ID
6218
Description
E3F05 Registration Worksheet (step 1) Radiation Therapy With or Without Temozolomide in Treating Patients With Low-Grade Glioma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=612A5FBA-FC8E-B3D3-E040-BB89AD437EF0
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Keywords
Versions (4)
- 12/18/14 12/18/14 - Martin Dugas
- 1/9/15 1/9/15 - Martin Dugas
- 8/4/15 8/4/15 - Martin Dugas
- 9/20/21 9/20/21 -
Uploaded on
December 18, 2014
DOI
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License
Creative Commons BY-NC 3.0 Legacy
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Brain and Central Nervous System Tumors NCT00978458 Eligibility - E3F05 Registration Worksheet (step 1) - 2829054v1.0
No Instruction available.
- StudyEvent: E3F05 Registration Worksheet (step 1)
Description
Race
Description
PatientRaceCategory
Data type
text
Description
Patient Demographics / Pre-treatment Characteristics
Description
PatientSexCode
Data type
text
Description
PatientBirthDate
Data type
date
Description
AddressPostalCodeIdentifier
Data type
text
Description
PatientEthnicGroupCategory
Data type
text
Description
PatientMedicalRecordNumber
Data type
text
Description
PatientSSNNumber
Data type
text
Description
PatientInternationalPaymentType
Data type
text
Description
AttendingPhysicianIdentifierIndividualsName
Data type
text
Description
InstitutionContactPersonName
Data type
text
Description
ProtocolRegistrarName
Data type
text
Description
PatientAddressCountryCode
Data type
text
Description
ResearchCommentsText
Data type
text
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