Case Reporting Form (CRF)
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Trial ID: T-003
Initials: FD
Gender: Female
Age: 45
Date of Entry: 07/12/2025
Habit Details
| Habit Name | Status | From Age | To Age | Frequency/Day |
|---|---|---|---|---|
| Smoking | Current regular User | 28 | 45 | 3 |
Clinical Course Details
Diagnosis & Staging
Site: Oral Cavity
Subsite: Upper alveolus
TNM: T:T2 N:N1 M:M0
Dimensions: Max: 4 cm, Min: 3 cm
Biopsy Report: MDSCC
Treatment History
Prior Radiotherapy: No
Prior Chemotherapy: No
Treatment Plan: WLE+ND
Surgery & Hospital Course
Admission Date: 10/12/2025
Surgery Date: 11/12/2025
Primary Surgery: WLE+ND
Neck Dissection: Level I, Level II, Level III, Level IV, Level V
Reconstruction: Local flap
Post-Op & Discharge
Course in Hospital: Un eventful
Tracheostomy: Yes
NG Tube: Yes
NG Tube Removal Date:
Discharge Date: 21/12/2025