ID

9404

Description

NSABP PROTOCOL B-39: Chemotherapy Report Radiation Therapy in Treating Women Who Have Undergone Surgery For Ductal Carcinoma In Situ or Stage I or Stage II Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=E6F98A67-4163-1881-E034-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=E6F98A67-4163-1881-E034-0003BA3F9857

Keywords

  1. 8/26/12 8/26/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
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 NCT00103181 Treatment - NSABP PROTOCOL B-39: Chemotherapy Report - 2295346v3.0

This form is to be submitted for all patients, including those who do not receive adjuvant chemotherapy.

Part 1. Patient Treatment Plan Based On Information Provided At Patient Registration
Intention to Administer Chemotherapy
Assigned Treatment
Treatment Plan
Part 2. To Be Completed By Institution
Did patient receive adjuvant chemotherapy? (If no, remaining questions do not apply.)
Adjuvant Chemotherapy (mark all types of chemotherapy patient received)

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