ID
11610
Beskrivning
CALGB: BACKGROUND INFORMATION FORM NCT00041119 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=A50BF263-C019-2D60-E034-080020C9C0E0
Länk
Nyckelord
Versioner (3)
- 2012-08-26 2012-08-26 -
- 2015-07-08 2015-07-08 -
- 2015-07-08 2015-07-08 -
Uppladdad den
8 juli 2015
DOI
För en begäran logga in.
Licens
Creative Commons BY-NC 3.0 Legacy
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CALGB: BACKGROUND INFORMATION FORM NCT00041119
THANK YOU VERY MUCH FOR YOUR VOLUNTARY PARTICIPATION! PLEASE RETURN TO THE PERSON WHO HANDED YOU THIS FORM.
- StudyEvent: CALGB: BACKGROUND INFORMATION FORM
Beskrivning
Patient demographics
Alias
- UMLS CUI-1
- C1955348
Beskrivning
Patient's Name
Datatyp
text
Alias
- UMLS CUI-1
- C1299487
Beskrivning
Participating Group
Datatyp
text
Alias
- NCI Thesaurus ObjectClass
- C17005
- NCI Thesaurus Property
- C25364
- UMLS CUI-1
- C1257890
- UMLS CUI-2
- C0600091
Beskrivning
Patient Hospital Number
Datatyp
text
Alias
- UMLS CUI-1
- C0421459
Beskrivning
Participating Group Protocol No.
Datatyp
text
Alias
- UMLS CUI-1
- C0008971
- UMLS CUI-2
- C0237753
Beskrivning
Main Member Institution/Adjunct
Datatyp
text
Alias
- UMLS CUI-1
- C0680022
- UMLS CUI-2
- C2607850
Beskrivning
Participating Group Patient No.
Datatyp
text
Alias
- UMLS CUI-1
- C1830427
- UMLS CUI-2
- C0441833
Beskrivning
Social status
Alias
- UMLS CUI-1
- C0699806
Beskrivning
If you do not wish to answer any of the following questions please mark an X here. (1.)
Datatyp
text
Beskrivning
Today's Date (M)
Datatyp
date
Beskrivning
Education level
Datatyp
text
Alias
- UMLS CUI-1
- C3166592
Beskrivning
What is your marital status? (mark one with an X)
Datatyp
text
Alias
- UMLS CUI-1
- C0024819
Beskrivning
With whom do you live? (mark all that apply with an X)
Datatyp
text
Alias
- UMLS CUI-1
- C0020052
- UMLS CUI-2
- C0018677
Beskrivning
Otherrelative,specify(withwhomyoulive)
Datatyp
text
Beskrivning
Other,specify(withwhomyoulive)
Datatyp
text
Beskrivning
Whatisyourcurrentemploymentstatus?
Datatyp
text
Beskrivning
Other,specify(currentemploymentstatus)
Datatyp
text
Beskrivning
Ccrr Module For Calgb: Background Information Form
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THANK YOU VERY MUCH FOR YOUR VOLUNTARY PARTICIPATION! PLEASE RETURN TO THE PERSON WHO HANDED YOU THIS FORM.
- StudyEvent: CALGB: BACKGROUND INFORMATION FORM
C25364 (NCI Thesaurus Property)
C1257890 (UMLS CUI-1)
C0600091 (UMLS CUI-2)
C0237753 (UMLS CUI-2)
C2607850 (UMLS CUI-2)
C0441833 (UMLS CUI-2)
C0870649 (UMLS CUI-1)
C0027952 (UMLS CUI-2)
C0555047 (UMLS CUI-1)
C0086972 (UMLS CUI-1)
C0086170 (UMLS CUI-1)
C0206275 (UMLS CUI-1)
C0018677 (UMLS CUI-2)
C0026193 (UMLS CUI-2)
C3840932 (UMLS CUI-2)
C1880351 (UMLS 2011AA)