Form (Form 24-B) Instructions: This form should reflect the status of the patient and disease at randomization. Please submit within one (1) month of randomization. Mark your selection with an ?X? in the appropriate box(es). Use minus one (-1) to indicate that an answer is unknown, unobtainable, or not done.

Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Ccrr Module For Clinical Form (form 24-b)
PatientStudyID,CoordinatingGroup
Item
Patient ID No. (Study No.)
text
Patient Initials
Item
Patient Initials (f m fl sl)
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
PatientBirthDate
Item
Patient's Date of Birth (day)
date
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
ParticipatingCenter/Affiliate
Item
Participating Center/Affiliate
text
ParticipatingGroupCode
Item
Center Code
text
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
Item Group
Initial Data
Item
Race (Non-North American) (Non-North American Centers select one)
text
Code List
Race (Non-North American) (Non-North American Centers select one)
CL Item
White / Caucasian (White / Caucasian)
CL Item
Black (Black)
CL Item
Asian (Asian)
CL106519 (NCI Metathesaurus)
CL Item
Other, Specify (Other, specify)
RaceOther,specify
Item
Other, specify (race) (specify)
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
Item
Race (Ethnicity)
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C17049 (NCI Thesaurus Property)
C0034510 (UMLS 2011AA Property)
Code List
Race (Ethnicity)
CL Item
Native_american_cdus (American Indian or Alaska Native)
CL Item
Asian_cdus (Asian)
CL Item
Black_cdus (Black or African American)
CL Item
Pacific_islander_cdus (Native Hawaiian or other Pacific Islander)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
CL Item
White_cdus (White)
Item
Ethnicity
text
C25372 (NCI Thesaurus ValueDomain)
C0015031 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C16564 (NCI Thesaurus Property)
Code List
Ethnicity
CL Item
A Person Of Mexican, Puerto Rican, Cuban, Central Or South American Or Other Spanish Culture Or Origin, Regardless Of Race. (HISPANIC OR LATINO)
C17459 (NCI Thesaurus)
C0086409 (UMLS 2011AA)
CL Item
A Person Not Meeting The Definition For Hispanic Or Latino. (NOT HISPANIC OR LATINO)
C41222 (NCI Thesaurus)
C1518424 (UMLS 2011AA)
CL Item
Could Not Be Determined Or Unsure (UNKNOWN)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
PatientWeight
Item
Weight (kg)
float
PatientHeight
Item
Height (cm)
float
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25347 (NCI Thesaurus Property)
C0489786 (UMLS 2011AA Property)
Item
Premenopausal determination
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C15491 (NCI Thesaurus Property-2)
C0279752 (UMLS 2011AA Property-2)
Code List
Premenopausal determination
CL Item
Estradiol Levels (Estradiol levels)
CL Item
Patient Did Not Receive Chemotherapy, Patient Menstruating Regularly And Has Not Had Any Hormonal Contraception Or Treatment During The 6 Months Before Randomization (Patient did NOT receive chemotherapy, patient menstruating regularly and has not had any hormonal contraception or treatment during the 6 months before randomization)
Estradiolpmol/L
Item
Estradiol value used to determine eligibility (pmol/L)
text
Dateblooddrawnforthisestradiollevel
Item
Date blood drawn for this estradiol level
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C0521425 (NCI Metathesaurus ObjectClass)
C2295 (NCI Thesaurus Property)
C0014912 (UMLS 2011AA Property)
C37984 (NCI Thesaurus Property-2)
C0022877 (UMLS 2011AA Property-2)
Institutionallowerlimitforpremenopausal
Item
Institutional lower limit for premenopausal (pmol/L)
text
Institutionalupperlimitforpostmenopausal
Item
Institutional upper limit for postmenopausal (pmol/L)
text
PatientMenarcheAgeYear
Item
Age at menarche
float
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C29848 (NCI Thesaurus ValueDomain)
C0439234 (UMLS 2011AA ValueDomain)
C25463 (NCI Thesaurus ValueDomain-2)
C0750480 (UMLS 2011AA ValueDomain-2)
C3228 (NCI Thesaurus Property)
C0025274 (UMLS 2011AA Property)
Dateofstartofthethreerecentmenstrualcyclespriortorandomization,mostrecentfirst
Item
Date of start of the three recent menstrual cycles prior to randomization, most recent first (most recent)
text
Item
Menstruation (select one)
text
Code List
Menstruation (select one)
CL Item
Normal (Normal)
C14165 (NCI Thesaurus)
C0205307 (UMLS 2011AA)
CL Item
Occasionally Irregular Or Lengthened Interval, But Continuing Menstrual Cycles (Irregular)
CL Item
Persistent Amenorrhea (Persistent amenorrhea)
Item
Has the patient had a hysterectomy? (D M Y )
text
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C15256 (NCI Thesaurus ObjectClass)
C0020699 (UMLS 2011AA ObjectClass)
Code List
Has the patient had a hysterectomy? (D M Y )
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes, specify reason(s) performed)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Yes,specifyreason(s)performed(hysterectomy)
Item
Specify reason(s) performed
text
Historyofdiabetes?
