Search results - Portal of Medical Data Models (MDM-Portal)

Breast Cancer Registration SWOG NCT00070564 - REGISTRATION Breast Cancer NCT00070564

- 11/17/21 - 1 form, 3 itemgroups, 26 items, 1 language

Itemgroups: Header,Patient characteristics,Patient Consent For Specimen Use

SOUTHWEST ONCOLOGY GROUP REGISTRATION FORM Adjuvant Doxorubicin, Cyclophosphamide, and Paclitaxel in Treating Patients With Breast Cancer NCT00070564 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A678842F-926F-5086-E034-0003BA0B1A09

Breast Cancer Registration SWOG S0226 NCT00075764 - Registration Breast Cancer NCT00075764

- 9/27/21 - 1 form, 3 itemgroups, 39 items, 1 language

Itemgroups: Header,Patient data,Consent

Southwest Oncology Group Registration Form (S0226) S0226 Anastrozole With or Without Fulvestrant as First-Line Therapy in Postmenopausal Women With Metastatic Breast Cancer NCT00075764 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=C3225DE6-8BA0-26CF-E034-0003BA12F5E7

Cervical Cancer Registration SWOG S0227 NCT00057928 - Registration Form Cervical Cancer NCT00057928

- 9/27/21 - 1 form, 2 itemgroups, 29 items, 1 language

Itemgroups: Header,Patient data

Southwest Oncology Group Registration Form (S0227) S0227 Comparison of Cisplatin Combined With Either Paclitaxel or Gemcitabine in Treating Patients With Recurrent, Persistent, or Metastatic Cervical Cancer NCT00057928 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A9C4563A-B1F7-3ACF-E034-0003BA12F5E7

ALTTO (Adjuvant Lapatinib And/Or Trastuzumab Treatment Optimisation) Study; BIG 2-06/N063D NCT00490139 - study documentation breast cancer NCT00490139

- 9/20/21 - 1 form, 42 itemgroups, 314 items, 2 languages

Itemgroups: Header Module,Registration Header,Contact Person For Pathology Results,Patient Demographics,Eligibility Screening Form,Randomization,Informed consent,Patient Status,ECG,Cardiac Monitoring,Local Her2 Results,Hormonal Receptor Status,History Of Primary Breast Cancer,History Of Primary Cancer (continued),Sentinel Node Sampling,Most Extensive Primary Surgery,Axillary Node Dissection,Chemotherapy,Previous Or Current Cardiovascular Disease,ECG,Translational Research,Central Her2 Testing Form - FISH,Central Her2 Testing Form - IHC,Radiotherapy,Hormonetherapy,Concomitant Treatment,Administration of Study Drug,Chemotherapy,Targeted Therapy,Hormonetherapy,Radiotherapy,Surgery,Adverse Event (AE),Second Primary Malignancy and Contralateral Breast Cancer,Patient Status,Cardiac Monitoring,Mammogram,Hematoly and Biochemistry,Survival Follow-Up,Treatment Completion,Additional Comments ,Death Form

A Randomised, Multi-centre, Open-label, Phase III Study of Adjuvant Lapatinib, Trastuzumab, Their Sequence and Their Combination in Patients With HER2/ErbB2 Positive Primary Breast Cancer NCT00490139

EUMDS registry DRKS00003844 NCT00600860 - Patient registration

- 9/20/21 - 9 forms, 1 itemgroup, 12 items, 1 language

Itemgroup: Patient registration

Further Information: http://www.eumds.org/

Eligibility

1 itemgroup 5 items

Visit details

6 itemgroups 29 items

Bone marrow assessment

3 itemgroups 13 items

Z6051 Registration Worksheet (RW) NCT00726622

- 9/20/21 - 1 form, 9 itemgroups, 67 items, 1 language

Itemgroups: Header module,Pre-Neoadjuvant Therapy Examination Data,Neoadjuvant Therapy Date,Footer Module,Patient Information,Eligibility Criteria,Randomization,Colorectal Surgical Procedure,Consent

Z6051 Registration Worksheet (RW) NCT00726622 Laparoscopic-Assisted Resection or Open Resection in Treating Patients With Stage IIA, Stage IIIA, or Stage IIIB Rectal Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=42C2D65A-ED39-4B6E-E044-0003BA3F9857

