ID

3344

Description

The collection of CDEs used in the Participant ID module. Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=46716FCE-3AD1-70D5-E044-0003BA3F9857

Lien

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=46716FCE-3AD1-70D5-E044-0003BA3F9857

Mots-clés

Versions (3)
  1. 20/09/2012 20/09/2012 -
  2. 09/01/2015 09/01/2015 - Martin Dugas
  3. 20/09/2021 20/09/2021 -
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20 septembre 2012

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Pre-Study - NCI Standard Participant Identification Template - 2729615v1.0

Anglais

No Instruction available.

1 Formulaires  
  1. StudyEvent: NCI Standard Participant Identification Template
    1. No Instruction available.
Mandatory Participant Id Questions
Description

Mandatory Participant Id Questions

Participant Last Name
Description

PersonFamily/LastName

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus Property
C40975
UMLS 2011AA Property
C1301584
Participant First Name
Description

PersonGiven/FirstName

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus Property
C40974
UMLS 2011AA Property
C1443235
Optional Participant Id Questions
Description

Optional Participant Id Questions

Participant Middle Name
Description

PersonMiddleName

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Metathesaurus Property
CL316906
Person Name Suffix
Description

IndividualGenealogySuffixCode

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25162
UMLS 2011AA ValueDomain
C0805701
NCI Thesaurus ObjectClass
C17719
NCI Metathesaurus Property
C0017299
Participant Home Street Address
Description

PersonAddressName

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C25407
UMLS 2011AA Property
C1442065
Participant City
Description

AddressCityName

Type de données

text

Alias
NCI Thesaurus ObjectClass
C25407
UMLS 2011AA ObjectClass
C1442065
NCI Thesaurus ValueDomain
C42614
UMLS 2011AA ValueDomain
C0027365
NCI Thesaurus Property
C25160
UMLS 2011AA Property
C0008848
Participant State
Description

AddressState/ProvinceName

Type de données

text

Alias
NCI Thesaurus ObjectClass
C25407
UMLS 2011AA ObjectClass
C1442065
NCI Thesaurus ValueDomain
C42614
UMLS 2011AA ValueDomain
C0027365
NCI Thesaurus Property
C87194
UMLS 2011AA Property
C1301808
Participant Postal Code
Description

AddressPostalCodeIdentifier

Type de données

text

Alias
NCI Thesaurus ObjectClass
C25407
UMLS 2011AA ObjectClass
C1442065
NCI Thesaurus Property
C25621
UMLS 2011AA Property
C1514254
NCI Thesaurus ValueDomain
C25364
UMLS 2011AA ValueDomain
C0600091
NCI Thesaurus ValueDomain
C25407
UMLS 2011AA ValueDomain
C1442065
NCI Thesaurus ValueDomain
C25621
UMLS 2011AA ValueDomain
C1514254
Telephone Number Type
Description

TelephoneNumberType

Type de données

text

Alias
NCI Thesaurus Property
C25284
UMLS 2011AA Property
C0332307
NCI Metathesaurus ObjectClass
C0039449
NCI Metathesaurus ValueDomain
C0332307
Participant Phone
Description

TelephoneNumber

Type de données

text

Alias
NCI Thesaurus Property
C25337
UMLS 2011AA Property
C0237753
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C25395
UMLS 2011AA ObjectClass
C0039457
NCI Thesaurus ValueDomain
C17188
UMLS 2011AA ValueDomain
C0039449
Participant Initials
Description

PatientInitialsName

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25536
UMLS 2011AA Property
C1555582
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1 Formulaires
  1. StudyEvent: NCI Standard Participant Identification Template
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Type de données
Alias
Item Group
Mandatory Participant Id Questions
PersonFamily/LastName
Item
Participant Last Name
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C40975 (NCI Thesaurus Property)
C1301584 (UMLS 2011AA Property)
PersonGiven/FirstName
Item
Participant First Name
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C40974 (NCI Thesaurus Property)
C1443235 (UMLS 2011AA Property)
Item Group
Optional Participant Id Questions
PersonMiddleName
Item
Participant Middle Name
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
CL316906 (NCI Metathesaurus Property)
Item
Person Name Suffix
text
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
C17719 (NCI Thesaurus ObjectClass)
C0017299 (NCI Metathesaurus Property)
CL.1
Code List
Person Name Suffix
CL Item
First (I)
C25509 (NCI Thesaurus)
C1279901 (UMLS 2011AA)
CL Item
Second: C49463 (II)
C49463 (NCI Thesaurus)
C1705190 (UMLS 2011AA)
CL Item
Third (III)
C49464 (NCI Thesaurus)
C1705160 (UMLS 2011AA)
CL Item
Fourth (IV)
C49465 (NCI Thesaurus)
C1706303 (UMLS 2011AA)
CL Item
Junior (Jr.)
C49466 (NCI Thesaurus)
C1708595 (UMLS 2011AA)
CL Item
Senior (Sr.)
C49467 (NCI Thesaurus)
C1705825 (UMLS 2011AA)
PersonAddressName
Item
Participant Home Street Address
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25407 (NCI Thesaurus Property)
C1442065 (UMLS 2011AA Property)
AddressCityName
Item
Participant City
text
C25407 (NCI Thesaurus ObjectClass)
C1442065 (UMLS 2011AA ObjectClass)
C42614 (NCI Thesaurus ValueDomain)
C0027365 (UMLS 2011AA ValueDomain)
C25160 (NCI Thesaurus Property)
C0008848 (UMLS 2011AA Property)
Item
Participant State
text
C25407 (NCI Thesaurus ObjectClass)
C1442065 (UMLS 2011AA ObjectClass)
C42614 (NCI Thesaurus ValueDomain)
C0027365 (UMLS 2011AA ValueDomain)
C87194 (NCI Thesaurus Property)
C1301808 (UMLS 2011AA Property)
CL.2
Code List
Participant State
CL Item
Aguascalientes (Aguascalientes)
CL Item
Alabama (Alabama)
C0001895 (NCI Metathesaurus)
CL Item
Alaska (Alaska)
C0001905 (NCI Metathesaurus)
CL Item
Alberta (Alberta)
CL Item
American Samoa (American Samoa)
C17739 (NCI Thesaurus)
C0242536 (UMLS 2011AA)
CL Item
Arizona (Arizona)
C0003787 (NCI Metathesaurus)
CL Item
Arkansas (Arkansas)
C0003790 (NCI Metathesaurus)
CL Item
Baja California (Baja California)
CL Item
Baja California Sur (Baja California Sur)
CL Item
British Columbia (British Columbia)
C0006193 (NCI Metathesaurus)
CL Item
California (California)
C0006754 (NCI Metathesaurus)
CL Item
Campeche (Campeche)
CL Item
Chiapas (Chiapas)
CL Item
Chihuahua (Chihuahua)
CL Item
Coahuila De Zaragoza (Coahuila de Zaragoza)
CL Item
Colima (Colima)
CL Item
Colorado (Colorado)
C43501 (NCI Thesaurus)
C0009399 (UMLS 2011AA)
CL Item
Connecticut (Connecticut)
C0009778 (NCI Metathesaurus)
CL Item
Delaware (Delaware)
C0011198 (NCI Metathesaurus)
CL Item
District Of Columbia (District of Columbia)
C43456 (NCI Thesaurus)
C0012764 (UMLS 2011AA)
CL Item
Distrito Federal (Distrito Federal)
CL Item
Durango (Durango)
CL Item
Florida (Florida)
C43478 (NCI Thesaurus)
C0016253 (UMLS 2011AA)
CL Item
Georgia (Georgia)
C43477 (NCI Thesaurus)
C0017452 (UMLS 2011AA)
CL Item
Guam (Guam)
C16652 (NCI Thesaurus)
C0018309 (UMLS 2011AA)
CL Item
Guanajuato (Guanajuato)
CL Item
Guerrero (Guerrero)
CL Item
Hawaii (Hawaii)
C43510 (NCI Thesaurus)
C0018619 (UMLS 2011AA)
CL Item
Hildalgo (Hildalgo)
CL Item
Idaho (Idaho)
C43499 (NCI Thesaurus)
C0020787 (UMLS 2011AA)
CL Item
Illinois (Illinois)
C43491 (NCI Thesaurus)
C0020898 (UMLS 2011AA)
CL Item
Indiana (Indiana)
C43483 (NCI Thesaurus)
C0021206 (UMLS 2011AA)
CL Item
Iowa (Iowa)
C43487 (NCI Thesaurus)
C0022037 (UMLS 2011AA)
CL Item
Jalisco (Jalisco)
CL Item
Kansas (Kansas)
C43493 (NCI Thesaurus)
C0022497 (UMLS 2011AA)
CL Item
Kentucky (Kentucky)
C43484 (NCI Thesaurus)
C0022557 (UMLS 2011AA)
CL Item
Louisiana (Louisiana)
C43496 (NCI Thesaurus)
C0024024 (UMLS 2011AA)
CL Item
Maine (Maine)
C43457 (NCI Thesaurus)
C0024497 (UMLS 2011AA)
CL Item
Manitoba (Manitoba)
C0024726 (NCI Metathesaurus)
CL Item
Marshall Islands (Marshall Islands)
C16822 (NCI Thesaurus)
C0024851 (UMLS 2011AA)
CL Item
Maryland (Maryland)
C43471 (NCI Thesaurus)
C0024858 (UMLS 2011AA)
CL Item
Massachusetts (Massachusetts)
C43463 (NCI Thesaurus)
C0024874 (UMLS 2011AA)
CL Item
Mexico (Mexico)
C16850 (NCI Thesaurus)
C0025885 (UMLS 2011AA)
CL Item
Michigan (Michigan)
C43481 (NCI Thesaurus)
C0025939 (UMLS 2011AA)
CL Item
Michoacan De Ocampo (Michoacan de Ocampo)
CL Item
Micronesia (Micronesia)
C0026001 (NCI Metathesaurus)
CL Item
Minnesota (Minnesota)
C43486 (NCI Thesaurus)
C0026183 (UMLS 2011AA)
CL Item
Mississippi (Mississippi)
C43480 (NCI Thesaurus)
C0026221 (UMLS 2011AA)
CL Item
Missouri (Missouri)
C43492 (NCI Thesaurus)
C0026222 (UMLS 2011AA)
CL Item
Montana (Montana)
C43490 (NCI Thesaurus)
C0026506 (UMLS 2011AA)
CL Item
Morelos (Morelos)
CL Item
Nayarit (Nayarit)
CL Item
Nebraska (Nebraska)
C43494 (NCI Thesaurus)
C0027523 (UMLS 2011AA)
CL Item
Nevada (Nevada)
C43503 (NCI Thesaurus)
C0027951 (UMLS 2011AA)
CL Item
New Brunswick (New Brunswick)
C0027963 (NCI Metathesaurus)
CL Item
New Hampshire (New Hampshire)
C43460 (NCI Thesaurus)
C0027969 (UMLS 2011AA)
CL Item
New Jersey (New Jersey)
C43467 (NCI Thesaurus)
C0027971 (UMLS 2011AA)
CL Item
New Mexico (New Mexico)
C43504 (NCI Thesaurus)
C0027972 (UMLS 2011AA)
CL Item
New York (New York)
C43468 (NCI Thesaurus)
C0027976 (UMLS 2011AA)
CL Item
Newfoundland (Newfoundland)
C0027985 (NCI Metathesaurus)
CL Item
North Carolina (North Carolina)
C43474 (NCI Thesaurus)
C0028407 (UMLS 2011AA)
CL Item
North Dakota (North Dakota)
C43488 (NCI Thesaurus)
C0028408 (UMLS 2011AA)
CL Item
Northern Mariana Islands (Northern Mariana Islands)
C17882 (NCI Thesaurus)
C0282245 (UMLS 2011AA)
CL Item
Northwest Territories (Northwest Territories)
C0028417 (NCI Metathesaurus)
CL Item
Nova Scotia (Nova Scotia)
C0028441 (NCI Metathesaurus)
CL Item
Nuevo Leon (Nuevo Leon)
CL Item
Nunavut (Nunavut)
C0752343 (NCI Metathesaurus)
CL Item
Oaxaca (Oaxaca)
CL Item
Ohio (Ohio)
C43482 (NCI Thesaurus)
C0028905 (UMLS 2011AA)
CL Item
Oklahoma (Oklahoma)
C43497 (NCI Thesaurus)
C0028914 (UMLS 2011AA)
CL Item
Ontario (Ontario)
C0029040 (NCI Metathesaurus)
CL Item
Oregon (Oregon)
C43508 (NCI Thesaurus)
C0029195 (UMLS 2011AA)
CL Item
Palau (Palau)
C17733 (NCI Thesaurus)
C0242397 (UMLS 2011AA)
CL Item
Pennsylvania (Pennsylvania)
C43469 (NCI Thesaurus)
C0030853 (UMLS 2011AA)
CL Item
Prince Edward Island (Prince Edward Island)
C0033157 (NCI Metathesaurus)
CL Item
Puebla (Puebla)
CL Item
Puerto Rico (Puerto Rico)
C17043 (NCI Thesaurus)
C0034044 (UMLS 2011AA)
CL Item
Quebec (Quebec)
C0034390 (NCI Metathesaurus)
CL Item
Queretaro De Arteaga (Queretaro de Arteaga)
CL Item
Quintana Roo (Quintana Roo)
CL Item
Rhode Island (Rhode Island)
C43464 (NCI Thesaurus)
C0035487 (UMLS 2011AA)
CL Item
San Luis Potosi (San Luis Potosi)
CL Item
Saskatchewan (Saskatchewan)
C0036234 (NCI Metathesaurus)
CL Item
Sinaloa (Sinaloa)
CL Item
Sonora (Sonora)
CL Item
South Carolina (South Carolina)
C43475 (NCI Thesaurus)
C0037716 (UMLS 2011AA)
CL Item
South Dakota (South Dakota)
C43489 (NCI Thesaurus)
C0037717 (UMLS 2011AA)
CL Item
Tabasco (Tabasco)
CL Item
Tamaulipas (Tamaulipas)
CL Item
Tennessee (Tennessee)
C43476 (NCI Thesaurus)
C0039514 (UMLS 2011AA)
CL Item
Texas (Texas)
C43498 (NCI Thesaurus)
C0039711 (UMLS 2011AA)
CL Item
Tlaxcala (Tlaxcala)
CL Item
Us Minor Outlying Islands (US Minor Outlying Islands)
CL Item
Utah (Utah)
C43502 (NCI Thesaurus)
C0042124 (UMLS 2011AA)
CL Item
Veracruz-llave (Veracruz-Llave)
CL Item
Vermont (Vermont)
C43462 (NCI Thesaurus)
C0042537 (UMLS 2011AA)
CL Item
Virgin Islands Of The Us (Virgin Islands of the US)
CL Item
Virginia (Virginia)
C43472 (NCI Thesaurus)
C0042753 (UMLS 2011AA)
CL Item
Washington (Washington)
C43507 (NCI Thesaurus)
C0043038 (UMLS 2011AA)
CL Item
West Virginia (West Virginia)
C43473 (NCI Thesaurus)
C0043127 (UMLS 2011AA)
CL Item
Wisconsin (Wisconsin)
C43485 (NCI Thesaurus)
C0043193 (UMLS 2011AA)
CL Item
Wyoming (Wyoming)
C43500 (NCI Thesaurus)
C0043287 (UMLS 2011AA)
CL Item
Yucatan (Yucatan)
CL Item
Yukon Territory (Yukon Territory)
C0043438 (NCI Metathesaurus)
CL Item
Zacatecas (Zacatecas)
AddressPostalCodeIdentifier
Item
Participant Postal Code
text
C25407 (NCI Thesaurus ObjectClass)
C1442065 (UMLS 2011AA ObjectClass)
C25621 (NCI Thesaurus Property)
C1514254 (UMLS 2011AA Property)
C25364 (NCI Thesaurus ValueDomain)
C0600091 (UMLS 2011AA ValueDomain)
C25407 (NCI Thesaurus ValueDomain)
C1442065 (UMLS 2011AA ValueDomain)
C25621 (NCI Thesaurus ValueDomain)
C1514254 (UMLS 2011AA ValueDomain)
Item
Telephone Number Type
text
C25284 (NCI Thesaurus Property)
C0332307 (UMLS 2011AA Property)
C0039449 (NCI Metathesaurus ObjectClass)
C0332307 (NCI Metathesaurus ValueDomain)
CL.3
Code List
Telephone Number Type
CL Item
Cellular Telephone (Cellular)
C60787 (NCI Thesaurus)
C1136359 (UMLS 2011AA)
CL Item
Facsimile Machine (Facsimile)
C60789 (NCI Thesaurus)
C1880669 (UMLS 2011AA)
CL Item
Home (Home)
C18002 (NCI Thesaurus)
C0442519 (UMLS 2011AA)
CL Item
Mobile Telephone (Mobile Telephone)
C60786 (NCI Thesaurus)
C1136360 (UMLS 2011AA)
CL Item
Modem Device Component (Modem)
C50072 (NCI Thesaurus)
C1704655 (UMLS 2011AA)
CL Item
Pager (Pager)
C64350 (NCI Thesaurus)
C0179284 (UMLS 2011AA)
CL Item
Worksite: C17556 (Work)
C17556 (NCI Thesaurus)
C0162579 (UMLS 2011AA)
TelephoneNumber
Item
Participant Phone
text
C25337 (NCI Thesaurus Property)
C0237753 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25395 (NCI Thesaurus ObjectClass)
C0039457 (UMLS 2011AA ObjectClass)
C17188 (NCI Thesaurus ValueDomain)
C0039449 (UMLS 2011AA ValueDomain)
PatientInitialsName
Item
Participant Initials
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25536 (NCI Thesaurus Property)
C1555582 (UMLS 2011AA Property)
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