Item
History of diabetes?
boolean
Haspatienteverbeenpregnant,regardlessofoutcome?
Item
Has patient ever been pregnant, regardless of outcome?
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
Totalnumberofpregnancies
Item
Total number of pregnancies
text
Numberofsuccessfulpregnancieswhichresultedinatleast1livebirth
Item
Number of successful pregnancies which resulted in at least 1 live birth
text
Numberofearlycompletions
Item
Number of early completions
text
Yearoffirstpregnancy
Item
Year of first pregnancy
text
Yearofmostrecentpregnancy
Item
Year of most recent pregnancy
text
PatientDiagnosisPregnancyInd-2
Item
Was patient pregnant at diagnosis?
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25742 (NCI Thesaurus Property)
C0032961 (UMLS 2011AA Property)
C15220 (NCI Thesaurus Property-2)
C0011900 (UMLS 2011AA Property-2)
Item Group
Primary Disease
Item
Tumor Laterality
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C25251 (NCI Thesaurus ObjectClass-2)
C0205225 (UMLS 2011AA ObjectClass-2)
C25185 (NCI Thesaurus Property)
C0332304 (UMLS 2011AA Property)
Code List
Tumor Laterality
CL Item
Right (Right)
C25228 (NCI Thesaurus)
C0205090 (UMLS 2011AA)
CL Item
Left (Left)
C25229 (NCI Thesaurus)
C0205091 (UMLS 2011AA)
CL Item
Bilateral (Bilateral)
C13332 (NCI Thesaurus)
C0238767 (UMLS 2011AA)
Item
Predominant site of primary right breast/side
text
C25228 (NCI Thesaurus ObjectClass)
C0205090 (UMLS 2011AA ObjectClass)
C12971 (NCI Thesaurus ObjectClass-2)
C0006141 (UMLS 2011AA ObjectClass-2)
C3262 (NCI Thesaurus Property)
C0027651 (UMLS 2011AA Property)
C25341 (NCI Thesaurus Property-2)
C0450429 (UMLS 2011AA Property-2)
C25251 (NCI Thesaurus Property-3)
C0205225 (UMLS 2011AA Property-3)
C13717 (NCI Thesaurus ValueDomain)
C1515974 (UMLS 2011AA ValueDomain)
Code List
Predominant site of primary right breast/side
CL Item
Lateral (Lateral)
C25230 (NCI Thesaurus)
C0205093 (UMLS 2011AA)
CL Item
Medial (Medial)
C25232 (NCI Thesaurus)
C0205098 (UMLS 2011AA)
CL Item
On The Vertical Central Line (On the vertical central line)
CL Item
Other, Specify (Other, specify)
Item
Predominant site of primary left breast/side
text
C25229 (NCI Thesaurus ObjectClass)
C0205091 (UMLS 2011AA ObjectClass)
C12971 (NCI Thesaurus ObjectClass-2)
C0006141 (UMLS 2011AA ObjectClass-2)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C25251 (NCI Thesaurus Property-2)
