ID
745
Descrizione
CALGB: PHYSICAL PROBLEMS DUE TO CANCER TREATMENT 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=A50CCBC1-A49F-3714-E034-080020C9C0E0
collegamento
Keywords
versioni (3)
- 26/08/12 26/08/12 -
- 22/05/15 22/05/15 -
- 03/06/15 03/06/15 -
Caricato su
26 agosto 2012
DOI
Per favore, per richiedere un accesso.
Licenza
Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT00024102 Quality of Life - CALGB: PHYSICAL PROBLEMS DUE TO CANCER TREATMENT FORM - 2044292v3.0
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 Data Management Center. 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.
Descrizione
Unnamed2
Descrizione
Patient'sName
Tipo di dati
text
Descrizione
ParticipatingGroup
Tipo di dati
text
Alias
- NCI Thesaurus ObjectClass
- C17005
- UMLS 2011AA ObjectClass
- C1257890
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
Descrizione
PatientHospitalNumber
Tipo di dati
text
Descrizione
ParticipatingGroupProtocolNo.
Tipo di dati
text
Descrizione
MainMemberInstitution/Adjunct
Tipo di dati
text
Descrizione
ParticipatingGroupPatientNo.
Tipo di dati
text
Descrizione
Unnamed3
Descrizione
Unnamed4
Descrizione
Mouthsores
Tipo di dati
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
Descrizione
Skinchanges(suchasrednessorpeeling)onhandsorfeet
Tipo di dati
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
Descrizione
Swellinginhandsorfeet
Tipo di dati
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
Descrizione
Paininhandsorfeet
Tipo di dati
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
Descrizione
whatnumberwouldyousaybestdescribesyourcurrentstatofhealthoverjustthepasttwoweeks?
Tipo di dati
double
Descrizione
Atmost,howmuchtimewouldyouadviseyourfriendtogiveupoutof15yearsinordertoreturntofullhealth?
Tipo di dati
double
Descrizione
Ccrr Module For Calgb: Physical Problems Due To Cancer Treatment Form
Similar models
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 Data Management Center. 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.
C1705108 (UMLS 2011AA)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C0332307 (UMLS 2011AA ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)