Version: 3.0.0.0 Install location: Survivor
Fields denoted with an asterisk (*) are required
*

General

Name
Date of birth
...
Gender
*
unknown male female 
Shared-Care trial participant
yes no 

Diagnosis

Tumortype
Testis
Seminoma/non-seminoma
Teratoma in tumor
yes no 

Treatment

Orchidectomy
*
Date orchidectomy
...
Chemotherapy
*
yes no 
Radiotherapy
*
yes no 
RPLND (abdominal surgery)
*
yes no 

Treatment

Bleomycin
Cardiovascular event
Trombo-embolic event

Status post-treatment

Weight (kg)
Length (cm)
Metabolic syndrome
yes no 
Paresthesia
yes no 
Medication





Relapse

Relapse
yes no 

Follow-up

Start of follow-up
*
...
Follow-up schedule
*

Follow-up according to Dutch Testicular Cancer guidelines


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