C0205225 (UMLS 2011AA Property-2)
CL053268 (NCI Metathesaurus Property)
C13717 (NCI Thesaurus ValueDomain)
C1515974 (UMLS 2011AA ValueDomain)
Code List
Predominant site of primary left breast/side
CL Item
Lateral (Lateral)
C25230 (NCI Thesaurus)
C0205093 (UMLS 2011AA)
CL Item
Medial (Medial)
C25232 (NCI Thesaurus)
C0205098 (UMLS 2011AA)
CL Item
On The Vertical Central Line (On the vertical central line)
CL Item
Other, Specify (Other, specify)
Primary Disease Site
Item
Other specify
text
C25685 (NCI Thesaurus ValueDomain)
C0449695 (UMLS CUI-1)
C25341 (NCI Thesaurus Property)
C25251 (NCI Thesaurus ObjectClass)
C2991 (NCI Thesaurus ObjectClass-2)
Primary Disease Site
Item
Other specify
text
C25685 (NCI Thesaurus ValueDomain)
C0449695 (UMLS CUI-1)
C25341 (NCI Thesaurus Property)
C25251 (NCI Thesaurus ObjectClass)
C2991 (NCI Thesaurus ObjectClass-2)
Item Group
Required Clinical Investigations
Item
Chest X-ray or chest CT
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25389 (NCI Thesaurus ObjectClass)
C0817096 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C17261 (NCI Thesaurus ObjectClass-2)
Code List
Chest X-ray or chest CT
CL Item
Abnormal (Abnormal)
C25401 (NCI Thesaurus)
C0205161 (UMLS 2011AA)
CL Item
Normal (Normal)
C14165 (NCI Thesaurus)
C0205307 (UMLS 2011AA)
ChestX-rayresultsdescription
Item
Results
text
Item
Right mammogram (PA and lateral views)
text
Code List
Right mammogram (PA and lateral views)
CL Item
Normal (Normal)
C14165 (NCI Thesaurus)
C0205307 (UMLS 2011AA)
CL Item
Abnormal (Abnormal)
C25401 (NCI Thesaurus)
C0205161 (UMLS 2011AA)
Ipsilateralmammogramresultsdescription
Item
Results
text
Item
Left mammogram (PA and lateral views)
text
C20178 (NCI Thesaurus ValueDomain)
C0024671 (UMLS 2011AA ValueDomain)
C25688 (NCI Thesaurus ValueDomain-2)
C0449438 (UMLS 2011AA ValueDomain-2)
Code List
Left mammogram (PA and lateral views)
CL Item
No Metastases (Normal)
CL Item
Suspicious For Metastases (Abnormal)
Contralateralmammogramresultsdescription
Item
Results
text
Item
Bone Scan
text
Code List
Bone Scan
CL Item
Not Done (Not Done)
CL281691 (NCI Metathesaurus)
CL Item
Normal (Normal)
C14165 (NCI Thesaurus)
C0205307 (UMLS 2011AA)
CL Item
Abnormal (Abnormal)
C25401 (NCI Thesaurus)
C0205161 (UMLS 2011AA)
Ifabnormal,bonescanresultsdescription
Item
Results
text
Ifabnormal,additionaltest(s)toruleoutbonemetastasis.
