Description:

Cidofovir in Treating HIV-Infected Patients With High-Grade Squamous Intraepithelial Lesions of the Skin Near the Anus NCT00550589 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=7D8985E5-2FE1-08A5-E040-BB89AD434A3B

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=7D8985E5-2FE1-08A5-E040-BB89AD434A3B

Versions (3)
  1. 8/26/12 8/26/12 -
  2. 3/16/15 3/16/15 - Martin Dugas
  3. 9/20/21 9/20/21 -
Uploaded on:

September 20, 2021

DOI:
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License :
Creative Commons BY-NC 3.0 Legacy
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Anal Cancer NCT00550589 On-Study - AMC-046 HPV On-Study Form (ONS) - 2989612v1.0

English
Details

No Instruction available.

1 forms  
  1. StudyEvent: AMC-046 HPV On-Study Form (ONS)
    1. No Instruction available.
Header Module
HIV History
mm/dd/yyyy
CDC HIV Risk Group
mm/dd/yyyy
Prior systemic chemotherapy or radiation therapy
Does the participant have a history of high grade dysplasia
Anal canal
Perianal
Penile
Scrotal
Vulvar
Cervical
Vaginal
Prior Therapy
Prior Treatment? (If "Yes", Check below)
Prior Cautery
Prior trichloroacetic acid (TCA)
mm/dd/yyyy
Prior Surgery
Prior cryotherapy
Prior topical/intralesional therapy
Other Prior Therapy (e.g. Hyperthermia, etc.)
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