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Informed Consent/Assent, Demographics

1 forms  
Administrative Data
Description

Administrative Data

Alias
UMLS CUI-1
C1320722
Site #
Description

Study centre number

Data type

integer

Alias
UMLS CUI [1,1]
C0600091
UMLS CUI [1,2]
C0019994
Patient #
Description

patient ID

Data type

integer

Alias
UMLS CUI [1]
C2348585
Visit Date
Description

visit date

Data type

date

Alias
UMLS CUI [1]
C1320303
Investigator Name
Description

Investigator Name

Data type

text

Alias
UMLS CUI [1]
C2826892
Informed Consent/Assent
Description

Informed Consent/Assent

Alias
UMLS CUI-1
C0021430
Date consent form/assent signed:
Description

(dd-mmm-yyyy)

Data type

date

Alias
UMLS CUI [1]
C2985782
UMLS CUI [2,1]
C5205794
UMLS CUI [2,2]
C0011008
Time consent form/assent signed:
Description

(0000-2359)

Data type

time

Alias
UMLS CUI [1]
C5206390
UMLS CUI [2,1]
C5205794
UMLS CUI [2,2]
C0040223
Demographics
Description

Demographics

Alias
UMLS CUI-1
C0011298
Date of Birth
Description

(dd-mmm-yyyy)

Data type

date

Alias
UMLS CUI [1]
C0421451
Sex
Description

gender

Data type

text

Alias
UMLS CUI [1]
C0079399
If patient is < 6 months old, number weeks gestation:
Description

Duration of gestation

Data type

integer

Measurement units
  • weeks
Alias
UMLS CUI [1]
C0460089
weeks
Corrected gestational age
Description

*Minimum corrected gestational age must be 37 weeks. If <44 weeks, a head ultrasound is required per protocol. (Record head ultrasound results on page 19 - Head Ultrasound Form.)

Data type

integer

Measurement units
  • weeks
Alias
UMLS CUI [1]
C3831006
weeks
Race
Description

Race

Data type

text

Alias
UMLS CUI [1]
C0034510
Other race, specify:
Description

Other race, specify

Data type

text

Alias
UMLS CUI [1,1]
C0034510
UMLS CUI [1,2]
C3845569
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Similar models

Informed Consent/Assent, Demographics

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Administrative Data
C1320722 (UMLS CUI-1)
Study centre number
Item
Site #
integer
C0600091 (UMLS CUI [1,1])
C0019994 (UMLS CUI [1,2])
patient ID
Item
Patient #
integer
C2348585 (UMLS CUI [1])
visit date
Item
Visit Date
date
C1320303 (UMLS CUI [1])
Investigator Name
Item
Investigator Name
text
C2826892 (UMLS CUI [1])
Item Group
Informed Consent/Assent
C0021430 (UMLS CUI-1)
Date of informed consent/assent
Item
Date consent form/assent signed:
date
C2985782 (UMLS CUI [1])
C5205794 (UMLS CUI [2,1])
C0011008 (UMLS CUI [2,2])
Informed consent time
Item
Time consent form/assent signed:
time
C5206390 (UMLS CUI [1])
C5205794 (UMLS CUI [2,1])
C0040223 (UMLS CUI [2,2])
Item Group
Demographics
C0011298 (UMLS CUI-1)
date of birth
Item
Date of Birth
date
C0421451 (UMLS CUI [1])
Item
Sex
text
C0079399 (UMLS CUI [1])
gender
Code List
Sex
CL Item
Male (Male)
CL Item
Female (Female)
Duration of gestation
Item
If patient is < 6 months old, number weeks gestation:
integer
C0460089 (UMLS CUI [1])
Corrected age
Item
Corrected gestational age
integer
C3831006 (UMLS CUI [1])
Item
Race
text
C0034510 (UMLS CUI [1])
Race
Code List
Race
CL Item
Asian (Asian)
CL Item
Black (Black)
CL Item
Caucasian (Caucasian)
CL Item
Hispanic (Hispanic)
CL Item
Other, Specify: (Other)
Other race, specify
Item
Other race, specify:
text
C0034510 (UMLS CUI [1,1])
C3845569 (UMLS CUI [1,2])
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