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UCSF Helen Diller Family Comprehensive Cancer Clinical Trials
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Please try again.</span></div> <div id="valtext_requiredformat"><span data-rc-lang="config_functions_94">Required format:</span></div> </div> <!-- Regex used for field validation --> <script> if (typeof window.REDCap == 'undefined') { window.REDCap = {}; } window.REDCap.validations = {}; window.REDCap.validations['postalcode_french'] = {"datatype":"postal_code","regex":"\/^((0?[1-9])|([1-8][0-9])|(9[0-8]))[0-9]{3}$\/"}; window.REDCap.validations['date_dmy'] = {"datatype":"date","regex":"\/^((29([-\\\/])02\\3(\\d{2}([13579][26]|[2468][048]|04|08)|(1600|2[048]00)))|((((0[1-9]|1\\d|2[0-8])([-\\\/])(0[1-9]|1[012]))|((29|30)([-\\\/])(0[13-9]|1[012]))|(31([-\\\/])(0[13578]|1[02])))(\\11|\\15|\\18)\\d{4}))$\/"}; window.REDCap.validations['date_mdy'] = {"datatype":"date","regex":"\/^((02([-\\\/])29\\3(\\d{2}([13579][26]|[2468][048]|04|08)|(1600|2[048]00)))|((((0[1-9]|1[012])([-\\\/])(0[1-9]|1\\d|2[0-8]))|((0[13-9]|1[012])([-\\\/])(29|30))|((0[13578]|1[02])([-\\\/])31))(\\11|\\15|\\19)\\d{4}))$\/"}; 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window.REDCap.validations['datetime_seconds_dmy'] = {"datatype":"datetime_seconds","regex":"\/^((29([-\\\/])02\\3(\\d{2}([13579][26]|[2468][048]|04|08)|(1600|2[048]00)))|((((0[1-9]|1\\d|2[0-8])([-\\\/])(0[1-9]|1[012]))|((29|30)([-\\\/])(0[13-9]|1[012]))|(31([-\\\/])(0[13578]|1[02])))(\\11|\\15|\\18)\\d{4})) (\\d|[0-1]\\d|[2][0-3])(:[0-5]\\d){2}$\/"}; window.REDCap.validations['datetime_seconds_mdy'] = {"datatype":"datetime_seconds","regex":"\/^((02([-\\\/])29\\3(\\d{2}([13579][26]|[2468][048]|04|08)|(1600|2[048]00)))|((((0[1-9]|1[012])([-\\\/])(0[1-9]|1\\d|2[0-8]))|((0[13-9]|1[012])([-\\\/])(29|30))|((0[13578]|1[02])([-\\\/])31))(\\11|\\15|\\19)\\d{4})) (\\d|[0-1]\\d|[2][0-3])(:[0-5]\\d){2}$\/"}; window.REDCap.validations['datetime_seconds_ymd'] = {"datatype":"datetime_seconds","regex":"\/^(((\\d{2}([13579][26]|[2468][048]|04|08)|(1600|2[048]00))([-\\\/])02(\\6)29)|(\\d{4}([-\\\/])((0[1-9]|1[012])(\\9)(0[1-9]|1\\d|2[0-8])|((0[13-9]|1[012])(\\9)(29|30))|((0[13578]|1[02])(\\9)31)))) (\\d|[0-1]\\d|[2][0-3])(:[0-5]\\d){2}$\/"}; window.REDCap.validations['email'] = {"datatype":"email","regex":"\/^(?!\\.)((?!.*\\.{2})[a-zA-Z0-9\\u0080-\\u02AF\\u0300-\\u07FF\\u0900-\\u18AF\\u1900-\\u1A1F\\u1B00-\\u1B7F\\u1D00-\\u1FFF\\u20D0-\\u214F\\u2C00-\\u2DDF\\u2F00-\\u2FDF\\u2FF0-\\u2FFF\\u3040-\\u319F\\u31C0-\\uA4CF\\uA700-\\uA71F\\uA800-\\uA82F\\uA840-\\uA87F\\uAC00-\\uD7AF\\uF900-\\uFAFF!#$%&'*+\\-\/=?^_`{|}~\\d]+)(\\.[a-zA-Z0-9\\u0080-\\u02AF\\u0300-\\u07FF\\u0900-\\u18AF\\u1900-\\u1A1F\\u1B00-\\u1B7F\\u1D00-\\u1FFF\\u20D0-\\u214F\\u2C00-\\u2DDF\\u2F00-\\u2FDF\\u2FF0-\\u2FFF\\u3040-\\u319F\\u31C0-\\uA4CF\\uA700-\\uA71F\\uA800-\\uA82F\\uA840-\\uA87F\\uAC00-\\uD7AF\\uF900-\\uFAFF!#$%&'*+\\-\/=?^_`{|}~\\d]+)*@(?!\\.)([a-zA-Z0-9\\u0080-\\u02AF\\u0300-\\u07FF\\u0900-\\u18AF\\u1900-\\u1A1F\\u1B00-\\u1B7F\\u1D00-\\u1FFF\\u20D0-\\u214F\\u2C00-\\u2DDF\\u2F00-\\u2FDF\\u2FF0-\\u2FFF\\u3040-\\u319F\\u31C0-\\uA4CF\\uA700-\\uA71F\\uA800-\\uA82F\\uA840-\\uA87F\\uAC00-\\uD7AF\\uF900-\\uFAFF\\-\\.