Description:

SOUTHWEST ONCOLOGY GROUP NOTICE OF DEATH Adjuvant Doxorubicin, Cyclophosphamide, and Paclitaxel in Treating Patients With Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A678BEDB-9FFF-50A6-E034-0003BA0B1A09

Link:
https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A678BEDB-9FFF-50A6-E034-0003BA0B1A09
Keywords:
  1. 8/26/12 8/26/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
  3. 7/5/15 7/5/15 -
Uploaded on:

January 9, 2015

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.

Breast Cancer NCT00070564 Follow-Up - SOUTHWEST ONCOLOGY GROUP NOTICE OF DEATH - 2050160v3.0

Instructions: Answer all questions and explain any blank fields or blank dates in the Notes section. Place an X in appropriate boxes. Circle AMENDED items in red.

Header
Unnamed2
Causes Of Death
If cancer was the primary cause or if cancer possibly or definitely contributed to death, and the patient had had multiple tumor types, specify those which were causes of death
Non-cancer and non-treatment related causes (select one)
Non-cancer and non-treatment related causes (select one)
Non-cancer and non-treatment related causes (select one)
Autopsy done?
Death information obtained from (select all that apply)
Notes
Ccrr Module For Southwest Oncology Group Notice Of Death

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