ID
10637
Descrição
CALGB: 49907 ADJUVANT TREATMENT SUMMARY FORM; Subset of Patients NCT00024102 Comparison of Combination Chemotherapy Regimens in Treating Older Women Who Have Undergone Surgery for Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A50CEAE3-8E50-387D-E034-080020C9C0E0
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Versões (4)
- 26/08/2012 26/08/2012 -
- 22/05/2015 22/05/2015 -
- 03/06/2015 03/06/2015 -
- 03/06/2015 03/06/2015 -
Transferido a
3 de junho de 2015
DOI
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Licença
Creative Commons BY-NC 3.0 Legacy
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CALGB: 49907 ADJUVANT TREATMENT SUMMARY FORM; Subset of Patients NCT00024102
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.
Descrição
Patient demographics
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Patient'sName
Tipo de dados
text
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ParticipatingGroup
Tipo de dados
text
Alias
- NCI Thesaurus ObjectClass
- C17005
- UMLS 2011AA ObjectClass
- C1257890
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
Descrição
PatientHospitalNumber
Tipo de dados
text
Descrição
ParticipatingGroupProtocolNo.
Tipo de dados
text
Descrição
MainMemberInstitution/Adjunct
Tipo de dados
text
Descrição
ParticipatingGroupPatientNo.
Tipo de dados
text
Descrição
Treatment Cycle Information
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Comments
Descrição
Ccrr Module For Calgb: 49907 Adjuvant Treatment Summary Form; Subset Of Patients
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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.
C1705108 (UMLS 2011AA)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C0010583 (UMLS 2011AA)
C0025677 (UMLS 2011AA)
C0016360 (UMLS 2011AA)
C0671970 (UMLS 2011AA)