\\d]+)((\\.([a-zA-Z\\u0080-\\u02AF\\u0300-\\u07FF\\u0900-\\u18AF\\u1900-\\u1A1F\\u1B00-\\u1B7F\\u1D00-\\u1FFF\\u20D0-\\u214F\\u2C00-\\u2DDF\\u2F00-\\u2FDF\\u2FF0-\\u2FFF\\u3040-\\u319F\\u31C0-\\uA4CF\\uA700-\\uA71F\\uA800-\\uA82F\\uA840-\\uA87F\\uAC00-\\uD7AF\\uF900-\\uFAFF]){2,63})+)$\/i"}; window.REDCap.validations['integer'] = {"datatype":"integer","regex":"\/^[-+]?\\b\\d+\\b$\/"}; window.REDCap.validations['alpha_only'] = {"datatype":"text","regex":"\/^[a-z]+$\/i"}; window.REDCap.validations['mrn_10d'] = {"datatype":"mrn","regex":"\/^\\d{10}$\/"}; window.REDCap.validations['mrn_generic'] = {"datatype":"mrn","regex":"\/^[a-z0-9-_]+$\/i"}; window.REDCap.validations['number'] = {"datatype":"number","regex":"\/^[-+]?[0-9]*\\.?[0-9]+([eE][-+]?[0-9]+)?$\/"}; window.REDCap.validations['number_1dp_comma_decimal'] = {"datatype":"number_comma_decimal","regex":"\/^-?\\d+,\\d$\/"}; window.REDCap.validations['number_1dp'] = {"datatype":"number","regex":"\/^-?\\d+\\.\\d$\/"}; window.REDCap.validations['number_2dp_comma_decimal'] = {"datatype":"number_comma_decimal","regex":"\/^-?\\d+,\\d{2}$\/"}; window.REDCap.validations['number_2dp'] = {"datatype":"number","regex":"\/^-?\\d+\\.\\d{2}$\/"}; window.REDCap.validations['number_3dp_comma_decimal'] = {"datatype":"number_comma_decimal","regex":"\/^-?\\d+,\\d{3}$\/"}; window.REDCap.validations['number_3dp'] = {"datatype":"number","regex":"\/^-?\\d+\\.\\d{3}$\/"}; window.REDCap.validations['number_4dp_comma_decimal'] = {"datatype":"number_comma_decimal","regex":"\/^-?\\d+,\\d{4}$\/"}; window.REDCap.validations['number_4dp'] = {"datatype":"number","regex":"\/^-?\\d+\\.\\d{4}$\/"}; window.REDCap.validations['number_comma_decimal'] = {"datatype":"number_comma_decimal","regex":"\/^[-+]?[0-9]*,?[0-9]+([eE][-+]?[0-9]+)?$\/"}; window.REDCap.validations['phone_australia'] = {"datatype":"phone","regex":"\/^(\\(0[2-8]\\)|0[2-8])\\s*\\d{4}\\s*\\d{4}$\/"}; window.REDCap.validations['phone_france'] = {"datatype":"phone","regex":"\/^(?:(?:\\+|00)(?:33|262|508|590|594|596|687)[\\s.-]{0,3}(?:\\(0\\)[\\s.-]{0,3})?|0)[1-9](?:(?:[\\s.-]?\\d{2}){4}|\\d{2}(?:[\\s.-]?\\d{3}){2})$\/"}; window.REDCap.validations['phone'] = {"datatype":"phone","regex":"\/^(?:\\(?([2-9]0[1-9]|[2-9]1[02-9]|[2-9][2-9][0-9]|800|811)\\)?)\\s*(?:[.-]\\s*)?([0-9]{3})\\s*(?:[.-]\\s*)?([0-9]{4})(?:\\s*(?:#|x\\.?|ext\\.?|extension)\\s*(\\d+))?$\/"}; window.REDCap.validations['phone_uk'] = {"datatype":"phone","regex":"\/^((((\\+44|0044)\\s?\\d{4}|\\(?0\\d{4}\\)?)\\s?\\d{3}\\s?\\d{3})|(((\\+44|0044)\\s?\\d{3}|\\(?0\\d{3}\\)?)\\s?\\d{3}\\s?\\d{4})|(((\\+44|0044)\\s?\\d{2}|\\(?0\\d{2}\\)?)\\s?\\d{4}\\s?\\d{4}))(\\s?\\#(\\d{4}|\\d{3}))?