Tracking Informaion
Institution/Affiliate Name
text
Treating Physician
text
Hospital Chart Number
integer
m/d/y
date
Social Security Number
integer
Zip Code
integer
if previously registered
integer
Payment Method
integer
Specify Other
text
Demographic Information
Race
integer
Specify Other
text
Height
integer
Weight
float
(Zubrod)
text
Previous Malignancy
boolean
Site of Previous Malignancy
text
Date of Dx
date
Disease Information
Primary Site
integer
Primary Diagnosis Date
date
FIGO Stage
text
Disease Status at Time of Registration
integer
i.e. Evaluable for response
boolean
Clinical/Radiological Method Measurement
text
clinical history
text
Cancer Therapy
Prior Surgery
boolean
Date
date
Prior Hormonal
boolean
Specify
text
Start Date
date
End Date
date
Prior Radiation
boolean
Specify
text
Start Date
date
End Date
date
Prior Immunological
boolean
Specify
text
Start Date
date
End Date
date
Prior Chemotherapy
boolean
Specify
text
Start Date
boolean
End Date
date
Number of Regimens
integer