ID

43024

Description

2804 Revision 3 - CIBMTR Recipient ID Assignment Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=89B7CC18-3E3B-B38F-E040-BB89AD433571

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=89B7CC18-3E3B-B38F-E040-BB89AD433571

Keywords

Clinical Trial

Registration

Uploaded on

September 17, 2021

DOI

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License

Creative Commons BY-NC 3.0 Legacy

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Registration - 2804 Revision 3 - CIBMTR Recipient ID Assignment Form - 3113592v1.0

model
Details

The form PDF contains information for "Sequence Number" and "Date Received." Since these fields are ignored by the FormsNet 2 application, they have been omitted on the Form Builder report. In addition, those CDEs in the module "Form Processing" are not contained on the form PDF. They are used for AGNIS processing.

1 forms

StudyEvent: 2804 Revision 3 - CIBMTR Recipient ID Assignment Form
1. The form PDF contains information for "Sequence Number" and "Date Received." Since these fields are ignored by the FormsNet 2 application, they have been omitted on the Form Builder report. In addition, those CDEs in the module "Form Processing" are not contained on the form PDF. They are used for AGNIS processing.

Name

Type

Description | Question | Decode (Coded Value)

Data type

Alias

Identification Data

Item Group

Identification Data

HematopoieticStemCellTransplantationRecipientInstitution::CenterforInternationalBloodandMarrowTransplantResearchFacilityNumber

Item

CIBMTR Center Number:

float

C12551 (NCI Thesaurus ObjectClass)
C0018956 (UMLS 2011AA ObjectClass)
C15342 (NCI Thesaurus ObjectClass-2)
C0029216 (UMLS 2011AA ObjectClass-2)
C53268 (NCI Thesaurus Property)
C1709854 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C41206 (NCI Thesaurus ValueDomain-2)
C1272753 (UMLS 2011AA ValueDomain-2)
C62574 (NCI Thesaurus ValueDomain-3)
C1547538 (UMLS 2011AA ValueDomain-3)

ClinicalDataFormTodayDate

Item

Today's date:

date

C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C19464 (NCI Thesaurus Property)
C0376315 (UMLS 2011AA Property)
C15783 (NCI Thesaurus ObjectClass)
C1516606 (UMLS 2011AA ObjectClass)
C41134 (NCI Thesaurus ValueDomain-2)
C0750526 (UMLS 2011AA ValueDomain-2)

Recipient Data Part 1 of 4

Item Group

Recipient Date

Institution::CenterForInternationalBloodAndMarrowResearchRecipientIdentificationNumberAssignmentReason

Item

What is the indication for CIBMTR recipient ID (CRID) assignment?

text

C25337 (NCI Thesaurus ObjectClass)
C0237753 (UMLS 2011AA ObjectClass)
C53268 (NCI Thesaurus ObjectClass-2)
C1709854 (UMLS 2011AA ObjectClass-2)
C25737 (NCI Thesaurus ObjectClass-3)
C0205396 (UMLS 2011AA ObjectClass-3)
C41206 (NCI Thesaurus ObjectClass-4)
C1272753 (UMLS 2011AA ObjectClass-4)
C25426 (NCI Thesaurus ObjectClass-5)
C1516050 (UMLS 2011AA ObjectClass-5)
C25638 (NCI Thesaurus Property)
C0392360 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25638 (NCI Thesaurus ValueDomain-2)
C0392360 (UMLS 2011AA ValueDomain-2)
C25737 (NCI Thesaurus ValueDomain-3)
C0205396 (UMLS 2011AA ValueDomain-3)
C25426 (NCI Thesaurus ValueDomain-4)
C1516050 (UMLS 2011AA ValueDomain-4)
C41184 (NCI Thesaurus ValueDomain-5)
C0392360 (UMLS 2011AA ValueDomain-5)

CL.1

Code List

What is the indication for CIBMTR recipient ID (CRID) assignment?

CL Item

Hematopoietic Stem Cell Transplantation (HSCT)

C12551 (NCI Thesaurus)
C0018956 (UMLS 2011AA)
C15342 (NCI Thesaurus-3)
C0029216 (UMLS 2011AA-4)

CL Item

Cellular Therapy Regenerative Medicine (Cellular therapy for regenerative medicine)

C70601 (NCI Thesaurus)
C0302189 (UMLS 2011AA)
C93254 (NCI Thesaurus-3)

CL Item

Mds Negation Hematopoietic Stem Cell Transplantation Therapeutic Procedure (Non-transplant therapy for MDS)

C25594 (NCI Thesaurus)
C1518422 (UMLS 2011AA)
C3247 (NCI Thesaurus-3)
C3463824 (UMLS 2011AA-4)
C12551 (NCI Thesaurus-5)
C0018956 (UMLS 2011AA-6)
C15342 (NCI Thesaurus-7)
C0029216 (UMLS 2011AA-8)
C49236 (NCI Thesaurus-9)
C0087111 (UMLS 2011AA-10)

CL Item

Other (Other)

C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)

Institution::CenterForInternationalBloodAndMarrowResearchRecipientIdentificationNumberAssignmentReasonSpecifyText

Item

Specify other indication for CRID assignment:

text

C25337 (NCI Thesaurus ObjectClass)
C0237753 (UMLS 2011AA ObjectClass)
C53268 (NCI Thesaurus ObjectClass-2)
C1709854 (UMLS 2011AA ObjectClass-2)
C25737 (NCI Thesaurus ObjectClass-3)
C0205396 (UMLS 2011AA ObjectClass-3)
C41206 (NCI Thesaurus ObjectClass-4)
C1272753 (UMLS 2011AA ObjectClass-4)
C25426 (NCI Thesaurus ObjectClass-5)
C1516050 (UMLS 2011AA ObjectClass-5)
C25638 (NCI Thesaurus Property)
C0392360 (UMLS 2011AA Property)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C25704 (NCI Thesaurus ValueDomain-2)
C1527021 (UMLS 2011AA ValueDomain-2)

Recipient Data Part 2 of 4

Item Group

Recipient Data Part 2 Of 3

StudyParticipationOccurrenceIndicator

Item

Is the recipient participating in any clinical trials? (To facilitate FormsNet validation, this CDE is included in the repeating module.)

boolean

C25608 (NCI Thesaurus ObjectClass)
C0679823 (UMLS 2011AA ObjectClass)
C71104 (NCI Thesaurus ObjectClass-2)
C0008976 (UMLS 2011AA ObjectClass-2)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C49488 (NCI Thesaurus ValueDomain-2)
C1705108 (UMLS 2011AA ValueDomain-2)
C49487 (NCI Thesaurus ValueDomain-3)
C1298908 (UMLS 2011AA ValueDomain-3)
C48660 (NCI Thesaurus ValueDomain-4)
C1272460 (UMLS 2011AA ValueDomain-4)
C17998 (NCI Thesaurus ValueDomain-5)
C0439673 (UMLS 2011AA ValueDomain-5)
C49484 (NCI Thesaurus ValueDomain-6)
C1272696 (UMLS 2011AA ValueDomain-6)