$\/"}; window.REDCap.validations['postalcode_australia'] = {"datatype":"postal_code","regex":"\/^\\d{4}$\/"}; window.REDCap.validations['postalcode_canada'] = {"datatype":"postal_code","regex":"\/^[ABCEGHJKLMNPRSTVXY]{1}\\d{1}[A-Z]{1}\\s*\\d{1}[A-Z]{1}\\d{1}$\/i"}; window.REDCap.validations['postalcode_germany'] = {"datatype":"postal_code","regex":"\/^(0[1-9]|[1-9]\\d)\\d{3}$\/"}; window.REDCap.validations['postalcode_uk'] = {"datatype":"postal_code","regex":"\/^(([A-Z]{1,2}\\d{1,2})|([A-Z]{1,2}\\d[A-Z])) \\d[ABD-HJLNP-Z]{2}$\/"}; window.REDCap.validations['ssn'] = {"datatype":"ssn","regex":"\/^\\d{3}-\\d\\d-\\d{4}$\/"}; window.REDCap.validations['time_hh_mm_ss'] = {"datatype":"time","regex":"\/^(\\d|[01]\\d|(2[0-3]))(:[0-5]\\d){2}$\/"}; window.REDCap.validations['time'] = {"datatype":"time","regex":"\/^([0-9]|[0-1][0-9]|[2][0-3]):([0-5][0-9])$\/"}; window.REDCap.validations['time_mm_ss'] = {"datatype":"time","regex":"\/^[0-5]\\d:[0-5]\\d$\/"}; window.REDCap.validations['vmrn'] = {"datatype":"mrn","regex":"\/^[0-9]{4,9}$\/"}; window.REDCap.validations['zipcode'] = {"datatype":"postal_code","regex":"\/^\\d{5}(-\\d{4})?$\/"}; </script> <div id="valregex_divs"> <div id="valregex-postalcode_french" datatype="postal_code" label="Code Postal 5 caracteres (France)"></div> <div id="valregex-date_dmy" datatype="date" label="Date (D-M-Y)"></div> <div id="valregex-date_mdy" datatype="date" label="Date (M-D-Y)"></div> <div id="valregex-date_ymd" datatype="date" label="Date (Y-M-D)"></div> <div id="valregex-datetime_dmy" datatype="datetime" label="Datetime (D-M-Y H:M)"></div> <div id="valregex-datetime_mdy" datatype="datetime" label="Datetime (M-D-Y H:M)"></div> <div id="valregex-datetime_ymd" datatype="datetime" label="Datetime (Y-M-D H:M)"></div> <div id="valregex-datetime_seconds_dmy" datatype="datetime_seconds" label="Datetime w/ seconds (D-M-Y H:M:S)"></div> <div id="valregex-datetime_seconds_mdy" datatype="datetime_seconds" label="Datetime w/ seconds (M-D-Y H:M:S)"></div> <div id="valregex-datetime_seconds_ymd" datatype="datetime_seconds" label="Datetime w/ seconds (Y-M-D H:M:S)"></div> <div id="valregex-email" datatype="email" label="Email"></div> <div id="valregex-integer" datatype="integer" label="Integer"></div> <div id="valregex-alpha_only" datatype="text" label="Letters only"></div> <div id="valregex-mrn_10d" datatype="mrn" label="MRN (10 digits)"></div> <div id="valregex-mrn_generic" datatype="mrn" label="MRN (generic)"></div> <div id="valregex-number" datatype="number" label="Number"></div> <div id="valregex-number_1dp_comma_decimal" datatype="number_comma_decimal" label="Number (1 decimal place - comma as decimal)"></div> <div id="valregex-number_1dp" datatype="number" label="Number (1 decimal place)"></div> <div id="valregex-number_2dp_comma_decimal" datatype="number_comma_decimal" label="Number (2 decimal places - comma as decimal)"></div> <div id="valregex-number_2dp" datatype="number" label="Number (2 decimal places)"></div> <div id="valregex-number_3dp_comma_decimal" datatype="number_comma_decimal" label="Number (3 decimal places - comma as decimal)"></div> <div id="valregex-number_3dp" datatype="number" label="Number (3 decimal places)"></div> <div id="valregex-number_4dp_comma_decimal" datatype="number_comma_decimal" label="Number (4 decimal places - comma as decimal)"></div> <div id="valregex-number_4dp" datatype="number" label="Number (4 decimal places)"></div> <div