ID

1964

Description

DEM Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FF1A18C7-58B3-19A7-E034-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FF1A18C7-58B3-19A7-E034-0003BA3F9857

Keywords

Versions (4)
  1. 9/19/12 9/19/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
  3. 6/27/15 6/27/15 -
  4. 9/20/21 9/20/21 -
Uploaded on

September 19, 2012

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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Leukemia, Myelocytic, Acute null Treatment - DEM - 2394908v3.0

English

No Instruction available.

1 forms  
Unnamed 1
Description

Unnamed 1

Gender
Description

PatientGenderCategory

Data type

text

Alias
NCI Thesaurus ValueDomain
C25372
UMLS 2011AA ValueDomain
C0683312
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C17357
UMLS 2011AA Property
C0079399
Date of Birth
Description

PersonBirthDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C25155
UMLS 2011AA Property
C0005615
Ethnicity
Description

PatientEthnicGroupCategory

Data type

text

Alias
NCI Thesaurus ValueDomain
C25372
UMLS 2011AA ValueDomain
C0683312
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C16564
UMLS 2011AA Property
C0015031
Race
Description

PatientRaceCategory

Data type

text

Alias
NCI Thesaurus ValueDomain
C25372
UMLS 2011AA ValueDomain
C0683312
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C17049
UMLS 2011AA Property
C0034510
Specify race
Description

OtherRaceCategoryText

Data type

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus Property
C25372
UMLS 2011AA Property
C0683312
NCI Thesaurus ObjectClass
C17049
UMLS 2011AA ObjectClass
C0034510
Specify race
Description

OtherRaceCategoryText

Data type

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus Property
C25372
UMLS 2011AA Property
C0683312
NCI Thesaurus ObjectClass
C17049
UMLS 2011AA ObjectClass
C0034510
Comments
Description

ResearchCommentsText

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
UMLS 2011AA Property
C0282411
Name code
Description

Namecode

Data type

text

IBMTR IUBMID # (if already known or assigned)
Description

IBMTRIUBMID#(ifalreadyknownorassigned)

Data type

text

Secondary race
Description

Secondaryrace

Data type

text

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Similar models

No Instruction available.

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Unnamed 1
Item
Gender
text
C25372 (NCI Thesaurus ValueDomain)
C0683312 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C17357 (NCI Thesaurus Property)
C0079399 (UMLS 2011AA Property)
CL.1
Code List
Gender
CL Item
Male (Male)
C46109 (NCI Thesaurus)
C1706180 (UMLS 2011AA)
CL Item
Female (Female)
C46110 (NCI Thesaurus)
C0015780 (UMLS 2011AA)
PersonBirthDate
Item
Date of Birth
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25155 (NCI Thesaurus Property)
C0005615 (UMLS 2011AA Property)
Item
Ethnicity
text
C25372 (NCI Thesaurus ValueDomain)
C0683312 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C16564 (NCI Thesaurus Property)
C0015031 (UMLS 2011AA Property)
CL.2
Code List
Ethnicity
CL Item
A Person Of Mexican, Puerto Rican, Cuban, Central Or South American Or Other Spanish Culture Or Origin, Regardless Of Race. (Hispanic or Latino)
C17459 (NCI Thesaurus)
C0086409 (UMLS 2011AA)
CL Item
A Person Not Meeting The Definition For Hispanic Or Latino. (Not Hispanic or Latino)
C41222 (NCI Thesaurus)
C1518424 (UMLS 2011AA)
CL Item
Could Not Be Determined Or Unsure (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
CL Item
Not Provided Or Available (Not answered)
C43234 (NCI Thesaurus)
C1706613 (UMLS 2011AA)
Item
Race
text
C25372 (NCI Thesaurus ValueDomain)
C0683312 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C17049 (NCI Thesaurus Property)
C0034510 (UMLS 2011AA Property)
CL.3
Code List
Race
CL Item
White (not otherwise specified) (White (not otherwise specified))
CL Item
European (not otherwise specified) (European (not otherwise specified))
CL Item
Mediterranean (Mediterranean)
CL Item
White North American (White North American)
CL Item
South or Central American White (South or Central American White)
CL Item
Eastern European (Eastern European)
CL Item
Northern European (Northern European)
CL Item
Western European (Western European)
CL Item
White Caribbean (White Caribbean)
CL Item
North Coast of Africa (North Coast of Africa)
CL Item
Black (not otherwise specified) (Black (not otherwise specified))
CL Item
African American (African American)
CL Item
African Black (both parents born in Africa) (African Black (both parents born in Africa))
CL Item
Caribbean Black (Caribbean Black)
CL Item
South or Central American Black (South or Central American Black)
CL Item
Black, other specify (Black, other specify)
CL Item
Asian (not otherwise specified) (Asian (not otherwise specified))
CL Item
Indian/South Asian (Indian/South Asian)
CL Item
Filipino (pilipino) (Filipino (pilipino))
CL Item
Japanese (Japanese)
CL Item
Korean (Korean)
CL Item
Chinese (Chinese)
CL Item
Other Southeast Asian (Other Southeast Asian)
CL Item
Vietnamese (Vietnamese)
CL Item
Native American (not otherwise specified) (Native American (not otherwise specified))
CL Item
Native Alaskan/Eskimo/Aleut (Native Alaskan/Eskimo/Aleut)
CL Item
American Indian (not otherwise specified) (American Indian (not otherwise specified))
CL Item
North American Indian (North American Indian)
CL Item
South or Central American Indian (South or Central American Indian)
CL Item
Caribbean Indian (Caribbean Indian)
CL Item
Native Pacific Islander (not otherwise specified) (Native Pacific Islander (not otherwise specified))
CL Item
Guamanian (Guamanian)
CL Item
Hawaiian (Hawaiian)
CL Item
Samoan (Samoan)
CL Item
Could Not Be Determined Or Unsure (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
CL Item
Other, specify (Other, specify)
CL Item
Not Provided Or Available (Not answered)
C43234 (NCI Thesaurus)
C1706613 (UMLS 2011AA)
OtherRaceCategoryText
Item
Specify race
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C25372 (NCI Thesaurus Property)
C0683312 (UMLS 2011AA Property)
C17049 (NCI Thesaurus ObjectClass)
C0034510 (UMLS 2011AA ObjectClass)
OtherRaceCategoryText
Item
Specify race
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C25372 (NCI Thesaurus Property)
C0683312 (UMLS 2011AA Property)
C17049 (NCI Thesaurus ObjectClass)
C0034510 (UMLS 2011AA ObjectClass)
ResearchCommentsText
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0282411 (UMLS 2011AA Property)
Namecode
Item
Name code
text
IBMTRIUBMID#(ifalreadyknownorassigned)
Item
IBMTR IUBMID # (if already known or assigned)
text
Item
Secondary race
text
CL.4
Code List
Secondary race
CL Item
White (not otherwise specified) (White (not otherwise specified))
CL Item
European (not otherwise specified) (European (not otherwise specified))
CL Item
Mediterranean (Mediterranean)
CL Item
White North American (White North American)
CL Item
South or Central American White (South or Central American White)
CL Item
Eastern European (Eastern European)
CL Item
Northern European (Northern European)
CL Item
Western European (Western European)
CL Item
White Caribbean (White Caribbean)
CL Item
North Coast of Africa (North Coast of Africa)
CL Item
Black (not otherwise specified) (Black (not otherwise specified))
CL Item
African American (African American)
CL Item
African Black (both parents born in Africa) (African Black (both parents born in Africa))
CL Item
Caribbean Black (Caribbean Black)
CL Item
South or Central American Black (South or Central American Black)
CL Item
Black, other specify (Black, other specify)
CL Item
Asian (not otherwise specified) (Asian (not otherwise specified))
CL Item
Indian/South Asian (Indian/South Asian)
CL Item
Filipino (pilipino) (Filipino (pilipino))
CL Item
Japanese (Japanese)
CL Item
Korean (Korean)
CL Item
Chinese (Chinese)
CL Item
Other Southeast Asian (Other Southeast Asian)
CL Item
Vietnamese (Vietnamese)
CL Item
Native American (not otherwise specified) (Native American (not otherwise specified))
CL Item
Native Alaskan/Eskimo/Aleut (Native Alaskan/Eskimo/Aleut)
CL Item
American Indian (not otherwise specified) (American Indian (not otherwise specified))
CL Item
North American Indian (North American Indian)
CL Item
South or Central American Indian (South or Central American Indian)
CL Item
Caribbean Indian (Caribbean Indian)
CL Item
Native Pacific Islander (not otherwise specified) (Native Pacific Islander (not otherwise specified))
CL Item
Guamanian (Guamanian)
CL Item
Hawaiian (Hawaiian)
CL Item
Samoan (Samoan)
CL Item
Unknown (Unknown)
CL Item
Other, specify (Other, specify)
CL Item
Not answered (Not answered)
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