ID
6183
Beschreibung
CALGB: 49907 CAPECITABINE DRUG SUPPLY RECORD FORM 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=A50CE624-6F5F-37E3-E034-080020C9C0E0
Link
Stichworte
Versionen (2)
- 19.04.12 19.04.12 -
- 16.12.14 16.12.14 - Martin Dugas
Hochgeladen am
16. Dezember 2014
DOI
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Lizenz
Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT00024102 Transmittal - CALGB 49907 CAPECITABINE DRUG SUPPLY RECORD FORM 2044684_v3_0
INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice. Print text in capital letters. Avoid contact with the edges of the boxes. Circle amended items and check "Amended data" box to the right. If submitting by mail, retain a copy for your records and send the original to the CALGB Statistical Center, Data Operations. If faxing, use an original form for maximum clarity in transmission and fax to 919-416-4990. If submitting electronically, click the Send button when you have completed the PDF version of the form.
Beschreibung
Medication
Alias
- UMLS CUI-1
- C0013227
Beschreibung
Dailycapecitabinedose
Datentyp
double
Beschreibung
Numberof500mgtabletsprescribedtobetakeneachday
Datentyp
double
Beschreibung
Numberof500mgtabletsissued
Datentyp
double
Beschreibung
Dateandtimetheelectronicdevicewasplacedonthevial
Datentyp
text
Beschreibung
Nameofthepersonwhofilledthevial
Datentyp
text
Beschreibung
DateandTimepillcountwasdone
Datentyp
text
Beschreibung
Howmany500mgtabletsreturned
Datentyp
double
Beschreibung
Dateandtimetheelectronicdevicewasremovedfromthevial
Datentyp
text
Beschreibung
Nameofthepersonwhoperformedthereturnpillcount
Datentyp
text
Beschreibung
CompletedBy
Datentyp
text
Beschreibung
DateCompleted
Datentyp
date
Ähnliche Modelle
INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice. Print text in capital letters. Avoid contact with the edges of the boxes. Circle amended items and check "Amended data" box to the right. If submitting by mail, retain a copy for your records and send the original to the CALGB Statistical Center, Data Operations. If faxing, use an original form for maximum clarity in transmission and fax to 919-416-4990. If submitting electronically, click the Send button when you have completed the PDF version of the form.
C0011008 (UMLS 2011AA ValueDomain)
C1705108 (UMLS 2011AA)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)