CoordinatingGroupIdentifierGroupName

Item

Specify the group that is administering the clinical trial:

text

C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C17005 (NCI Thesaurus ObjectClass)
C1257890 (UMLS 2011AA ObjectClass)
C25462 (NCI Thesaurus ObjectClass-2)
C0700114 (UMLS 2011AA ObjectClass-2)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)

CL.3

Code List

Specify the group that is administering the clinical trial:

CL Item

Bmt Ctn (BMT CTN)

CL Item

Rci Bmt (RCI BMT)

CL Item

Other (Other)

C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)

CoordinatingGroupIdentifierSpecifyText

Item

Specify other group:

text

C17005 (NCI Thesaurus ObjectClass)
C1257890 (UMLS 2011AA ObjectClass)
C25462 (NCI Thesaurus ObjectClass-2)
C0700114 (UMLS 2011AA ObjectClass-2)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C25704 (NCI Thesaurus ValueDomain-2)
C1527021 (UMLS 2011AA ValueDomain-2)

ClinicalStudyProtocolIdentifierNumber

Item

Study ID number:

text

C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C42651 (NCI Thesaurus Property)
C0442711 (UMLS 2011AA Property)
C15206 (NCI Thesaurus ObjectClass)
C0008972 (UMLS 2011AA ObjectClass)
C83082 (NCI Thesaurus ValueDomain-2)
C2826693 (UMLS 2011AA ValueDomain-2)

Recipient Data Part 3 of 4

Item Group

Recipient Data Part 3 Of 4

FacilityDataSetStorageAnd/OrCreationDesignatedInstitution::CenterForInternationalBlood&MarrowTransplantResearchIndicator

Item

Has your center designated the CIBMTR to store and create a data set? (For autologous HSCTs only.)

boolean

C47824 (NCI Thesaurus ObjectClass)
C0150098 (UMLS 2011AA ObjectClass)
C62574 (NCI Thesaurus ObjectClass-2)
C1547538 (UMLS 2011AA ObjectClass-2)
C48928 (NCI Thesaurus Property)
C1706528 (UMLS 2011AA Property)
C42620 (NCI Thesaurus Property-2)
C1706214 (UMLS 2011AA Property-2)
C41206 (NCI Thesaurus Property-3)
C1272753 (UMLS 2011AA Property-3)
C60824 (NCI Thesaurus Property-4)
C1698986 (UMLS 2011AA Property-4)
C25479 (NCI Thesaurus Property-5)
C1524084 (UMLS 2011AA Property-5)
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C49488 (NCI Thesaurus ValueDomain-2)
C1705108 (UMLS 2011AA ValueDomain-2)
C49487 (NCI Thesaurus ValueDomain-3)
C1298908 (UMLS 2011AA ValueDomain-3)
C48660 (NCI Thesaurus ValueDomain-4)
C1272460 (UMLS 2011AA ValueDomain-4)
C17998 (NCI Thesaurus ValueDomain-5)
C0439673 (UMLS 2011AA ValueDomain-5)
C49484 (NCI Thesaurus ValueDomain-6)
C1272696 (UMLS 2011AA ValueDomain-6)

HematopoieticStemCellTransplantationRecipientResearchDataSharedConsentYesNoCharacterIndicator

Item

Has the recipient given written consent to allow his / her transplant data to be used for research? (For autologous HSCTs only.)

boolean

C12551 (NCI Thesaurus ObjectClass)
C0018956 (UMLS 2011AA ObjectClass)
C15342 (NCI Thesaurus ObjectClass-2)
C0029216 (UMLS 2011AA ObjectClass-2)
C15319 (NCI Thesaurus Property)
C25474 (NCI Thesaurus Property-2)
C1511726 (UMLS 2011AA Property)
C53268 (NCI Thesaurus Property-3)
C1709854 (UMLS 2011AA Property-2)
C25460 (NCI Thesaurus Property-4)
C1511481 (UMLS 2011AA Property-3)
C38019 (NCI Thesaurus Property-5)
C1522138 (UMLS 2011AA Property-4)
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)

PersonGiven/FirstName

Item

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-2)
C1443235 (UMLS 2011AA Property-2)

PersonFamily/LastName

Item

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-2)
C1301584 (UMLS 2011AA Property-2)

Birth Date

Item

Recipient date of birth: (For autologous HSCTs at centers that are not using the CIBMTR as their data repository and the recipient has not given consent to allow his / her transplant data to be used for research, report year of birth only.)

date

C25164 (NCI Thesaurus ValueDomain)
C0421451 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25155 (NCI Thesaurus Property)

AddressCityName

Item

City: (Recipient location of birth.)

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)
C25160 (NCI Thesaurus ValueDomain-2)
C0008848 (UMLS 2011AA ValueDomain-2)

AddressState/ProvinceName

Item

State: (Recipient location of birth.)

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.6

Code List

State: (Recipient location of birth.)

CL Item

Alabama (Alabama)

C0001895 (NCI Metathesaurus)

CL Item

Alaska (Alaska)

C0001905 (NCI Metathesaurus)

CL Item

Arizona (Arizona)

C0003787 (NCI Metathesaurus)

CL Item

Arkansas (Arkansas)

C0003790 (NCI Metathesaurus)

CL Item

California (California)

C0006754 (NCI Metathesaurus)

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

Florida (Florida)

C43478 (NCI Thesaurus)
C0016253 (UMLS 2011AA)

CL Item

Georgia (Georgia)

C43477 (NCI Thesaurus)
C0017452 (UMLS 2011AA)

CL Item

Hawaii (Hawaii)

C43510 (NCI Thesaurus)
C0018619 (UMLS 2011AA)

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

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

Maryland (Maryland)

C43471 (NCI Thesaurus)
C0024858 (UMLS 2011AA)

CL Item

Massachusetts (Massachusetts)

C43463 (NCI Thesaurus)
C0024874 (UMLS 2011AA)

CL Item

Michigan (Michigan)

C43481 (NCI Thesaurus)
C0025939 (UMLS 2011AA)

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

Nebraska (Nebraska)

C43494 (NCI Thesaurus)
C0027523 (UMLS 2011AA)

CL Item

Nevada (Nevada)

C43503 (NCI Thesaurus)
C0027951 (UMLS 2011AA)

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

North Carolina (North Carolina)

C43474 (NCI Thesaurus)
C0028407 (UMLS 2011AA)

CL Item

North Dakota (North Dakota)

C43488 (NCI Thesaurus)
C0028408 (UMLS 2011AA)

CL Item

Ohio (Ohio)

