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Pre-Study Form ×
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Table of contents
  1. 1. Klinisk studie
    1. 1.1. Inkluderande/exkluderande
    1. 1.2. Anamnes
    1. 1.3. Kroppsundersökning
    1. 1.4. Poäng
    1. 1.5. Apparativ diagnostik
    1. 1.6. Laboratorium
    1. 1.7. Patologi och histologi
    1. 1.8. Upplysning/samtycke
    1. 1.9. Terapi
    1. 1.10. Operationsberättelse
    1. 1.11. Oönskad händelse
    1. 1.12. Uppföljning
  2. 2. Rutindokumentation
  3. 3. Register- och kohortstudier
  4. 4. Kvalitetssäkring
  5. 5. Datastandard
  6. 6. Frågeformulär för patienter
  7. 7. Medicinsk specialitet
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Pre-Study - PRIOR RADIATION SUPPLEMENT - 2398684v1.0 - PRIOR RADIATION SUPPLEMENT

- 2021-09-20 - 1 form, 1 itemgroup, 11 items, 1 language
Itemgroup: PRIOR RADIATION SUPPLEMENT
Prior Radiation form for C3D 3.12 Adopters Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FF41EFA1-C05B-5480-E034-0003BA3F9857

Pre-Study - PRIOR SURGERY SUPPLEMENT - 2398212v1.0 - PRIOR SURGERY SUPPLEMENT

- 2021-09-20 - 1 form, 2 itemgroups, 8 items, 1 language
Itemgroups: PRIOR SURGERY SUPPLEMENT, COMMENTS
Prior Surgery form for C3D 3.12 Adopters Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FF2F7B22-5065-707B-E034-0003BA3F9857

Prestudy form NSCLC Stage III NCT00020709

- 2021-09-20 - 1 form, 4 itemgroups, 25 items, 1 language
Itemgroups: SWOG clinical trial administrative data, PATIENT AND DISEASE DESCRIPTION, CURRENT LABORATORY VALUES (SI UNITS), Notes
NCT00020709 S0023: Combination Chemo Plus RT With or Without Gefitinib in Treating Patients With Unresectable Stage III NSCLC Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9CA62D43-4AA8-361C-E034-080020C9C0E0

Lung Cancer NCT00946712 Pre-Study - Southwest Oncology Group S0819 Prestudy Form - 2863901v1.0 - Southwest Oncology Group S0819 Prestudy Form

- 2021-09-20 - 1 form, 8 itemgroups, 72 items, 1 language
Itemgroups: Header Module, PATIENT AND DISEASE DESCRIPTION, PATIENT AND DISEASE DESCRIPTION1, LABORATORY VALUES, LABORATORY VALUES1, ADDITIONAL PRESTUDY DATA, PRIOR TREATMENT RELATED TO THIS CANCER, Comments
Southwest Oncology Group S0819 Prestudy Form Carboplatin and Paclitaxel With or Without Bevacizumab and/or Cetuximab in Treating Patients With Stage IV or Recurrent Non-Small Cell Lung Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=684FE956-5AAF-A7DA-E040-BB89AD432A2B

Lung Cancer NCT00863512 Pre-Study - CALGB 30506 Pre-Study/Surgical Resection Form - 2821782v1.0 - CALGB 30506 Pre-Study/Surgical Resection Form

- 2021-09-20 - 1 form, 9 itemgroups, 46 items, 1 language
Itemgroups: Header Module, Header, Initial Laboratory Values, Smoking Status, Pre-surgical Disease Status, Surgical Disease Status, Planned Treatment, Contact Information, Footer Module
CALGB 30506 Pre-Study/Surgical Resection Form Chemotherapy or Observation in Treating Patients With Early Stage Non-Small Cell Lung Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=5FE8C8A3-6705-BC07-E040-BB89AD4332A8

Pre-Study - BASELINE MEDICAL HISTORY - 2393057v1.0 - BASELINE MEDICAL HISTORY

- 2021-09-20 - 1 form, 2 itemgroups, 5 items, 1 language
Itemgroups: BASELINE MEDICAL HISTORY, COMMENTS
Baseline Medical History form for C3D 3.12 Adopters Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FF0830C9-70C7-12CC-E034-0003BA3F9857

Pre-Study - NCI Standard Participant Identification Template - 2729615v1.0 - NCI Standard Participant Identification Template

- 2021-09-20 - 1 form, 2 itemgroups, 11 items, 1 language
Itemgroups: Conditional Participant ID Questions, Optional Participant ID Questions
The collection of CDEs used in the Participant ID module. Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=46716FCE-3AD1-70D5-E044-0003BA3F9857

Cisplatin and Topotecan Recurrent or Persistent Carcinoma of the Cervix - 103369 - Pre-Treatment Summary Sheet

- 2019-03-14 - 1 form, 5 itemgroups, 41 items, 1 language
Itemgroups: Administrative data, Physical Examination, Laboratory Findings, Measurable Mass, Performance Grade
Study ID: 103369 Clinical Study ID: 103369 Study Title: A Randomized Phase III Study of Cisplatin Versus Cisplatin plus Topotecan Versus MVAC in Stage IVB, Recurrent or Persistent Squamous Cell Carcinoma of the Cervix Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: N/A Sponsor: GlaxoSmithKline Collaborators: N/A Phase: Phase 3 Study Recruitment Status: Completed Generic Name: Topotecan Trade Name: Topotecan Study Indication: Cancer 

Cisplatin and Topotecan Recurrent on Persistent Carcinoma of the Cervix - 103369 - Initial On Study Form

- 2019-03-14 - 1 form, 5 itemgroups, 47 items, 1 language
Itemgroups: Administrative data, Tracking Informaion, Demographic Information, Disease Information, Cancer Therapy
Study ID: 103369 Clinical Study ID: 103369 Study Title: A Randomized Phase III Study of Cisplatin Versus Cisplatin plus Topotecan Versus MVAC in Stage IVB, Recurrent or Persistent Squamous Cell Carcinoma of the Cervix Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: N/A Sponsor: GlaxoSmithKline Collaborators: N/A Phase: Phase 3 Study Recruitment Status: Completed Generic Name: Topotecan Trade Name: Topotecan Study Indication: Cancer 

Pre-Study - BASELINE SYMP - 2393103v1.0 - BASELINE SYMP

- 2019-02-06 - 1 form, 2 itemgroups, 9 items, 1 language
Itemgroups: BASELINE SYMPTOMS, COMMENTS
Baseline Symptoms form for C3D 3.12 Adopters Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FF084994-8361-14D0-E034-0003BA3F9857

Baseline Symptoms

- 2019-02-06 - 1 form, 2 itemgroups, 9 items, 1 language
Itemgroups: Baseline Symptoms, Comments
Baseline Symptoms form for C3D 3.12 Adopters Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FF084994-8361-14D0-E034-0003BA3F9857

A Cross-Over Study of Alcohol Effect on the Pharmacokinetics of Carvedilol - 106904 - Eligibility Question

- 2018-12-13 - 1 form, 2 itemgroups, 5 items, 1 language
Itemgroups: Administrative data, Eligibility Question
Study ID: 106904 Clinical Study ID: CRV106904 Study Title: A Randomized, Open-Label, Single-Dose, Four-Period Cross-Over Study to Determine the Effects of Alcohol on the Pharmacokinetics of Carvedilol CR Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier:  Sponsor: GlaxoSmithKline Collaborators: N/A Phase: Phase 1 Study Recruitment Status: Completed Generic Name: carvedilol Trade Name: Coreg CR,Coreg Study Indication: Hypertension

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