Reset filter
Keywords
Pre-Study Form ×
Show more Keywords
Table of contents
  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
  7. 7. Medical Specialty
Selected data models

You must log in to select data models for download or further analysis.

73 Search results.
Relevance Rating New first Old first

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

- 2/6/19 - 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

Breast Cancer NCT01272037 Pre-Study - S1007 Prestudy Form - Randomized Study (6230) - 3141162v1.0 - S1007 Prestudy Form - Randomized Study (6230)

- 1/9/15 - 1 form, 3 itemgroups, 18 items, 1 language
Itemgroups: Header Module, PATIENT AND DISEASE DESCRIPTION, Comments
S1007 Prestudy Form - Randomized Study (6230) Tamoxifen Citrate, Letrozole, Anastrozole, or Exemestane With or Without Chemotherapy in Treating Patients With Invasive RxPONDER Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=90DE259F-A7AB-E9EB-E040-BB89AD436D98

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

- 9/20/21 - 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 - PRIOR RADIATION SUPPLEMENT - 2398684v1.0 - PRIOR RADIATION SUPPLEMENT

- 9/20/21 - 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

- 9/20/21 - 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

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

- 9/20/21 - 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 - PRIOR THERAPY SUPPLEMENT - 2394210v1.0 - PRIOR THERAPY SUPPLEMENT

- 1/9/15 - 1 form, 2 itemgroups, 11 items, 1 language
Itemgroups: PRIOR THERAPY SUPPLEMENT, COMMENTS
Prior Therapy form for C3D 3.12 Adopters Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FF07B012-CA3F-1CA3-E034-0003BA3F9857

Pre-Study Breast Cancer SWOG S0307 NCT00127205

- 8/26/15 - 1 form, 10 itemgroups, 46 items, 1 language
Itemgroups: Administrative documentation, DISEASE DESCRIPTION, LABORATORY VALUES, CONSENT FOR SUBMISSION AND BANKING, PATIENT CHARACTERISTICS, DISEASE DESCRIPTION, TREATMENT WITH STATINS, PATIENT PREFERENCE, PRIOR TREATMENT RELATED TO THIS CANCER, SYSTEMIC TREATMENT FOR THIS CANCER
SOUTHWEST ONCOLOGY GROUP S0307 PRESTUDY FORM Zoledronate, Clodronate, or Ibandronate in Treating Women Who Have Undergone Surgery for Stage I, Stage II, or Stage III Breast SOUTHWEST ONCOLOGY GROUP S0307 PRESTUDY FORM Zoledronate, Clodronate, or Ibandronate in Treating Women Who Have Undergone Surgery for Stage I, Stage II, or Stage III Breast Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=DEA0B902-CDD3-54E6-E034-0003BA12F5E7

Pre-Study - NCI Standard Registration Template - 2745056v1.0 - NCI Standard Registration Template

- 9/20/12 - 1 form, 3 itemgroups, 18 items, 1 language
Itemgroups: Mandatory Registration Questions, Conditional Registration Questions, Optional Registration Questions
The collection of CDEs used in the registration module. Registration consists of the registering institution applying for entry of a consented participant into a specific research study by conveying designated registration information to a central facility that is in charge of accepting participants into the study. Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=4C056DEC-99CB-35E0-E044-0003BA3F9857

Pre-Study - NCI Standard Enrollment Template - 2745052v1.0 - NCI Standard Enrollment Template

- 9/19/12 - 1 form, 3 itemgroups, 5 items, 1 language
Itemgroups: Mandatory Enrollment Questions, Conditional Enrollment Questions, Optional Enrollment Questions
The collection of CDEs used in the Enrollment module. The enrollment process occurs when the center's registrar receives and reviews the registration information and makes a determination to accept or not accept the application. If the participant is deemed acceptable, the center enrolls the participant in the study and the coordinating center returns a notification to the registering institution indicating that the proposed participant is enrolled. Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=4C051B61-911C-226D-E044-0003BA3F9857

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

- 9/20/21 - 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

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

- 12/13/18 - 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

Help

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