C43482 (NCI Thesaurus)
C0028905 (UMLS 2011AA)

CL Item

Oklahoma (Oklahoma)

C43497 (NCI Thesaurus)
C0028914 (UMLS 2011AA)

CL Item

Oregon (Oregon)

C43508 (NCI Thesaurus)
C0029195 (UMLS 2011AA)

CL Item

Pennsylvania (Pennsylvania)

C43469 (NCI Thesaurus)
C0030853 (UMLS 2011AA)

CL Item

Rhode Island (Rhode Island)

C43464 (NCI Thesaurus)
C0035487 (UMLS 2011AA)

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

Tennessee (Tennessee)

C43476 (NCI Thesaurus)
C0039514 (UMLS 2011AA)

CL Item

Texas (Texas)

C43498 (NCI Thesaurus)
C0039711 (UMLS 2011AA)

CL Item

Utah (Utah)

C43502 (NCI Thesaurus)
C0042124 (UMLS 2011AA)

CL Item

Vermont (Vermont)

C43462 (NCI Thesaurus)
C0042537 (UMLS 2011AA)

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)

AddressCountryName

Item

Country: (Recipient location of birth.)

text

C25464 (NCI Thesaurus Property)
C0454664 (UMLS 2011AA Property)
C25464 (NCI Thesaurus ValueDomain)
C0454664 (UMLS 2011AA ValueDomain)
C25407 (NCI Thesaurus ObjectClass)
C1442065 (UMLS 2011AA ObjectClass)
C42614 (NCI Thesaurus ValueDomain-2)
C0027365 (UMLS 2011AA ValueDomain-2)

CL.7

Code List

Country: (Recipient location of birth.)

CL Item

Afghanistan (Afghanistan)

C16267 (NCI Thesaurus)
C0001732 (UMLS 2011AA)

CL Item

Aland Islands (Aland Islands)

CL Item

Albania (Albania)

CL Item

Algeria (Algeria)

CL Item

American Samoa (American Samoa)

CL Item

Andorra (Andorra)

CL Item

Angola (Angola)

CL Item

Anguilla (Anguilla)

CL Item

Antarctica (Antarctica)

CL Item

Antigua And Barbuda (Antigua and Barbuda)

CL Item

Argentina (Argentina)

C16305 (NCI Thesaurus)
C0003761 (UMLS 2011AA)

CL Item

Armenia (Armenia)

CL Item

Aruba (Aruba)

CL Item

Australia (Australia)

C16311 (NCI Thesaurus)
C0004340 (UMLS 2011AA)

CL Item

Austria (Austria)

C16312 (NCI Thesaurus)
C0004348 (UMLS 2011AA)

CL Item

Azerbaijan (Azerbaijan)

CL Item

Bahamas (Bahamas)

CL Item

Bahrain (Bahrain)

CL Item

Bangladesh (Bangladesh)

CL Item

Barbados (Barbados)

CL Item

Belarus (Belarus)

CL Item

Belgium (Belgium)

C16329 (NCI Thesaurus)
C0004950 (UMLS 2011AA)

CL Item

Belize (Belize)

CL Item

Benin Republic (Benin Republic)

CL Item

Bermuda (Bermuda)

CL Item

Bhutan (Bhutan)

CL Item

Bolivia (Bolivia)

CL Item

Bosnia-herzegovina (Bosnia and Herzegovinia)

C16361 (NCI Thesaurus)
C0006036 (UMLS 2011AA)

CL Item

Botswana (Botswana)

CL Item

Bouvet Island (Bouvet Island)

CL Item

Brazil (Brazil)

C16364 (NCI Thesaurus)
C0006137 (UMLS 2011AA)

CL Item

British Indian Ocean Territory (British Indian Ocean Territory)

CL Item

Brunei Darussalam (Brunei Darussalam)

CL Item

Bulgaria (Bulgaria)

CL Item

Burkina Faso (Burkina Faso)

CL Item

Burundi (Burundi)

CL Item

Cambodia (Cambodia)

CL Item

Cameroon (Cameroon)

CL Item

Canada (Canada)

C16380 (NCI Thesaurus)
C0006823 (UMLS 2011AA)

CL Item

Cape Verde (Cape Verde)

CL Item

Cayman Islands (Cayman Islands)

CL Item

Central African Republic (Central African Republic)

CL Item

Chad (Chad)

CL Item

Chile (Chile)

C16427 (NCI Thesaurus)
C0008107 (UMLS 2011AA)

CL Item

China (China)

C16428 (NCI Thesaurus)
C0008115 (UMLS 2011AA)

CL Item

Christmas Island (Christmas Island)

CL Item

Cocos (keeling) Islands (Cocos (Keeling) Islands)

CL Item

Colombia (Colombia)

CL Item

Comoros (Comoros)

CL Item

Congo (Congo)

CL Item

Congo, The Democratic Republic Of The (Congo, the Democratic Republic of the)

CL Item

Cook Islands (Cook Islands)

CL Item

Costa Rica (Costa Rica)

C16470 (NCI Thesaurus)
C0010182 (UMLS 2011AA)

CL Item

Cote D'ivoire (Cote d'Ivoire)

CL Item

Croatia (Croatia)

C16474 (NCI Thesaurus)
C0010343 (UMLS 2011AA)

CL Item

Cuba (Cuba)

C16477 (NCI Thesaurus)
C0010435 (UMLS 2011AA)

CL Item

Cyprus (Cyprus)

C16480 (NCI Thesaurus)
C0010622 (UMLS 2011AA)

CL Item

Czech Republic (Czech Republic)

C17668 (NCI Thesaurus)
C0206578 (UMLS 2011AA)

CL Item

Denmark (Denmark)

C16496 (NCI Thesaurus)
C0011318 (UMLS 2011AA)

CL Item

Djibouti (Djibouti)

CL Item

Dominica (Dominica)

CL Item

Dominican Republic (Dominican Republic)

CL Item

Ecuador (Ecuador)

CL Item

Egypt (Egypt)

C16530 (NCI Thesaurus)
C0013715 (UMLS 2011AA)

CL Item

El Salvador (El Salvador)

CL Item

Equatorial Guinea (Equatorial Guinea)

CL Item

Eritrea (Eritrea)

C16558 (NCI Thesaurus)
C0014716 (UMLS 2011AA)

CL Item

Estonia (Estonia)

C16562 (NCI Thesaurus)
C0014908 (UMLS 2011AA)

CL Item

Ethiopia (Ethiopia)

C16563 (NCI Thesaurus)
C0015024 (UMLS 2011AA)

CL Item

Falkland Islands (Falkland Islands)

C17954 (NCI Thesaurus)
C0349396 (UMLS 2011AA)

CL Item

Faroe Islands (Faroe Islands)

C16573 (NCI Thesaurus)
C0015541 (UMLS 2011AA)

CL Item

Fiji (Fiji)

