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  1. 1. Clinical Trial
  2. 2. Routine Documentation
  3. 3. Registry/Cohort Study
  4. 4. Quality Assurance
  5. 5. Data Standard
  6. 6. Patient-Reported Outcome
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Breast Cancer NCT00433589 Treatment - Endocrine therapy - 2498727v1.0 - Endocrine therapy

- 1/9/15 - 1 form, 3 itemgroups, 14 items, 1 language
Itemgroups: Header,Endocrine therapy,Footer Module
Endocrine therapy Genetic Testing or Clinical Assessment in Determining the Need for Chemotherapy in Women With Breast Cancer That Involves No More Than 3 Lymph Nodes Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=19677A9A-FFBD-2E6F-E044-0003BA3F9857

Infection Episode

- 9/20/21 - 1 form, 1 itemgroup, 11 items, 1 language
Itemgroup: Infection Episode
Information summarizing episodes of infection associated with treatment. Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=ACFF6F4C-B15B-1776-E040-BB89AD43285B

Esophageal Cancer NCT00655876 Treatment - TF: Radiation Therapy Oncology Group Phase III Esophagus Systemic Treatment Summary Form - 2598533v1.0 - TF: Radiation Therapy Oncology Group Phase III Esophagus Systemic Treatment Summary Form

- 9/27/21 - 1 form, 6 itemgroups, 56 items, 1 language
Itemgroups: MODULE 1,Summary of Systemic Treatment,Summary of Systemic Treatment,Protocol Specific Adverse Events Evaluation,REPORT ALL CONTINUING OR NEW ADVERSE EVENTS,Footer
TF: Radiation Therapy Oncology Group Phase III Esophagus Systemic Treatment Summary Form Paclitaxel, Cisplatin, and Radiation Therapy With or Without Cetuximab in Treating Patients With Locally Advanced Esophageal Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=2A02FE34-6EF5-5B5C-E044-0003BA3F9857

Treatment - Infection Episode - 3277947v1.0 - Infection Episode

- 9/27/21 - 1 form, 1 itemgroup, 11 items, 1 language
Itemgroup: Infection Episode
Information summarizing episodes of infection associated with treatment. Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=ACFF6F4C-B15B-1776-E040-BB89AD43285B

Treatment Summary NSCLC Stage III RTOG NCT00533949

- 9/20/21 - 1 form, 3 itemgroups, 36 items, 1 language
Itemgroups: RTOG clinical trial administrative data,Assessment of Chemotherapy,REPORT ALL CONTINUING OR NEW ADVERSE EVENTS
NCT00533949 TF: Radiation Therapy Oncology Group Phase III High-dose Vs Standard-dose Conformal XRT with Chemotherapy Treatment Summary Form High-Dose or Standard-Dose Radiation Therapy and Chemotherapy With or Without Cetuximab in Treating Patients With Newly Diagnosed Stage III Non-Small Cell Lung Cancer That Cannot Be Removed by Surgery Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=24FB4F78-9A8F-669C-E044-0003BA3F9857

Prior Radiation Supplement

- 9/20/21 - 1 form, 1 itemgroup, 12 items, 1 language
Itemgroup: Prior Radiation Supplement
Details of prior radiation therapy related to the disease being studies by the protocol or when the details would be clinically significant for the evaluation of this study. Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AD011733-7341-F6FC-E040-BB89AD436515

AMC-070 Interventions Form (RK5)

- 9/20/21 - 1 form, 3 itemgroups, 16 items, 1 language
Itemgroups: Header - Interventions Form,Interventions,Comments
AMC-070 Interventions Form (RK5) Lenalidomide in Treating Patients With AIDS-Related Kaposi Sarcoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=91E37C30-3E56-3E5F-E040-BB89AD43368B

AMC-063 Interventions Form (RK5)

- 9/20/21 - 1 form, 3 itemgroups, 16 items, 1 language
Itemgroups: Header - Interventions Form,Interventions,Comments
AMC-063 Interventions Form (RK5) Bortezomib in Treating Patients With Relapsed or Refractory AIDS-Related Kaposi Sarcoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=8163A333-B8CA-35E0-E040-BB89AD435080

ACNS0122 Surgical Checklist Worksheet NCT00047320

- 9/20/21 - 1 form, 7 itemgroups, 22 items, 1 language
Itemgroups: Header,Primary Surgery,REASON FOR SURGERY,CNS PERI-OPERATIVE COMPLICATIONS,POST-OP STEROIDS USED,Comments,CCRR MODULE
ACNS0122 Surgical Checklist Worksheet NCT00047320 Neoadjuvant Chemotherapy With or Without Second-Look Surgery Followed by Radiation Therapy With or Without Peripheral Stem Cell Transplantation in Treating Patients With Intracranial Germ Cell Tumors Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=BD7B6161-4826-29D3-E034-0003BA12F5E7

NCIC-PR.11 Form 6 - Final Report NCT00499174

- 9/20/21 - 1 form, 9 itemgroups, 45 items, 1 language
Itemgroups: Patient Information,Cause of Death,Autopsy,Adverse Event Status,Therapy for Lower Urinary Tract Symptoms/Prostate Cancer since the last report,Other Malignancies or Marrow Dysplasia,Comments,Supporting Documentation,Form Completion
NCIC-PR.11 Form 6 - Final Report NCT00499174 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=0EF82236-51E0-1D54-E044-0003BA3F9857

Symptomatische Osteonekrosen OPAL-Studie DRKS00004421 NCT01619124 ALL - Symptomatische Osteonekrosen OPAL-Studie

- 9/20/21 - 1 form, 6 itemgroups, 75 items, 2 languages
Itemgroups: Allgemeine Angaben,Nichtoperative Therapie - Analgetika,Nichtoperative Therapie - Physikalische Therapie,Nichtoperative Therapie - Medikamentöse Therapie,Operative Therapie - Gelenkerhaltende Therapie,Operative Therapie - Gelenkersatz
Osteonekrosen bei pädiatrischen Patienten mit ALL Studienleitung: Dr. M. Kuhlen, Universitätsklinikum Düsseldorf, Klinik für Kinder-­Onkologie, -­Hämatologie und Klinische Immunologie, Moorenstr. 5, 40225 Düsseldorf, Tel.: 0211 81 17687, Fax: 0211 81 04982, Email: Michaela.Kuhlen@med.uni-duesseldorf.de

CALGB: Thoracic Lymph Node Sampling Report NCT00499330

- 9/20/21 - 1 form, 7 itemgroups, 24 items, 1 language
Itemgroups: Header,Patient demographics,Surgical Approach Right Sided Nodes,Right Sided Nodes,Surgical Approach Left Sided Nodes,Left Sided Nodes,Footer module
CALGB: Thoracic Lymph Node Sampling Report NCT00499330 Comparison of Different Types of Surgery in Treating Patients With Stage IA Non-Small Cell Lung Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=225E819D-890F-6685-E044-0003BA3F9857

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