ID
10616
Descripción
CALGB: 49903 ADVANCED FOLLOW-UP FORM NCT00053339 Trastuzumab With or Without Tamoxifen in Treating Women With Progressive Stage IV Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A73D2007-5070-476F-E034-0003BA0B1A09
Link
Palabras clave
Versiones (3)
- 26/8/12 26/8/12 -
- 22/5/15 22/5/15 -
- 3/6/15 3/6/15 -
Subido en
3 de junio de 2015
DOI
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Licencia
Creative Commons BY-NC 3.0 Legacy
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CALGB: 49903 ADVANCED FOLLOW-UP FORM NCT00053339
INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice. Print text in capital letters. Avoid contact with the edges of the boxes. Circle amended items and check "Amended data" box to the right. If submitting by mail, retain a copy for your records and send the original to the CALGB Data Management Center. If faxing, use an original form for maximum clarity in transmission and fax to 919-416-4990. If submitting electronically, click the Send button when you have completed the PDF version of the form.
Descripción
Patient clinical trial data
Descripción
Patient'sName
Tipo de datos
text
Descripción
ParticipatingGroup
Tipo de datos
text
Alias
- NCI Thesaurus ObjectClass
- C17005
- UMLS 2011AA ObjectClass
- C1257890
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
Descripción
PatientHospitalNumber
Tipo de datos
text
Descripción
ParticipatingGroupProtocolNo.
Tipo de datos
text
Descripción
AffiliateName
Tipo de datos
text
Descripción
ParticipatingGroupPatientID
Tipo de datos
text
Descripción
Cancer follow up
Descripción
Patient'sVitalStatus
Tipo de datos
text
Descripción
DeathReason
Tipo de datos
text
Descripción
DeathDate/LastContactDate
Tipo de datos
date
Descripción
CancerFollow-upStatusInd
Tipo de datos
text
Descripción
CancerFollow-upStatusDate
Tipo de datos
date
Alias
- NCI Thesaurus ObjectClass
- C2991
- UMLS 2011AA ObjectClass
- C0012634
- NCI Thesaurus Property
- C25365
- UMLS 2011AA Property
- C0678257
Descripción
OverallTumorResponse
Tipo de datos
text
Descripción
ResponseDurationBeginDate
Tipo de datos
date
Alias
- NCI Thesaurus ObjectClass
- C25755
- UMLS 2011AA ObjectClass
- C0871261
- NCI Thesaurus Property
- C25275
- UMLS 2011AA Property
- C2745955
Descripción
ProgressionInd
Tipo de datos
text
Descripción
ProgressionDate
Tipo de datos
date
Descripción
Non-protocol Therapy
Descripción
Non-ProtocolTherapyInd
Tipo de datos
text
Descripción
Non-ProtocolHormonalTherapyInd
Tipo de datos
text
Descripción
OtherNon-ProtocolTherapyName
Tipo de datos
text
Descripción
Non-ProtocolTherapyDate,First
Tipo de datos
date
Descripción
AgentEndDate
Tipo de datos
date
Descripción
Comments
Tipo de datos
text
Descripción
PersonCompletingForm,FirstName
Tipo de datos
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
Descripción
FormCompletionDate,Original
Tipo de datos
date
Descripción
Ccrr Module For Calgb: 49903 Advanced Follow-up Form
Similar models
INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice. Print text in capital letters. Avoid contact with the edges of the boxes. Circle amended items and check "Amended data" box to the right. If submitting by mail, retain a copy for your records and send the original to the CALGB Data Management Center. If faxing, use an original form for maximum clarity in transmission and fax to 919-416-4990. If submitting electronically, click the Send button when you have completed the PDF version of the form.
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
C1705108 (UMLS 2011AA)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C0439673 (UMLS 2011AA)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0012634 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
C0677946 (UMLS 2011AA)
C0871261 (UMLS 2011AA ObjectClass)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0027361 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)