ACOSOG-Z1072 OPEN Registration Worksheet NCT00723294

- 9/20/21 - 1 form, 3 itemgroups, 27 items, 1 language

Itemgroups: Patient demographics,General Information,Eligibility Checklist

ACOSOG-Z1072 OPEN Registration Worksheet NCT00723294 Cryoablation Therapy in Treating Patients With Invasive Ductal Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=7FF941F7-5D5F-47CE-E040-BB89AD432465

Registration - Registration - 2768468v1.0 - Registration

- 9/20/21 - 1 form, 3 itemgroups, 19 items, 1 language

Itemgroups: DCP Template Header,Registration,DCP Template Footer

The Division of Cancer Prevention's registration case report form (CRF) template. Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=52C7202A-91E5-347F-E044-0003BA3F9857

Colorectal Cancer NCT01189227 Registration - NSABP C-11 OPEN Worksheet for Form Entry - 3105627v1.0 - NSABP C-11 OPEN Worksheet for Form Entry

- 9/20/21 - 1 form, 12 itemgroups, 106 items, 1 language

Itemgroups: Header Module,Race,Demographics,Patient Consent,Page Headers,Section 1 - Surgery and Pathology,Section 2 - Imaging Studies,Section 2 -Imaging Studies (continued),Section 3 - Baseline Values (I),Section 3 - Baseline Values (II),Section 3 - Baseline Values (III),Section 4 - Patient History, Current and Recent Conditions

NSABP C-11 OPEN Worksheet for Form Entry Combination Chemotherapy Before or After Surgery in Treating Patients With Colorectal Cancer With Liver Metastases That Could Be Removed By Surgery Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=8836C32C-ED52-3A5B-E040-BB89AD436D98

Sarcoma NCT01247571 Pre-Study - GOG-0230: Fast Fact Sheet for Protocol 0230-D (Uterus) - 3174263v1.0 - GOG-0230: Fast Fact Sheet for Protocol 0230-D (Uterus)

- 9/20/21 - 1 form, 3 itemgroups, 91 items, 1 language

Itemgroups: Patient Information,Eligibility 1,Provide comments about this Fast Fact Sheet

GOG-0230: Fast Fact Sheet for Protocol 0230-D (Uterus) Pazopanib Hydrochloride in Treating Patients With Recurrent or Persistent Uterine Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=97F2A353-AB36-7B12-E040-BB89AD432C3D

Fallopian Tube Cancer NCT01167712 Pre-Study - GOG-0262: Fast Fact Sheet for Protocol 0262 (Ovary, Fallopian Tube, Primary Peritoneal) - 3110638v1.0 - GOG-0262: Fast Fact Sheet for Protocol 0262 (Ovary, Fallopian Tube, Primary Peritoneal)

- 9/20/21 - 1 form, 6 itemgroups, 81 items, 1 language

Itemgroups: Patient Information,Eligibility 1,Eligibility 2,Eligibility 3,Eligibility 4,Provide comments about this Fast Fact Sheet

GOG-0262: Fast Fact Sheet for Protocol 0262 (Ovary, Fallopian Tube, Primary Peritoneal) Paclitaxel and Carboplatin With or Without Bevacizumab in Treating Patients With Stage II, Stage III, or Stage IV Ovarian Epithelial Cancer, Primary Peritoneal Cancer, or Fallopian Tube Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=893B4E4E-209D-97F3-E040-BB89AD4371DB

Kidney Cancer NCT01198158 Registration - CALGB 90802 Registration Worksheet Form - 3103555v1.0 - CALGB 90802 Registration Worksheet Form

- 9/20/21 - 1 form, 10 itemgroups, 44 items, 1 language

Itemgroups: Header Module,Protocol Administration,Patient Demographics/Pre-Treatment Characteristics1,Patient Demographics/Pre-Treatment Characteristics2,Patient Demographics/Pre-Treatment Characteristics3,Certification Of Eligibility,Protocol Design,Initial Patient Consent For Specimen Use,CALGB 580902,Registration Information

CALGB 90802 Registration Worksheet Form Everolimus With or Without Bevacizumab in Treating Patients With Advanced Kidney Cancer That Progressed After First-Line Therapy Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=879626AD-DB8C-4AF2-E040-BB89AD4364E1

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