Beskrivning:

CALGB: 90104 SPECIMEN SUBMISSION FORM NCT00014534 Combination Chemotherapy in Treating Patients With Bladder Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=E5F4A97F-274E-398C-E034-0003BA3F9857

Länk:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=E5F4A97F-274E-398C-E034-0003BA3F9857

Nyckelord:

D016430

C80.1

D010336

C67

Uppladdad den:

20 september 2021

DOI:

För en begäran logga in.

Licens :

Creative Commons BY-NC 3.0 Legacy

Modellkommentarer :

Här kan du kommentera modellen. Med hjälp av pratbubblor i Item-grupperna och Item kan du lägga in specifika kommentarer.

Tillbaka till modellkommentarer

Itemgroup-kommentar för :

Item-kommentar för :

Du måste vara inloggad för att kunna ladda ner formulär. Var vänlig logga in eller registrera dig utan kostnad.

CALGB: 90104 SPECIMEN SUBMISSION FORM NCT00014534

Detaljer

No Instruction available.

1 Formulär

StudyEvent: CALGB: 90104 SPECIMEN SUBMISSION FORM
1. No Instruction available.

Header

CALGB Form

CALGB Study No

CALGB Patient ID

Are data amended?

Yes

Patient demographics

Patient Initials

Patient Hospital No

Institution/Affiliate

Participating Group

Participating Group Study No

Participating Group Patient ID

SPECIMEN SUBMISSION

Does specimen accompany this form

Yes

Form without specimen, reason

Date specimen collected

Specimen Tissue source (Mark one with an X.)

Primary Tumor (Primary tumor)

Lymph Node Metastasis (Lymph node metastasis)

Specimen collection method (Mark one with an X.)

Biopsy (Biopsy)

Cystectomy (Cystectomy)

Pelvic Lymph Node Dissection (Pelvic lymph node dissection)

Number of blocks submitted

Number of slides submitted

Pathology accession number

LabTrak sample ID (Required of all institutions with access to LabTrak.)

Shipment date

Shipped by

Phone number

LabTrak shipment ID (Required of all institutions with access to LabTrak.)

Tillbaka till toppen

Similar models

Show recommended models