C16582 (NCI Thesaurus)
C0016080 (UMLS 2011AA)

CL Item

Finland (Finland)

C16584 (NCI Thesaurus)
C0016132 (UMLS 2011AA)

CL Item

France (France)

C16592 (NCI Thesaurus)
C0016674 (UMLS 2011AA)

CL Item

French Guiana (French Guiana)

C16593 (NCI Thesaurus)
C0016703 (UMLS 2011AA)

CL Item

French Polynesia (French Polynesia)

C16594 (NCI Thesaurus)
C0016704 (UMLS 2011AA)

CL Item

French Southern Territories (French Southern Territories)

C20105 (NCI Thesaurus)
C1517317 (UMLS 2011AA)

CL Item

Gabon (Gabon)

C16596 (NCI Thesaurus)
C0016910 (UMLS 2011AA)

CL Item

Gambia (Gambia)

C16598 (NCI Thesaurus)
C0016993 (UMLS 2011AA)

CL Item

Georgia (Georgia)

C16634 (NCI Thesaurus)
C0017454 (UMLS 2011AA)

CL Item

Germany (Germany)

C16636 (NCI Thesaurus)
C0017480 (UMLS 2011AA)

CL Item

Ghana (Ghana)

C26330 (NCI Thesaurus)
C0017516 (UMLS 2011AA)

CL Item

Gibraltar (Gibraltar)

C16638 (NCI Thesaurus)
C0017540 (UMLS 2011AA)

CL Item

Greece (Greece)

C16645 (NCI Thesaurus)
C0018226 (UMLS 2011AA)

CL Item

Greenland (Greenland)

C16646 (NCI Thesaurus)
C0018229 (UMLS 2011AA)

CL Item

Grenada (Grenada)

C16647 (NCI Thesaurus)
C0018232 (UMLS 2011AA)

CL Item

Guadeloupe (Guadeloupe)

C16651 (NCI Thesaurus)
C0018301 (UMLS 2011AA)

CL Item

Guam (Guam)

C16652 (NCI Thesaurus)
C0018309 (UMLS 2011AA)

CL Item

Guatemala (Guatemala)

C16654 (NCI Thesaurus)
C0018367 (UMLS 2011AA)

CL Item

Guernsey (Guernsey)

C64375 (NCI Thesaurus)
C0018370 (UMLS 2011AA)

CL Item

Guinea (Guinea)

C16655 (NCI Thesaurus)
C0018381 (UMLS 2011AA)

CL Item

Guinea-bissau (Guinea-Bissau)

C16656 (NCI Thesaurus)
C0018387 (UMLS 2011AA)

CL Item

Guyana (Guyana)

C16657 (NCI Thesaurus)
C0018408 (UMLS 2011AA)

CL Item

Haiti (Haiti)

C16660 (NCI Thesaurus)
C0018510 (UMLS 2011AA)

CL Item

Heard Island And Mcdonald Islands (Heard Island and McDonald Islands)

C20106 (NCI Thesaurus)
C1512358 (UMLS 2011AA)

CL Item

Holy See (Holy See)

C17249 (NCI Thesaurus)
C0042427 (UMLS 2011AA)

CL Item

Honduras (Honduras)

C16694 (NCI Thesaurus)
C0019905 (UMLS 2011AA)

CL Item

Hong Kong (Hong Kong)

C16695 (NCI Thesaurus)
C0019907 (UMLS 2011AA)

CL Item

Hungary (Hungary)

C16699 (NCI Thesaurus)
C0020174 (UMLS 2011AA)

CL Item

Iceland (Iceland)

C16704 (NCI Thesaurus)
C0020750 (UMLS 2011AA)

CL Item

India (India)

C16727 (NCI Thesaurus)
C0021201 (UMLS 2011AA)

CL Item

Indonesia (Indonesia)

C16728 (NCI Thesaurus)
C0021247 (UMLS 2011AA)

CL Item

Iran (Iran)

C16755 (NCI Thesaurus)
C0022065 (UMLS 2011AA)

CL Item

Iraq (Iraq)

C16756 (NCI Thesaurus)
C0022066 (UMLS 2011AA)

CL Item

Ireland (Ireland)

C16757 (NCI Thesaurus)
C0022067 (UMLS 2011AA)

CL Item

Isle Of Man (Isle of Man)

C44480 (NCI Thesaurus)
C0022132 (UMLS 2011AA)

CL Item

Israel (Israel)

C16760 (NCI Thesaurus)
C0022271 (UMLS 2011AA)

CL Item

Italy (Italy)

C16761 (NCI Thesaurus)
C0022277 (UMLS 2011AA)

CL Item

Jamaica (Jamaica)

C16763 (NCI Thesaurus)
C0022337 (UMLS 2011AA)

CL Item

Japan (Japan)

C16764 (NCI Thesaurus)
C0022341 (UMLS 2011AA)

CL Item

Jersey (Jersey)

C64374 (NCI Thesaurus)
C0454673 (UMLS 2011AA)

CL Item

Jordan (Jordan)

C16765 (NCI Thesaurus)
C0022418 (UMLS 2011AA)

CL Item

Kazakhstan (Kazakhstan)

C20107 (NCI Thesaurus)
C0022537 (UMLS 2011AA)

CL Item

Kenya (Kenya)

C16769 (NCI Thesaurus)
C0022558 (UMLS 2011AA)

CL Item

Kiribati (Kiribati)

C16639 (NCI Thesaurus)
C0017550 (UMLS 2011AA)

CL Item

North Korea (North Korea)

C16773 (NCI Thesaurus)
C0022772 (UMLS 2011AA)

CL Item

South Korea (South Korea)

C16774 (NCI Thesaurus)
C0022773 (UMLS 2011AA)

CL Item

Kuwait (Kuwait)

C16775 (NCI Thesaurus)
C0022804 (UMLS 2011AA)

CL Item

Kyrgyzstan (Kyrgyzstan)

C16771 (NCI Thesaurus)
C0022718 (UMLS 2011AA)

CL Item

Lao People's Democratic Republic (Lao People's Democratic Republic)

C16780 (NCI Thesaurus)
C0023034 (UMLS 2011AA)

CL Item

Latvia (Latvia)

C16783 (NCI Thesaurus)
C0023128 (UMLS 2011AA)

CL Item

Lebanon (Lebanon)

C16784 (NCI Thesaurus)
C0023190 (UMLS 2011AA)

CL Item

Lesotho (Lesotho)

C16787 (NCI Thesaurus)
C0023376 (UMLS 2011AA)

CL Item

Liberia (Liberia)

C16791 (NCI Thesaurus)
C0023617 (UMLS 2011AA)

CL Item

Libyan Arab Jamahiriya (Libyan Arab Jamahiriya)

C16793 (NCI Thesaurus)
C0023634 (UMLS 2011AA)

