(WDL -CV) Form B1 - based on grossing reports
Study Case Number (Different from case number, See Form A for details)
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What is the specimen type of this case? (Colon, rectum, neck, etc.)
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What is the patient's age?
What is the patient's sex?
Male
Female
What is the patient's ethnicity?
Asian
Black or African American
Hispanic or Latino
White
Other
How many years of grossing experience does this clinician have?
Did the patient receive neoadjuvant chemotherapy or treatments before surgery? If so, what type?
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Batch A cassettes labels (For example, A1, D12, etc):
Batch A likely lymph node count:
Batch B cassettes labels (For example, A1, D12, etc):
Batch B likely lymph node count:
Batch C cassette labels (For example, A1, D12, etc):
Any additional information to share regarding this case? (Please don't share any patient identity related information.)
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Should be Empty: