Description:

AMC-061 Baseline Evaluation Form (B61) Sunitinib Malate in Treating HIV-Positive Patients With Cancer Undergoing Highly Active Antiretroviral Therapy Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=715BD918-9168-2975-E040-BB89AD434610

Link:
https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=715BD918-9168-2975-E040-BB89AD434610
Keywords:
  1. 8/26/12 8/26/12 -
  2. 5/20/15 5/20/15 - Martin Dugas
Uploaded on:

August 26, 2012

DOI:
To request one please log in.
License :
Creative Commons BY-NC 3.0 Legacy
Model comments :

You can comment on the data model here. Via the speech bubbles at the itemgroups and items you can add comments to those specificially.

Itemgroup comments for :

Item comments for :

In order to download data models you must be logged in. Please log in or register for free.

Brain and Central Nervous System Tumors NCT00890747 On-Study - AMC-061 Baseline Evaluation Form (B61) - 2933416v1.0

Complete this form at baseline only

  1. StudyEvent: AMC-061 Baseline Evaluation Form (B61)
    1. Complete this form at baseline only
Visit Number
Unnamed2
Disease status
Hematopoietic Diagnosis
If diffuse large B-cell lymphoma, specify morphologic type
If Burkitt lymphoma/leukemia, specify morphologic type
Kaposi's Sarcoma Assessment
Does the patient have >=50 cutaneous lesions
Are there any oral cavity lesions present
Is there visceral disease
Hematologic Malignancy Assessment
Hematologic diagnosis
Acute Lymphoblastic Leukemia
Acute Myeloid Leukemia
Chronic Lymphoid Leukemia
Chronic Myeloproliferative Disease
Leukemia Miscellaneous
Comments

Similar models

Please use this form for feedback, questions and suggestions for improvements.

Fields marked with * are required.

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial