Diagnosis NCI Standard Template

Mandatory Diagnosis Questions

These items must be included when this data is collected for reporting.

  Date of Current Pathologic Diagnosis: 02/18/2003
  Diagnosis Type                      : Primary Diagnosis__
  Primary Site                        : Left Ovary

Conditional Diagnosis Questions

There are business rules to indicate situations under which these elements should be used on a case report form.

  Diagnosis Time Point: Restaging

Optional Diagnosis Conditions

There is no requirement for inclusion of these elements on the case report form. If the design and scientific questions posed in the study dictate the need to collect this type of data, these elements should be included.

  Reviewing Pathologist: Harold Ornada
  MedDRA Source Code   : __________
  Assessment Method    : Histological Procedure
  Tumor Grade          : Moderately Differentiated