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Fallopian Tube Cancer NCT00108745 Treatment - Treatment Completion Form, GOG-0212, Form Q0 - 2296418v3.0 - Treatment Completion Form, GOG-0212, Form Q0

- 08.01.15 - 1 Formular, 5 Itemgruppen, 19 Datenelemente, 1 Sprache
Itemgruppen: HEADER MODULE, TREATMENT SCHEDULE, OFF-TREATMENT REASON, COMMENTS, FOOTER MODULE
Treatment Completion Form, GOG-0212, Form Q0 Paclitaxel or Polyglutamate Paclitaxel or Observation in Treating Patients With Stage III or Stage IV Ovarian Epithelial or Peritoneal Cancer or Fallopian Tube Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=E7489B50-2644-4BC6-E034-0003BA3F9857

Off Treatment - Off Treatment - 3278673v1.0 - Off Treatment

- 08.01.15 - 1 Formular, 1 Itemgruppe, 9 Datenelemente, 1 Sprache
Itemgruppe: Off Treatment
Information concerning the patient's off treatment date, reason and best response to treatment. Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AD006CC7-CD06-B0A3-E040-BB89AD437A16

Treatment - E2906 Leukemia Treatment Form - Observation (Arm C) - 2949093v1.0 - E2906 Leukemia Treatment Form - Observation (Arm C)

- 08.01.15 - 1 Formular, 8 Itemgruppen, 24 Datenelemente, 1 Sprache
Itemgruppen: Header Module, Reporting Period, Header, Treatment Period, Vital Status, Patient Characteristics, Non-Protocol Therapy, Footer Module
E2906 Treatment Form - Observation (Arm C)Not longer part of CRF set 4/13/10 version Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=74CEC72C-CCC3-2C0E-E040-BB89AD4367D1

Sarcoma, Kaposi xxx Off Treatment - Off Protocol Treatment Summary - RF05B - 2266924v3.0 - Off Protocol Treatment Summary - RF05B

- 08.01.15 - 1 Formular, 1 Itemgruppe, 8 Datenelemente, 1 Sprache
Itemgruppe: CCRR MODULE
Off Protocol Treatment Summary - RF05B Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=CCE2A45C-D0F7-48EE-E034-0003BA12F5E7

Sarcoma, Kaposi xxx Treatment - Concomitant Antiretroviral Medications - RF08 - 2266224v3.0 - Concomitant Antiretroviral Medications - RF08

- 08.01.15 - 1 Formular, 1 Itemgruppe, 16 Datenelemente, 1 Sprache
Itemgruppe: CCRR MODULE
Concomitant Antiretroviral Medications - RF08 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=CCE1D5AB-D35E-42F6-E034-0003BA12F5E7

Breast Cancer NCT00513292 Treatment - Z1041: End of Intervention Period Form - 2533589v1.0 - Z1041: End of Intervention Period Form

- 08.01.15 - 1 Formular, 3 Itemgruppen, 13 Datenelemente, 1 Sprache
Itemgruppen: Header Module, Header, Footer Module
Z1041: End of Intervention Period Form Combination Chemotherapy and Paclitaxel Plus Trastuzumab in Treating Women With Palpable Breast Cancer That Can Be Removed by Surgery Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=211D4CFE-8742-4C95-E044-0003BA3F9857

Treatment - Head and Neck Cancers - Treatment Summary Form - 2268818v3.0 - Head and Neck Cancers - Treatment Summary Form

- 08.01.15 - 1 Formular, 9 Itemgruppen, 95 Datenelemente, 1 Sprache
Itemgruppen: CRF Header, Head & Neck: Patient Treatment Assessment, Head & Neck: Treatment Plan, Head & Neck: Surgical Treatment, Head & Neck: Treatment Summary - Radiation Therapy, Head & Neck: Treatment Summary - Chemotherapy Concurrent with Radiation Therapy, Head & Neck: Treatment Summary - Systemic Therapy, Head & Neck: Supportive Care Assessment, Head & Neck: Treatment Schedule - Non-Protocol Cancer Therapy
Head and Neck Cancers - Treatment Summary Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=D496F3F7-A64E-62CE-E034-0003BA12F5E7

Off Treatment - Phase II Breast Cancer - End of Treatment Summary Form - 2583167v1.0 - Phase II Breast Cancer - End of Treatment Summary Form

- 08.01.15 - 1 Formular, 7 Itemgruppen, 26 Datenelemente, 1 Sprache
Itemgruppen: CRF Header, Form Administration, Breast: Treatment Plan , Breast: Treatment Schedule ¿ Systemic Therapy, Breast: Treatment Schedule ¿ Radiation Therapy , Breast: Off-Study Follow-up, Comments
Phase II Breast Cancer - End of Treatment Summary Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=2588598D-D8D0-1B66-E044-0003BA3F9857

Treatment - Phase II Breast Cancer - Adjuvant Treatment Summary Form - All Patients - 2583736v1.0 - Phase II Breast Cancer - Adjuvant Treatment Summary Form - All Patients

- 08.01.15 - 1 Formular, 6 Itemgruppen, 26 Datenelemente, 1 Sprache
Itemgruppen: CRF Header, Breast: Form Administration, Breast: Treatment Plan, Breast: Treatment Schedule - Systemic Therapy, Breast: Treatment Schedule - Other Therapy, Comments
Phase II Breast Cancer - Adjuvant Treatment Summary Form - All Patients Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=25A33C64-E547-43BB-E044-0003BA3F9857

Off Treatment - Phase II Lung Cancer - End of Treatment Summary Form - 2404726v1.0 - Phase II Lung Cancer - End of Treatment Summary Form

- 08.01.15 - 1 Formular, 7 Itemgruppen, 30 Datenelemente, 1 Sprache
Itemgruppen: CRF Header, Form Administration, Lung: Treatment Plan , Lung: Treatment Schedule - Systemic Therapy, Lung: Treatment Schedule - Radiation Therapy , Lung: Off-Study Follow-up, Comments
Phase II Consortium - Phase II Lung Cancer - End of Treatment Summary Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=00974A58-3367-1106-E044-0003BA3F9857

TREATMENT AND RESPONSE SUMMARY FORM Breast Cancer (NCT00390455)

- 08.01.15 - 1 Formular, 5 Itemgruppen, 48 Datenelemente, 1 Sprache
Itemgruppen: Header, lapatinib/placebo, Fluvestrant, Laboratory Values, Response Assessment
CALGB 40302 TREATMENT AND RESPONSE SUMMARY FORM (SUBSET OF PATIENTS) Fulvestrant With or Without Lapatinib in Treating Postmenopausal Women With Stage III or Stage IV Breast Cancer That is Hormone Receptor-Positive NCT00390455 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=F5BC1727-9755-553F-E034-0003BA3F9857

TREATMENT FORM Breast Cancer (NCT00770809)

- 08.01.15 - 1 Formular, 6 Itemgruppen, 47 Datenelemente, 1 Sprache
Itemgruppen: Header, Bevacizumab/placebo, Paclitaxel, Trastuzumab, Lapatinib, MUGA Results
CALGB 40601 TREATMENT FORM Paclitaxel and Trastuzumab With or Without Lapatinib in Treating Patients With Stage II or Stage III Breast Cancer That Can Be Removed by Surgery NCT00770809 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=3A0519D7-D7F7-3073-E044-0003BA3F9857

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