Description:

CALGB: HER-2/neu TESTING 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=0DF2A238-0D66-4C86-E044-0003BA3F9857

Link:
https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=0DF2A238-0D66-4C86-E044-0003BA3F9857
Keywords:
  1. 8/26/12 8/26/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
  3. 7/3/15 7/3/15 -
Uploaded on:

August 26, 2012

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License :
Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT00024102 On-Study - CALGB: HER-2/neu TESTING FORM - 2453404v1.0

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.

Unnamed1
Amended data?
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Unnamed3
Immunohistochemistry Kit or Test Type (Mark all that apply with an X)
Scoring System (Score) (Mark one with an X)
Scoring System (Score) (Mark one with an X)
FISH Assessment Test Type (Mark all that apply with an X)
Ventana Scoring System (Score)
Ventana Scoring System (Score)
Testing Results
HER-2/neu status (Mark one with an Xby institutional standards)
Ccrr Module For Calgb: 49907 Capecitabine Drug Supply Record Form

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