Item
Additional test(s) to rule out bone metastasis
text
Item
Bone densitometry
text
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C48789 (NCI Thesaurus ObjectClass-2)
C1510486 (UMLS 2011AA ObjectClass-2)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
Code List
Bone densitometry
CL Item
Below Normal (Below Normal)
CL Item
Normal (Normal)
C14165 (NCI Thesaurus)
C0205307 (UMLS 2011AA)
CL Item
Not Done (Not Done)
DualX-rayAbsorptiometryAssessmentPerformedDate
Item
Date performed
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C48789 (NCI Thesaurus ObjectClass-2)
C1510486 (UMLS 2011AA ObjectClass-2)
Item
SGOT (AST)
text
C25202 (NCI Thesaurus Property)
C0242192 (UMLS 2011AA Property)
C20200 (NCI Thesaurus Property-2)
C1274040 (UMLS 2011AA Property-2)
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
Code List
SGOT (AST)
CL Item
Not Done (Not Done)
CL281691 (NCI Metathesaurus)
CL Item
Normal (Normal)
C14165 (NCI Thesaurus)
C0205307 (UMLS 2011AA)
C14165 (NCI Thesaurus-3)
C0205307 (UMLS 2011AA-4)
CL Item
Abnormal (Abnormal)
C25401 (NCI Thesaurus)
C0205161 (UMLS 2011AA)
C25401 (NCI Thesaurus-3)
C0205161 (UMLS 2011AA-4)
Lab,Hepatic,SGOT
Item
SGOT
float
Item
SGPT (ALT)
text
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
C25293 (NCI Thesaurus Property-2)
C0376147 (UMLS 2011AA Property-2)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
Code List
SGPT (ALT)
CL Item
Not Done (Not Done)
CL281691 (NCI Metathesaurus)
CL Item
Normal (Normal)
C14165 (NCI Thesaurus)
C0205307 (UMLS 2011AA)
C14165 (NCI Thesaurus-3)
C0205307 (UMLS 2011AA-4)
CL Item
Abnormal (Abnormal)
C25401 (NCI Thesaurus)
C0205161 (UMLS 2011AA)
C25401 (NCI Thesaurus-3)
C0205161 (UMLS 2011AA-4)
Lab,Hepatic,SGPT
Item
SGPT
float
Item
Alkaline Phosphatase
text
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
C16276 (NCI Thesaurus Property-2)
C0002059 (UMLS 2011AA Property-2)
Code List
Alkaline Phosphatase
CL Item
Not Done (Not Done)
CL281691 (NCI Metathesaurus)
CL Item
Normal (Normal)
C14165 (NCI Thesaurus)
C0205307 (UMLS 2011AA)
C14165 (NCI Thesaurus-3)
C0205307 (UMLS 2011AA-4)
CL Item
Abnormal (Abnormal)
C25401 (NCI Thesaurus)
C0205161 (UMLS 2011AA)
C25401 (NCI Thesaurus-3)
C0205161 (UMLS 2011AA-4)
Lab,Hepatic,AlkalinePhosphatase
Item
Alkaline Phosphatase
float
Item
Bilirubin
text
C25304 (NCI Thesaurus ObjectClass)
C0439810 (UMLS 2011AA ObjectClass)
C305 (NCI Thesaurus ObjectClass-2)
C0005437 (UMLS 2011AA ObjectClass-2)
C13308 (NCI Thesaurus Property)
C0205054 (UMLS 2011AA Property)
C37984 (NCI Thesaurus Property-2)
C0022877 (UMLS 2011AA Property-2)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
Code List
Bilirubin
CL Item
Not Done (Not Done)
CL281691 (NCI Metathesaurus)
CL Item
Normal (Normal)
C14165 (NCI Thesaurus)
C0205307 (UMLS 2011AA)
C14165 (NCI Thesaurus-3)
C0205307 (UMLS 2011AA-4)
CL Item
Abnormal (Abnormal)
C25401 (NCI Thesaurus)
C0205161 (UMLS 2011AA)
C25401 (NCI Thesaurus-3)
C0205161 (UMLS 2011AA-4)
Lab,Hepatic,Bilirubin
Item
Bilirubin
float
Item
Peripheral WBC Count x 10^9/l
text
Code List
Peripheral WBC Count x 10^9/l
CL Item
Not Done (Not Done)
CL281691 (NCI Metathesaurus)
CL Item
Normal (Normal)
C14165 (NCI Thesaurus)
C0205307 (UMLS 2011AA)
CL Item
Abnormal (Abnormal)
C25401 (NCI Thesaurus)
C0205161 (UMLS 2011AA)
Lab,Hematology,WBC
Item
Peripheral WBC Count
float
Item
Peripheral Platelet Count x 10^9/l
text
Code List
Peripheral Platelet Count x 10^9/l
CL Item
Not Done (Not Done)
CL281691 (NCI Metathesaurus)
CL Item
Normal (Normal)
C14165 (NCI Thesaurus)
C0205307 (UMLS 2011AA)
CL Item
Abnormal (Abnormal)
C25401 (NCI Thesaurus)
C0205161 (UMLS 2011AA)
Lab,Hematology,Platelets
Item
Peripheral Platelet Count
float
Item
Hemoglobin g/l
text
Code List
Hemoglobin g/l
CL Item
Not Done (Not Done)
CL281691 (NCI Metathesaurus)
CL Item
Normal (Normal)
C14165 (NCI Thesaurus)
C0205307 (UMLS 2011AA)
CL Item
Abnormal (Abnormal)
C25401 (NCI Thesaurus)
C0205161 (UMLS 2011AA)
Lab,Hematology,Hemoglobin
Item
Hemoglobin
float
Item
Performance status at randomization (Karnofsky 90-100)
text
Code List
Performance status at randomization (Karnofsky 90-100)
CL Item
0 (Fully active, able to carry on all pre-disease performance without restriction)
C0919414 (NCI Metathesaurus)
CL Item
1 (Restricted in physically strenuous activity, but ambulatory)
CL Item
2 (Ambulatory and capable of all selfcare but unable to carry out any work activities (K 50 - 60))
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (Capable of only limited selfcare, confined to bed or chair more than 50% of waking hours (K 30 - 40))
CL Item
4 (Completely disabled)
Item Group
Family History
Item
Any known female blood relative(s) diagnosed with breast cancer or ovarian cancer?
text
Code List
Any known female blood relative(s) diagnosed with breast cancer or ovarian cancer?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Patient Adopted (Patient adopted)
Item
Relative (unnamed)
text
Code List
Relative (unnamed)
CL Item
Mother (Mother)
C25189 (NCI Thesaurus)
C0026591 (UMLS 2011AA)
CL Item
Maternal Grandmother (Maternal grandmother)
CL Item
Paternal Grandmother (Paternal grandmother)
CL Item
Sister(s) (Sister(s))
CL Item
Daughter(s) (Daughter(s))
CL Item
Maternal Aunt(s) (Maternal aunt(s))
CL Item
Paternal Aunt(s) (Paternal aunt(s))
Diagnosedwithbreastcancer
Item
Diagnosed with breast cancer
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
Diagnosedwithovariancancer
Item
Diagnosed with ovarian cancer
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
Agediagnosed
Item
Age diagnosed
text
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
C25150 (NCI Thesaurus ObjectClass)
C0001779 (UMLS 2011AA ObjectClass)
Agediagnosed
Item
Age diagnosed
text
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
C25150 (NCI Thesaurus ObjectClass)
C0001779 (UMLS 2011AA ObjectClass)
PatientRelativeDescriptionTotalNumber
Item
Total number (of relatives)
float
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C21480 (NCI Thesaurus Property)
C0080103 (UMLS 2011AA Property)
C25365 (NCI Thesaurus Property-2)
C0678257 (UMLS 2011AA Property-2)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25304 (NCI Thesaurus ValueDomain-2)
C0439810 (UMLS 2011AA ValueDomain-2)
Numberwithbreastcancer
Item
Number with breast cancer
text
Numberwithovariancancer
Item
Number with ovarian cancer
text
Youngestagediagnosed
Item
Youngest age diagnosed
text
Youngestagediagnosed
Item
Youngest age diagnosed
text
Anyknownmalebloodrelativesdiagnosedwithbreastcancer?
Item
Any known male blood relatives diagnosed with breast cancer?
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
Specifyfamilyrelationship.
Item
Specify family relationship.
text
Investigator Signature
Item
Investigator Signature (/Designee)
text
C25704 (NCI Thesaurus ValueDomain)
C2346576 (UMLS CUI-1)
C25678 (NCI Thesaurus Property)
C17089 (NCI Thesaurus ObjectClass)
Investigator Signature Date
Item
Date
date
C25164 (NCI Thesaurus ValueDomain)
C2346576 (UMLS CUI-1)
C25678 (NCI Thesaurus Property)
C0011008 (UMLS CUI-2)
C25367 (NCI Thesaurus ValueDomain-2)
C17089 (NCI Thesaurus ObjectClass)

Please use this form for feedback, questions and suggestions for improvements.

Fields marked with * are required.

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial