Demography
Date of birth
date
Sex
text
ETHNICITY • Hispanic or Latino A person of Cuban, Mexican, Puerto Rican, South American or other Spanish culture or origin, regardless of race Note: If the subject does not meet the definition above, ✔ Not Hispanic or Latino. • Not Hispanic or Latino Neither Hispanic or Latino
text
The racial groups below are based on the FDA and ICH Guidelines. Note: In order to provide for all eventualities, it is permissible to ✔ multiple boxes. A person having origins in any of the black racial groups of Africa
boolean
The racial groups below are based on the FDA and ICH Guidelines. Note: In order to provide for all eventualities, it is permissible to ✔ multiple boxes. A person having origins in any of the original peoples of North and South America (including Central America) and who maintains tribal affiliation or community attachment
boolean
The racial groups below are based on the FDA and ICH Guidelines. Note: In order to provide for all eventualities, it is permissible to ✔ multiple boxes. A person having origins in Central Asia and Indian Subcontinent (India, Pakistan, Bangladesh and Sri Lanka)
boolean
The racial groups below are based on the FDA and ICH Guidelines. Note: In order to provide for all eventualities, it is permissible to ✔ multiple boxes. A person having origins in China, Korea
boolean
The racial groups below are based on the FDA and ICH Guidelines. Note: In order to provide for all eventualities, it is permissible to ✔ multiple boxes. A person having origins in Japan
boolean
The racial groups below are based on the FDA and ICH Guidelines. Note: In order to provide for all eventualities, it is permissible to ✔ multiple boxes. A person having origins in Malaysia, the Philippines, Indonesia, Thailand, Vietnam, Laos, Burma or Cambodia
boolean
The racial groups below are based on the FDA and ICH Guidelines. Note: In order to provide for all eventualities, it is permissible to ✔ multiple boxes. A person having origins in any of the original peoples of Hawaii, Guam, Samoa or other Pacific Islands, Australia (Aborigines), Papua New Guinea, New Zealand, Marshalls and other island groups west and south of Japan
boolean
The racial groups below are based on the FDA and ICH Guidelines. Note: In order to provide for all eventualities, it is permissible to ✔ multiple boxes. A person having origins in any of the original peoples of Middle East or North Africa
boolean
The racial groups below are based on the FDA and ICH Guidelines. Note: In order to provide for all eventualities, it is permissible to ✔ multiple boxes. A person having origins in any of the original peoples of Europe
boolean