Description:

Cisplatin, Fluorouracil, Cetuximab, and Radiation Therapy in Treating Patients With HIV and Stage I, Stage II, or Stage III Anal Cancer NCT00324415 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=72873427-47DC-3052-E040-BB89AD43686C

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=72873427-47DC-3052-E040-BB89AD43686C

8/26/12 8/26/12 -
3/14/15 3/14/15 - Martin Dugas

Uploaded on:

March 14, 2015

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Creative Commons BY-NC 3.0 Legacy

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Anal Cancer NCT00324415 On-Study - AMC-045 History of AIDS Defining Disease Form (F03) - 2937261v1.0

Details

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1 forms

StudyEvent: AMC-045 History of AIDS Defining Disease Form (F03)
1. No Instruction available.

Header Module

Visit number

History of AIDS Defining Disease

Date of Evaluation

mm/dd/yyyy

History of opportunistic diseases and predisposing disease

Yes

Disease Type

Candidiasis Of Bronchi, Trachea Or Lungs (Candidiasis of bronchi, trachea or lungs)

Candidiasis, Esophageal (Candidiasis, esophageal)

Cervical Cancer (Cervical cancer, invasive)

20 more items in the detailed view.

Disease status (Please select the disease status of the diseases listed)

Active (Currently active)

Present (Ever present)

Never Present (Never present)

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