Registration Header
Protocol ID Coordinating Group
text
Coordinating Group Code
text
Protocol Title
text
PathologyCoreFacilityLaboratoryIdentifierNumber
text
Patient Initials
text
Medical Record Number
text
ParticipatingGroupIdentifierCode
text
Institution Name
text
Data amended
boolean
Header
PatientPre-studyEligibilityDeterminationType
text
Header
Pre-studyEligibilityDeterminationFormSubmittedType
text
PatientPre-studyEligibilityDeterminationType
text
Contact Person For Pathology Results
ContactPersonLastIdentifierName
text
ContactPersonFirstIdentifierName
text
ContactPersonTelephoneNumber
text
ContactPersonFaxNumber
text
ContactPersonE-mailText
text
Contact Person For Pathology Results
ContactPersonLastIdentifierName
text
ContactPersonFirstIdentifierName
text
ContactPersonTelephoneNumber
text
ContactPersonFaxNumber
text
ContactPersonE-mailText
text
Header
Pre-studyEligibilityDeterminationFormSubmittedType
text
PatientPre-studyEligibilityDeterminationType
text
Contact Person For Pathology Results
ContactPersonLastIdentifierName
text
ContactPersonFirstIdentifierName
text
ContactPersonTelephoneNumber
text
ContactPersonFaxNumber
text
ContactPersonE-mailText
text
Contact Person For Pathology Results
ContactPersonLastIdentifierName
text
ContactPersonFirstIdentifierName
text
ContactPersonTelephoneNumber
text
ContactPersonFaxNumber
text
ContactPersonE-mailText
text
Patient Demographics/pre-treatment Characteristics
Gender
text
Patient Birth Date
date
AddressPostalCodeIdentifier
text
Country of current residence
text
PatientPaymentType
text
Racial Group
text
Ethnic Group
text