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Appendices

1. Data Submission Checklist
2.  Eligibility Checklist   
3. Performance Status
4. Med Watch    
5.  Study Parameters Table   
6. TNM Nomenclature and Staging   
7.  Baseline Breast Cancer Risk Study Questionnaire
8.  Follow-Up Breast Cancer Study Risk Questionnaire
9.  Modified Skindex-16 QOL Questionnaire
10.  Appendix 10A - B39 QOL In Tact     Appendix 10B - B39 QOL Chest Wall
11. RTOG SOMA Criteria
12.  Instructions for Photographs
13.  Breast Chest Wall RT Completion Form
14.  ONS Criteria for Acute Radiation Induced Skin Reaction
15.  FACT- B*
16.  Specimen Collection and Shipping Instructions
17. CTSU Participation Procedures
18. Flow Sheet / Addenda 
    
     Combined Appendices   

Spanish Versions:
7. Baseline Breast Cancer Risk Study Questionnaire 
8. Follow-Up Breast Cancer Study Risk Questionnaire  
9.  Modified Skindex-16 QOL Questionnaire 
10. Appendix 10A - B39 QOL In Tact     Appendix 10B - B39 QOL Chest Wall

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*1.To obtain this copyrighted form, please enter CCRBIS.
 2. Click on “login CCRBIS” at the top right of the CCRBIS screen.
 3. Type Username and Password.
 4. Click on “login.”
 5. Click on “Information” on the left side of the green bar at the top of the page.
 6. Click the "97609 Forms" box to obtain the FACT-B
 7. Print.
Contact June Fletcher-Steede at jsteede@wakehealth.edu for password information.