Beskrivning:

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

Länk:

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

Nyckelord:

2012-08-26 2012-08-26 -
2015-01-09 2015-01-09 - Martin Dugas

Uppladdad den:

9 januari 2015

DOI:

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Licens :

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

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

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

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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