CL Item

Liechtenstein (Liechtenstein)

C16794 (NCI Thesaurus)
C0023668 (UMLS 2011AA)

CL Item

Lithuania (Lithuania)

C16799 (NCI Thesaurus)
C0023879 (UMLS 2011AA)

CL Item

Luxembourg (Luxembourg)

C16803 (NCI Thesaurus)
C0024176 (UMLS 2011AA)

CL Item

Macau (Macau)

C16807 (NCI Thesaurus)
C0024403 (UMLS 2011AA)

CL Item

Republic Of Macedonia (Macedonia)

C17654 (NCI Thesaurus)
C0206004 (UMLS 2011AA)

CL Item

Madagascar (Madagascar)

C16808 (NCI Thesaurus)
C0024443 (UMLS 2011AA)

CL Item

Malawi (Malawi)

C16813 (NCI Thesaurus)
C0024548 (UMLS 2011AA)

CL Item

Malaysia (Malaysia)

C16814 (NCI Thesaurus)
C0024552 (UMLS 2011AA)

CL Item

Maldives (Maldives)

C16815 (NCI Thesaurus)
C0024553 (UMLS 2011AA)

CL Item

Mali (Mali)

C16816 (NCI Thesaurus)
C0024581 (UMLS 2011AA)

CL Item

Malta (Malta)

C16817 (NCI Thesaurus)
C0024653 (UMLS 2011AA)

CL Item

Marshall Islands (Marshall Islands)

C16822 (NCI Thesaurus)
C0024851 (UMLS 2011AA)

CL Item

Martinique (Martinique)

C16823 (NCI Thesaurus)
C0024853 (UMLS 2011AA)

CL Item

Mauritania (Mauritania)

C16826 (NCI Thesaurus)
C0024943 (UMLS 2011AA)

CL Item

Mauritius (Mauritius)

C16827 (NCI Thesaurus)
C0024944 (UMLS 2011AA)

CL Item

Mayotte (Mayotte)

C16828 (NCI Thesaurus)
C0024974 (UMLS 2011AA)

CL Item

Mexico (Mexico)

C16850 (NCI Thesaurus)
C0025885 (UMLS 2011AA)

CL Item

Micronesia (Micronesia)

C0026001 (NCI Metathesaurus)

CL Item

Moldova (Moldova)

C16871 (NCI Thesaurus)
C0026374 (UMLS 2011AA)

CL Item

Monaco (Monaco)

C16874 (NCI Thesaurus)
C0026405 (UMLS 2011AA)

CL Item

Mongolia (Mongolia)

C16875 (NCI Thesaurus)
C0026410 (UMLS 2011AA)

CL Item

Montenegro (Montenegro)

C64378 (NCI Thesaurus)
C0026510 (UMLS 2011AA)

CL Item

Montserrat (Montserrat)

C16876 (NCI Thesaurus)
C0026514 (UMLS 2011AA)

CL Item

Morocco (Morocco)

C16878 (NCI Thesaurus)
C0026544 (UMLS 2011AA)

CL Item

Mozambique (Mozambique)

C16882 (NCI Thesaurus)
C0026655 (UMLS 2011AA)

CL Item

Myanmar (Myanmar)

C16370 (NCI Thesaurus)
C0006416 (UMLS 2011AA)

CL Item

Namibia (Namibia)

C16891 (NCI Thesaurus)
C0027366 (UMLS 2011AA)

CL Item

Nauru (Nauru)

C16896 (NCI Thesaurus)
C0027496 (UMLS 2011AA)

CL Item

Nepal (Nepal)

C16901 (NCI Thesaurus)
C0027689 (UMLS 2011AA)

CL Item

Netherlands (Netherlands)

C16903 (NCI Thesaurus)
C0027778 (UMLS 2011AA)

CL Item

Netherlands Antilles (Netherlands Antilles)

C16904 (NCI Thesaurus)
C0027779 (UMLS 2011AA)

CL Item

New Caledonia (New Caledonia)

C16913 (NCI Thesaurus)
C0027964 (UMLS 2011AA)

CL Item

New Zealand (New Zealand)

C16914 (NCI Thesaurus)
C0027978 (UMLS 2011AA)

CL Item

Nicaragua (Nicaragua)

C16915 (NCI Thesaurus)
C0028002 (UMLS 2011AA)

CL Item

Niger (Niger)

C16916 (NCI Thesaurus)
C0028074 (UMLS 2011AA)

CL Item

Nigeria (Nigeria)

C16917 (NCI Thesaurus)
C0028075 (UMLS 2011AA)

CL Item

Niue (Niue)

C16918 (NCI Thesaurus)
C0028219 (UMLS 2011AA)

CL Item

Norfolk Island (Norfolk Island)

C16919 (NCI Thesaurus)
C0028366 (UMLS 2011AA)

CL Item

Northern Mariana Islands (Northern Mariana Islands)

C17882 (NCI Thesaurus)
C0282245 (UMLS 2011AA)

CL Item

Norway (Norway)

C16920 (NCI Thesaurus)
C0028423 (UMLS 2011AA)

CL Item

Oman (Oman)

C16933 (NCI Thesaurus)
C0028971 (UMLS 2011AA)

CL Item

Pakistan (Pakistan)

C16949 (NCI Thesaurus)
C0030211 (UMLS 2011AA)

CL Item

Palau (Palau)

C17733 (NCI Thesaurus)
C0242397 (UMLS 2011AA)

CL Item

Palestinian Territory, Occupied (Palestinian Territory, Occupied)

C20110 (NCI Thesaurus)
C1518860 (UMLS 2011AA)

CL Item

Panama (Panama)

C16951 (NCI Thesaurus)
C0030266 (UMLS 2011AA)

CL Item

Papua New Guinea (Papua New Guinea)

C16952 (NCI Thesaurus)
C0030375 (UMLS 2011AA)

CL Item

Paraguay (Paraguay)

C16953 (NCI Thesaurus)
C0030428 (UMLS 2011AA)

CL Item

Peru (Peru)

C16972 (NCI Thesaurus)
C0031238 (UMLS 2011AA)

CL Item

Philippines (Philippines)

C16978 (NCI Thesaurus)
C0031529 (UMLS 2011AA)

CL Item

Pitcairn (Pitcairn)

C16993 (NCI Thesaurus)
C0031995 (UMLS 2011AA)

CL Item

Poland (Poland)

C17002 (NCI Thesaurus)
C0032356 (UMLS 2011AA)

CL Item

Portugal (Portugal)

C17006 (NCI Thesaurus)
C0032729 (UMLS 2011AA)

CL Item

Puerto Rico (Puerto Rico)

C17043 (NCI Thesaurus)
C0034044 (UMLS 2011AA)

CL Item

Qatar (Qatar)

C17045 (NCI Thesaurus)
C0034366 (UMLS 2011AA)

