PI Name
Item
PI Name
text
C0027365 (UMLS CUI [1])
Protocol or IRB Number
Item
Protocol or IRB Number
integer
C0008971 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
Protocol Short Title
Item
Protocol Short Title
text
C2986303 (UMLS CUI [1])
Subject Initials
Item
Subject Initials
text
C0681850 (UMLS CUI [1,1])
C1555582 (UMLS CUI [1,2])
Subject ID
Item
Subject ID
integer
C2348585 (UMLS CUI [1])
Date
Item
Date
date
C0011008 (UMLS CUI [1])
Subject UWHC Medical Record Number
Item
Subject UWHC Medical Record Number
integer
C1301894 (UMLS CUI [1])
First Name
Item
First Name
text
C1443235 (UMLS CUI [1])
Middle Name (or initial)
Item
Middle Name (or initial)
text
C2598119 (UMLS CUI [1])
Last Name
Item
Last Name
text
C1301584 (UMLS CUI [1])
Birthdate
Item
Birthdate
date
C0421451 (UMLS CUI [1])
Item
Gender
text
C0079399 (UMLS CUI [1])
CL Item
Unknown or not Reported (3)
Item
Ethnicity
text
C0015031 (UMLS CUI [1])
CL Item
Unknown or not Reported (3)
Race
Item
American Indian or Alaska Native
boolean
C0002460 (UMLS CUI [1,1])
C0682125 (UMLS CUI [1,2])
Race
Item
Asian
boolean
C0078988 (UMLS CUI [1])
Race
Item
Black or African American
boolean
C0085756 (UMLS CUI [1])
Race
Item
Native Hawaiian or Other Pacific Islander
boolean
C3845561 (UMLS CUI [1])
Race
Item
White or Caucasian
boolean
C0043157 (UMLS CUI [1])
Race
Item
Unknown or not Reported
boolean
C0439673 (UMLS CUI [1])
Medical Record Number
Item
integer
C1301894 (UMLS CUI [1])
Hospital/Care Provider (e.g VA Hospital, Meriter Hospital, EPIC)
Item
Hospital/Care Provider (e.g VA Hospital, Meriter Hospital, EPIC)
text
C0019994 (UMLS CUI [1])
Address
Item
Address
text
C0421449 (UMLS CUI [1])
Unit number
Item
Unit number
integer
C0439148 (UMLS CUI [1])
City
Item
City
text
C0008848 (UMLS CUI [1])
State
Item
State
text
C1442792 (UMLS CUI [1])
Zip
Item
Zip
integer
C1521842 (UMLS CUI [1])
Phone number
Item
Phone number
integer
C1515258 (UMLS CUI [1])
Item
What kind of phone number is it?
text
C1515258 (UMLS CUI [1,1])
C0332307 (UMLS CUI [1,2])
Code List
What kind of phone number is it?
Alternate Phone Number
Item
Alternate Phone Number
integer
C1515258 (UMLS CUI [1,1])
C1523987 (UMLS CUI [1,2])
Item
What kind of Phone number is it?
text
C1515258 (UMLS CUI [1,1])
C0332307 (UMLS CUI [1,2])
Code List
What kind of Phone number is it?
Email address
Item
Email address
text
C1705961 (UMLS CUI [1])
Preferred method of contact
Item
Preferred method of contact
text
C1997600 (UMLS CUI [1])
Name
Item
Name
text
C0027365 (UMLS CUI [1])
Address
Item
Address
text
C0421449 (UMLS CUI [1])
Unit number
Item
integer
C0439148 (UMLS CUI [1])
City
Item
City
text
C0008848 (UMLS CUI [1])
State
Item
State
text
C1442792 (UMLS CUI [1])
Zip
Item
Zip
integer
C1521842 (UMLS CUI [1])
Phone Number
Item
Phone Number
integer
C1515258 (UMLS CUI [1])
Item
What kind of phone number is it?
text
C1515258 (UMLS CUI [1,1])
C0332307 (UMLS CUI [1,2])
Code List
What kind of phone number is it?
Alternate Phone Number
Item
Alternate Phone Number
integer
C1515258 (UMLS CUI [1,1])
C1523987 (UMLS CUI [1,2])
Item
What kind of phone number is it?
text
C1515258 (UMLS CUI [1,1])
C0332307 (UMLS CUI [1,2])
Code List
What kind of phone number is it?
Email address
Item
Email address
text
C1705961 (UMLS CUI [1])
Form completed By
Item
Form completed By
text
Date
Item
Date
date
C0011008 (UMLS CUI [1])