Descripción:

WHOLE BLOOD for SERUM/DNA BANKING SUBMISSION REPORT Quality Of Life Companion Study For JMA27 (NCIC-MA.27): A Randomized Phase III Trial Of Exemestane Versus Anastrozole With Or Without Celecoxib In Postmenopausal Women With Receptor Positive Primary Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=ABE25A45-A7B6-53B4-E034-0003BA12F5E7

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=ABE25A45-A7B6-53B4-E034-0003BA12F5E7

Palabras clave:

Clinical Trial

Mammatumoren, Mensch

Specimen

26/8/12 26/8/12 -
9/1/15 9/1/15 - Martin Dugas

Subido en:

9 de enero de 2015

DOI:

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Licencia :

Creative Commons BY-NC 3.0 Legacy

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Breast Cancer NCT00090974 Transmittal - WHOLE BLOOD for SERUM/DNA BANKING SUBMISSION REPORT - 2058882v3.0

Detalles

To be submitted with Form 1 - Eligibility Checklist and Initial Evalution within 6 weeks of randomization.

1 formularios

StudyEvent: WHOLE BLOOD for SERUM/DNA BANKING SUBMISSION REPORT
1. To be submitted with Form 1 - Eligibility Checklist and Initial Evalution within 6 weeks of randomization.

Patient Information

Patient Study ID, Coordinating Group (NCIC CTG Patient Serial Number)

Patient Initials (first - middle - last)

Patient Medical Record Number

Investigator Name

Institution Name

Registered Investigator (NCI Investigator #)

Whole Blood Submission

Specimen Collection Date (Whole Blood in EDTA)

Unnamed question (specimen type) (check one)

Baseline Specimen (Baseline Specimen)

6-month Specimen (6-month Specimen)

Comments

COMMENTS

Investigator Signature

Person Completing Form, Last Name

Person Completing Form, First Name

Form Completion Date, Original (yyyy mmm dd)

Ccrr Module For Whole Blood For Serum/dna Banking Submission Report

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