CL Item

Reunion (Reunion)

C17095 (NCI Thesaurus)
C0035373 (UMLS 2011AA)

CL Item

Romania (Romania)

C17108 (NCI Thesaurus)
C0035826 (UMLS 2011AA)

CL Item

Russia (Russia)

C17111 (NCI Thesaurus)
C0035970 (UMLS 2011AA)

CL Item

Rwanda (Rwanda)

C17112 (NCI Thesaurus)
C0035978 (UMLS 2011AA)

CL Item

Saint Barthelemy (Saint Barthelemy)

C83609 (NCI Thesaurus)
C2827109 (UMLS 2011AA)

CL Item

Saint Helena (Saint Helena)

C17164 (NCI Thesaurus)
C0038108 (UMLS 2011AA)

CL Item

Saint Kitts And Nevis (Saint Kitts and Nevis)

C17885 (NCI Thesaurus)
C0282380 (UMLS 2011AA)

CL Item

Saint Lucia (Saint Lucia)

C17113 (NCI Thesaurus)
C0036056 (UMLS 2011AA)

CL Item

Saint Martin, French (Saint Martin, French)

C83610 (NCI Thesaurus)
C2827110 (UMLS 2011AA)

CL Item

Saint Pierre And Miquelon (Saint Pierre and Miquelon)

C17165 (NCI Thesaurus)
C0038111 (UMLS 2011AA)

CL Item

Saint Vincent And The Grenadines (Saint Vincent and the Grenadines)

C17114 (NCI Thesaurus)
C0036057 (UMLS 2011AA)

CL Item

Samoa (Samoa)

C17740 (NCI Thesaurus)
C0242537 (UMLS 2011AA)

CL Item

San Marino (San Marino)

C17115 (NCI Thesaurus)
C0036154 (UMLS 2011AA)

CL Item

Sao Tome And Principe (Sao Tome and Principe)

C17116 (NCI Thesaurus)
C0036183 (UMLS 2011AA)

CL Item

Saudi Arabia (Saudi Arabia)

C17117 (NCI Thesaurus)
C0036243 (UMLS 2011AA)

CL Item

Senegal (Senegal)

C17121 (NCI Thesaurus)
C0036644 (UMLS 2011AA)

CL Item

Serbia (Serbia)

C64377 (NCI Thesaurus)
C0036708 (UMLS 2011AA)

CL Item

Seychelles (Seychelles)

C17129 (NCI Thesaurus)
C0036919 (UMLS 2011AA)

CL Item

Sierra Leone (Sierra Leone)

C17130 (NCI Thesaurus)
C0037063 (UMLS 2011AA)

CL Item

Singapore (Singapore)

C17134 (NCI Thesaurus)
C0037173 (UMLS 2011AA)

CL Item

Slovakia (Slovak Republic)

C17669 (NCI Thesaurus)
C0206579 (UMLS 2011AA)

CL Item

Slovenia (Slovenia)

C17138 (NCI Thesaurus)
C0037334 (UMLS 2011AA)

CL Item

Solomon Islands (Solomon Islands)

C17148 (NCI Thesaurus)
C0037623 (UMLS 2011AA)

CL Item

Somalia (Somalia)

C17149 (NCI Thesaurus)
C0037640 (UMLS 2011AA)

CL Item

South Africa (South Africa)

C17151 (NCI Thesaurus)
C0037712 (UMLS 2011AA)

CL Item

South Georgia And The South Sandwich Islands (South Georgia and the South Sandwich Islands)

C20111 (NCI Thesaurus)
C1519428 (UMLS 2011AA)

CL Item

Spain (Spain)

C17152 (NCI Thesaurus)
C0037747 (UMLS 2011AA)

CL Item

Sri Lanka (Sri Lanka)

C17163 (NCI Thesaurus)
C0038088 (UMLS 2011AA)

CL Item

Sudan (Sudan)

C17170 (NCI Thesaurus)
C0038642 (UMLS 2011AA)

CL Item

Suriname (Suriname)

C17175 (NCI Thesaurus)
C0038944 (UMLS 2011AA)

CL Item

Svalbard And Jan Mayen (Svalbard and Jan Mayen)

C17178 (NCI Thesaurus)
C1515101 (UMLS 2011AA)

CL Item

Swaziland (Swaziland)

C17179 (NCI Thesaurus)
C0038983 (UMLS 2011AA)

CL Item

Sweden (Sweden)

C17180 (NCI Thesaurus)
C0038995 (UMLS 2011AA)

CL Item

Switzerland (Switzerland)

C17181 (NCI Thesaurus)
C0039021 (UMLS 2011AA)

CL Item

Syria (Syrian Arab Republic)

C17182 (NCI Thesaurus)
C0039138 (UMLS 2011AA)

CL Item

Taiwan (Taiwan)

C17184 (NCI Thesaurus)
C0039260 (UMLS 2011AA)

CL Item

Tajikistan (Tajikistan)

C17183 (NCI Thesaurus)
C0039247 (UMLS 2011AA)

CL Item

Tanzania (Tanzania)

C17185 (NCI Thesaurus)
C0039298 (UMLS 2011AA)

CL Item

Thailand (Thailand)

C17192 (NCI Thesaurus)
C0039725 (UMLS 2011AA)

CL Item

East Timor (Timor-Leste)

C17200 (NCI Thesaurus)
C1452561 (UMLS 2011AA)

CL Item

Togo (Togo)

C17202 (NCI Thesaurus)
C0040363 (UMLS 2011AA)

CL Item

Tokelau (Tokelau)

C17704 (NCI Thesaurus)
C0220928 (UMLS 2011AA)

CL Item

Tonga (Tonga)

C17205 (NCI Thesaurus)
C0040407 (UMLS 2011AA)

CL Item

Trinidad And Tobago (Trinidad and Tobago)

C17217 (NCI Thesaurus)
C0041061 (UMLS 2011AA)

CL Item

Tunisia (Tunisia)

C17221 (NCI Thesaurus)
C0041388 (UMLS 2011AA)

CL Item

Turkey (Turkey)

C17222 (NCI Thesaurus)
C0041400 (UMLS 2011AA)

CL Item

Turkmenistan (Turkmenistan)

C17223 (NCI Thesaurus)
C0041403 (UMLS 2011AA)

CL Item

Turks And Caicos Islands (Turks and Caicos Islands)

C17224 (NCI Thesaurus)
C0041405 (UMLS 2011AA)

CL Item

Tuvalu (Tuvalu)

C17225 (NCI Thesaurus)
C0041413 (UMLS 2011AA)

CL Item

Uganda (Uganda)

C17228 (NCI Thesaurus)
C0041573 (UMLS 2011AA)

CL Item

Ukraine (Ukraine)

C17229 (NCI Thesaurus)
C0041580 (UMLS 2011AA)

