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"",Version Date: 07/01 |
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Participant ID Number, |
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"Prostate, Lung, Colorectal and Ovarian", |
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Cancer Screening Trial, |
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MEDICAL RECORD ABSTRACT FORM, |
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TREATMENT INFORMATION β COLORECTUM (TIC2/TCQ2), |
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1. Date Abstracted: ___________________________________________, |
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Month Day Year, |
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2. Abstractor ID#: ___ ___ ___ ___, |
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3. CTR ID: ___ ___ ___ ___, |
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4. Study Year T0-T13: ___ ___, |
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5. Purpose of Abstract:, |
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γ Initial abstract, |
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γ Re-abstract for QA, |
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FOR OFFICE USE ONLY, |
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6. Form Processing (MARK RESPONSES AS STEPS ARE COMPLETED), |
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γ Form Receipted into SMS, |
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γ Manual Review Completed, |
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Data Entry of Non-Scannable Items:, |
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γ Completed, |
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γ None Required, |
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Data Retrieval:, |
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γ Attempted, |
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γ None Required, |
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Disposition:, |
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γ Interim Complete (ICM), |
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γ Final Complete (FCM), |
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γ Final Incomplete (FIC), |
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