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Description:

E1900 Cover Page for Adverse Event Form Combination Chemotherapy With or Without Monoclonal Antibody Therapy Followed by Stem Cell Transplant in Treating Patients With Acute Myeloid Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B19AAD35-91C7-25DB-E034-0003BA12F5E7

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B19AAD35-91C7-25DB-E034-0003BA12F5E7

Keywords:

5/25/12 5/25/12 -
1/9/15 1/9/15 - Martin Dugas

Uploaded on:

May 25, 2012

DOI:

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License :

Creative Commons BY-NC 3.0 Legacy

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Leukemia NCT00049517 Toxicity - E1900 Cover Page for Adverse Event Form - 2075062v3.0

No Instruction available.

StudyEvent: E1900 Cover Page for Adverse Event Form
1. No Instruction available.

Unnamed1

DCI Name

Patient Initials

ECOG Protocol Number

ECOG Protocol Number

ECOG Protocol Number

ECOG Patient ID

ECOG Patient ID

Participating Group Protocol No.

Participating Group Patient ID

Institution/Affiliate

On Treatment

On Treatment Time Period

Induction (Induction)

Induction, Additional Forms (Induction, additional Forms)

Consolidation (Consolidation)

Post-transplant (Post-Transplant)

Off Treatment

Off Treatment Time Period

3 Months (3 months)

6 Months (6 months)

9 Months (9 months)

12 Months (12 months)

18 more items in the detailed view.

Ccrr Module For E1900 Cover Page For Adverse Event Form

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