CL Item

United Arab Emirates (United Arab Emirates)

C17232 (NCI Thesaurus)
C0041698 (UMLS 2011AA)

CL Item

United Kingdom (United Kingdom (England, Wales, Scotland, Northern Ireland))

C17233 (NCI Thesaurus)
C0041700 (UMLS 2011AA)

CL Item

United States (United States)

C17234 (NCI Thesaurus)
C0041703 (UMLS 2011AA)

CL Item

United States Minor Outlying Islands (United States Minor Outlying Islands)

C20112 (NCI Thesaurus)
C1519796 (UMLS 2011AA)

CL Item

Uruguay (Uruguay)

C17244 (NCI Thesaurus)
C0042113 (UMLS 2011AA)

CL Item

Uzbekistan (Uzbekistan)

C17246 (NCI Thesaurus)
C0042177 (UMLS 2011AA)

CL Item

Vanuatu (Vanuatu)

C17247 (NCI Thesaurus)
C0042321 (UMLS 2011AA)

CL Item

Venezuela (Venezuela)

C17250 (NCI Thesaurus)
C0042469 (UMLS 2011AA)

CL Item

Vietnam (Vietnam)

C17252 (NCI Thesaurus)
C0042658 (UMLS 2011AA)

CL Item

British Virgin Islands (British Virgin Islands)

C17653 (NCI Thesaurus)
C0205999 (UMLS 2011AA)

CL Item

United States Virgin Islands (United States Virgin Islands)

C17255 (NCI Thesaurus)
C0042752 (UMLS 2011AA)

CL Item

Wallis And Futuna Islands (Wallis and Futuna Islands)

C17259 (NCI Thesaurus)
C0043021 (UMLS 2011AA)

CL Item

Western Sahara (Western Sahara)

C20113 (NCI Thesaurus)
C1520135 (UMLS 2011AA)

CL Item

Yemen (Yemen)

C17264 (NCI Thesaurus)
C0043402 (UMLS 2011AA)

CL Item

Zambia (Zambia)

C17267 (NCI Thesaurus)
C0043445 (UMLS 2011AA)

CL Item

Zimbabwe (Zimbabwe)

C17268 (NCI Thesaurus)
C0043476 (UMLS 2011AA)

PersonSexGenderType

Item

Recipient Gender:

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C28421 (NCI Thesaurus Property)
C1522384 (UMLS 2011AA Property)

CL.8

Code List

Recipient Gender:

CL Item

Male (male)

C20197 (NCI Thesaurus)
C0086582 (UMLS 2011AA)

CL Item

Female (female)

C16576 (NCI Thesaurus)
C0086287 (UMLS 2011AA)

PersonSocialSecurityNumber

Item

Recipient Social Security number:

text

C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25686 (NCI Thesaurus Property)
C1301821 (UMLS 2011AA Property)

PersonSocialSecurityNumberDataValidationIndicator

Item

If necessary, please validate the Social Security number response:

text

C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25686 (NCI Thesaurus Property)
C1301821 (UMLS 2011AA Property)
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C25474 (NCI Thesaurus ValueDomain-2)
C1511726 (UMLS 2011AA ValueDomain-2)
C16237 (NCI Thesaurus ValueDomain-3)
C1519941 (UMLS 2011AA ValueDomain-3)

CL.9

Code List

If necessary, please validate the Social Security number response:

CL Item

Not Applicable (Not applicable)

C48660 (NCI Thesaurus)
C1272460 (UMLS 2011AA)

PatientInstitution::NationalMarrowDonorProgramIdentifier

Item

Recipient NMDP ID:

float

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25364 (NCI Thesaurus ValueDomain)
C0600091 (UMLS 2011AA ValueDomain)
C41206 (NCI Thesaurus ValueDomain-2)
C1272753 (UMLS 2011AA ValueDomain-2)

PatientIdentifierDataValidationIndicator

Item

If necessary, please validate patient identifier response.

text

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C25474 (NCI Thesaurus ValueDomain-2)
C1511726 (UMLS 2011AA ValueDomain-2)
C16237 (NCI Thesaurus ValueDomain-3)
C1519941 (UMLS 2011AA ValueDomain-3)

CL.10

Code List

If necessary, please validate patient identifier response.

CL Item

Not Applicable (Not applicable)

C48660 (NCI Thesaurus)
C1272460 (UMLS 2011AA)

PatientIdentifierInstitution::EuropeanGroupforBloodAndMarrowTransplantationIdentifier

Item

Recipient EBMT ID:

text

ClinicsandHospitalsIdentifierInstitution::EuropeanGroupforBloodAndMarrowTransplantationFacilityNumber

Item

EBMT CIC:

float

C19326 (NCI Thesaurus ObjectClass)
C0587906 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C41206 (NCI Thesaurus ValueDomain-2)
C1272753 (UMLS 2011AA ValueDomain-2)
C62574 (NCI Thesaurus ValueDomain-3)
C1547538 (UMLS 2011AA ValueDomain-3)

PatientAndClinicsandHospitalsEntityIdentifierDataValidationIndicator

Item

If necessary, please validate the recipient IUBMID and / or Team ID response.

text

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C37912 (NCI Thesaurus ObjectClass-2)
C1515981 (UMLS 2011AA ObjectClass-2)
C19326 (NCI Thesaurus ObjectClass-3)
C0587906 (UMLS 2011AA ObjectClass-3)
C51070 (NCI Thesaurus ObjectClass-4)
C1551338 (UMLS 2011AA ObjectClass-4)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C25474 (NCI Thesaurus ValueDomain-2)
C1511726 (UMLS 2011AA ValueDomain-2)
C16237 (NCI Thesaurus ValueDomain-3)
C1519941 (UMLS 2011AA ValueDomain-3)

CL.12

Code List

If necessary, please validate the recipient IUBMID and / or Team ID response.