id="valregex-number_comma_decimal" datatype="number_comma_decimal" label="Number (comma as decimal)"></div> <div id="valregex-phone_australia" datatype="phone" label="Phone (Australia)"></div> <div id="valregex-phone_france" datatype="phone" label="Phone (France) (xx xx xx xx xx)(+33 x xx xx xx xx)"></div> <div id="valregex-phone" datatype="phone" label="Phone (North America)"></div> <div id="valregex-phone_uk" datatype="phone" label="Phone (UK)"></div> <div id="valregex-postalcode_australia" datatype="postal_code" label="Postal Code (Australia)"></div> <div id="valregex-postalcode_canada" datatype="postal_code" label="Postal Code (Canada)"></div> <div id="valregex-postalcode_germany" datatype="postal_code" label="Postal Code (Germany)"></div> <div id="valregex-postalcode_uk" datatype="postal_code" label="Postal Code (UK)"></div> <div id="valregex-ssn" datatype="ssn" label="Social Security Number (U.S.)"></div> <div id="valregex-time_hh_mm_ss" datatype="time" label="Time (HH:MM:SS)"></div> <div id="valregex-time" datatype="time" label="Time (HH:MM)"></div> <div id="valregex-time_mm_ss" datatype="time" label="Time (MM:SS)"></div> <div id="valregex-vmrn" datatype="mrn" label="Vanderbilt MRN"></div> <div id="valregex-zipcode" datatype="postal_code" label="Zipcode (U.S.)"></div> </div> <div id="random_text_hidden_div" style="display:none;">6IdbMXAkNtUGSeH</div> <div id="pagecontainer" class="container-fluid" role="main"><div id="container"><div id="pagecontent"> <style> #questiontable td.questionnum, #questiontable td.questionnummatrix { display: none !important; } /* When we clean up the left space, we can extend enhanced choice options to be full width for a better appearance, but we have to fix the gap for horizontal alignments */ div.enhancedchoice label { width: 94%; margin: 0 3% 0.5em 3%; } </style> <script type="text/javascript" src="/redcap_v14.5.43/Resources/js/Libraries/geoPosition.js?1738877563"></script> <script type="text/javascript" src="/redcap_v14.5.43/Resources/js/Libraries/geoPositionSimulator.js?1738877563"></script> <script type="text/javascript"> if(typeof lang=='undefined'){var lang={}}; lang.dataqueries_160='There was an error during file upload!'; lang.data_entry_199='SAVE YOUR CHANGES?'; lang.data_entry_265='Are you sure you wish to close the survey? Any responses you have added on this page will be lost if you close the survey now. IF YOU DO NOT WISH TO ABANDON YOUR CHANGES, click the \'Stay on page\' button below and then click the button at the bottom of the page to save your changes.'; lang.data_entry_433='This field\'s value contains extra spaces at the beginning or end. Would you like to remove them?'; lang.data_entry_459='Upload new version'; lang.design_100='Yes'; lang.form_renderer_24='Remove file'; lang.form_renderer_25='Send-It'; lang.form_renderer_43='Remove signature'; lang.form_renderer_60='File was successfully uploaded!'; lang.global_53='Cancel'; lang.survey_01='End the survey?'; lang.survey_562='WARNING: Value not selected'; lang.survey_1311='End Survey'; lang.survey_1312='Return and Edit Response'; </script> <script type="text/javascript"> // Set variables var record_exists = 0; var require_change_reason = 0; var event_id = 128822; $(function() { // Check for any reserved parameters in query string checkReservedSurveyParams(new Array('s','hash','page','event_id','pid','pnid','preview','id','sq')); // Enable green row highlight for data entry form table enableDataEntryRowHighlight(); }); </script> <!-- Title and/or Logo --> <div id="surveytitlelogo"> <table cellspacing="0" style="width:100%;max-width:100%;"> <tr> <td valign="top"> <div style='padding:10px 0 0;'><img id='survey_logo' onload='try{reloadSpeakIconsForLogo()}catch(e){}' src='/surveys/index.php?pid=27179&doc_id_hash=3cd4682b616e418bea84b61bd5e9a4fbe59899c6&__passthru=DataEntry%2Fimage_view.php&s=X7W7PXAY8D&id=2078572' alt='image' data-mlm-attrs='alt=survey-logo_alt_text' style='max-width:600px;width:500px;max-width:500px;height:107px;max-height:107px;'></div><h1 id='surveytitle' data-mlm='survey-title'>UCSF Helen Diller Family Comprehensive Cancer Clinical Trials</h1> </td> <!-- Language, Voice, Font Controls; Return & Survey Queue Links --> <td valign="top" id="changeFont" aria-hidden="true" width="1%"> <span class="nowrap font-resize-header"><span style="font-size:150%">A</span> <span style="font-size:125%">A</span> <span style="font-size:100%">A</span> </span> <div class="nowrap"> <button id="mlm-change-lang" class="btn btn-link btn-sm" data-rc-lang-attrs="aria-label=multilang_02 data-bs-original-title=multilang_02" title="Change language" aria-label="Change language" data-toggle="tooltip" style="display:none;"><i class="fas fa-globe"></i> <span class="btn-link-lang-name"></span></button> <button id="enable_text-to-speech" class="btn btn-link btn-sm" data-rc-lang-attrs="data-bs-original-title=survey_997 aria-label=survey_997" title="Enable speech" aria-label="Enable speech" data-toggle="tooltip" style="display:none;" onclick="addSpeakIconsToSurveyViaBtnClick(1);"><i class="fas fa-volume-up"></i></button> <button id="disable_text-to-speech" class="btn btn-link btn-sm" data-rc-lang-attrs="data-bs-original-title=survey_998 aria-label=survey_998" title="Disable speech" aria-label="Disable speech" data-toggle="tooltip" style="display:none;" onclick="addSpeakIconsToSurveyViaBtnClick(0);"><i class="fas fa-volume-mute"></i></button> <button class="increaseFont btn btn-link btn-sm" data-rc-lang-attrs="data-bs-original-title=survey_1129 aria-label=survey_1129" title="Click to increase font size" aria-label="Click to increase font size" data-toggle="tooltip"><i class="far fa-plus-square"></i></button> <button class="decreaseFont btn btn-link btn-sm" data-rc-lang-attrs="data-bs-original-title=survey_1130 aria-label=survey_1130" title="Click to decrease font size" aria-label="Click to decrease font size" data-toggle="tooltip"><i class="far fa-minus-square"></i></button> </div> </td> </tr> </table> </div> <div class='red fs15 p-3' style='max-width:1150px;'> <span data-rc-lang="data_entry_602"> We're sorry, but your current web browser (<b>Internet Explorer</b>) is not compatible with this web page. 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