CL Item

Not Applicable (Not applicable)

C48660 (NCI Thesaurus)
C1272460 (UMLS 2011AA)

Recipient Data Part 4 of 4

Item Group

Recipient Date

PatientIdentifierInstitutionBloodOrBoneMarrowUniqueIdentifierNumber

Item

Recipient IUBMID: (Former CIBMTR #)

text

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C12431 (NCI Thesaurus ValueDomain-2)
C0005953 (UMLS 2011AA ValueDomain-2)
C37998 (NCI Thesaurus ValueDomain-3)
C1518602 (UMLS 2011AA ValueDomain-3)
C12434 (NCI Thesaurus ValueDomain-4)
C0229664 (UMLS 2011AA ValueDomain-4)
C41206 (NCI Thesaurus ValueDomain-5)
C1272753 (UMLS 2011AA ValueDomain-5)
C70663 (NCI Thesaurus ValueDomain-6)
C2349022 (UMLS 2011AA ValueDomain-6)

ClinicsandHospitalsIdentifierNumber

Item

Team ID: (Former CIBMTR #)

float

C19326 (NCI Thesaurus ObjectClass)
C0587906 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25364 (NCI Thesaurus ValueDomain-2)
C0600091 (UMLS 2011AA ValueDomain-2)
C19326 (NCI Thesaurus ValueDomain-3)
C0587906 (UMLS 2011AA ValueDomain-3)

MotherMaidenName

Item

Recipient's mother's maiden name: (Optional for non-U.S. centers)

text

C25189 (NCI Thesaurus ObjectClass)
C0026591 (UMLS 2011AA ObjectClass)
C42614 (NCI Thesaurus ValueDomain)
C0027365 (UMLS 2011AA ValueDomain)
C25381 (NCI Thesaurus Property)
C0806887 (UMLS 2011AA Property)

ScheduleInfusionProcedurePerformedDate

Item

Tentative infusion date:

date

C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C15388 (NCI Thesaurus ObjectClass)
C0574032 (UMLS 2011AA ObjectClass)
C25211 (NCI Thesaurus ObjectClass-2)
C0086960 (UMLS 2011AA ObjectClass-2)

PatientAndClinicsandHospitalsEntityIdentifierDataValidationIndicator

Item

If necessary, please validate the recipient IUBMID and / or Team ID response.

text

CL.12

Code List

If necessary, please validate the recipient IUBMID and / or Team ID response.

CL Item

Not Applicable (Not applicable)

C48660 (NCI Thesaurus)
C1272460 (UMLS 2011AA)

Hematopoietic Stem Cell Transplant (HSCT) Part 1 of 4

Item Group

Recipient Date

HematopoieticStemCellGraftSourceName

Item

Cell source for the HSCT: (Planned)

text

C12551 (NCI Thesaurus ObjectClass)
C0018956 (UMLS 2011AA ObjectClass)
C12981 (NCI Thesaurus ObjectClass-2)
C0332835 (UMLS 2011AA ObjectClass-2)
C25683 (NCI Thesaurus Property)
C0449416 (UMLS 2011AA Property)
C12551 (NCI Thesaurus ValueDomain)
C0018956 (UMLS 2011AA ValueDomain)
C25683 (NCI Thesaurus ValueDomain-2)
C0449416 (UMLS 2011AA ValueDomain-2)
C42614 (NCI Thesaurus ValueDomain-3)
C0027365 (UMLS 2011AA ValueDomain-3)

CL.13

Code List

Cell source for the HSCT: (Planned)

CL Item

Autologous (Autologous)

C28000 (NCI Thesaurus)
C0439859 (UMLS 2011AA)

CL Item

Unrelated Allogenic (Allogeneic, unrelated)

C25328 (NCI Thesaurus)
C0445356 (UMLS 2011AA)
C28343 (NCI Thesaurus-3)
C1515895 (UMLS 2011AA-4)

CL Item

Related Allogenic (Allogeneic, related)

C25648 (NCI Thesaurus)
C0439849 (UMLS 2011AA)
C28343 (NCI Thesaurus-3)
C1515895 (UMLS 2011AA-4)

CL Item

Syngeneic (Syngeneic (identical twin))

HematopoieticStemCellGraftSourceTherapyInd-2

Item

Was a particular hematopoietic stem cell source used?

boolean

C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C12551 (NCI Thesaurus ObjectClass)
C0018956 (UMLS 2011AA ObjectClass)
C12981 (NCI Thesaurus ObjectClass-2)
C0332835 (UMLS 2011AA ObjectClass-2)
C25683 (NCI Thesaurus Property)
C0449416 (UMLS 2011AA Property)

Hematopoietic Stem Cell Transplant (HSCT) Part 2 of 4

Item Group

Hematopoietic Stem Cell Transplant Date Part 2 Of 4

HematopoieticStemCellGraftTypeName

Item

Product type (Planned)

text

C12551 (NCI Thesaurus ObjectClass)
C0018956 (UMLS 2011AA ObjectClass)
C12981 (NCI Thesaurus ObjectClass-2)
C0332835 (UMLS 2011AA ObjectClass-2)
C25284 (NCI Thesaurus Property)
C0332307 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C12551 (NCI Thesaurus ValueDomain-2)
C0018956 (UMLS 2011AA ValueDomain-2)
C12981 (NCI Thesaurus ValueDomain-3)
C0332835 (UMLS 2011AA ValueDomain-3)
C42614 (NCI Thesaurus ValueDomain-4)
C0027365 (UMLS 2011AA ValueDomain-4)

CL.15

Code List

Product type (Planned)

CL Item

Bone Marrow (Marrow)

C12431 (NCI Thesaurus)
C0005953 (UMLS 2011AA)

CL Item

Peripheral Blood Stem Cell (PBSC)

C12946 (NCI Thesaurus)
C1518999 (UMLS 2011AA)

CL Item

Umbilical Cord Blood (Cord blood)

C13300 (NCI Thesaurus)
C0162371 (UMLS 2011AA)

CL Item

Multiple Umbilical Cord Blood (Multiple cord blood units infused)

C13300 (NCI Thesaurus)
C0162371 (UMLS 2011AA)
C17648 (NCI Thesaurus-3)
C0439064 (UMLS 2011AA-4)

CL Item

Other (Other)

C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)

HematopoieticStemCellGraftTypeTherapyInd-2

Item

Was a particular hematopoietic stem cell transplant type used?

boolean

C25284 (NCI Thesaurus Property)
C0332307 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C12551 (NCI Thesaurus ObjectClass)
C0018956 (UMLS 2011AA ObjectClass)
C12981 (NCI Thesaurus ObjectClass-2)
C0332835 (UMLS 2011AA ObjectClass-2)

HematopoieticStemCellGraftOtherTypeSpecify

Item

Specify other product: (Answer only if the response to CDE 2730912 is "Other.")

text

C12551 (NCI Thesaurus ObjectClass)
C0018956 (UMLS 2011AA ObjectClass)
C12981 (NCI Thesaurus ObjectClass-2)
C0332835 (UMLS 2011AA ObjectClass-2)
C25284 (NCI Thesaurus Property)
C0332307 (UMLS 2011AA Property)
C17649 (NCI Thesaurus Property-2)
C0205394 (UMLS 2011AA Property-2)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C17649 (NCI Thesaurus ValueDomain-2)
C0205394 (UMLS 2011AA ValueDomain-2)

Hematopoietic Stem Cell Transplant (HSCT) Data Part 3 of 4

Item Group

Hematopoietic Stem Cell Transplant Part 3 Of 4

HematopoieticStemCellTransplantationDiseasePrimaryClassificationType

Item

Primary disease for which the HSCT would be performed:

text

C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C12551 (NCI Thesaurus ObjectClass-2)
C0018956 (UMLS 2011AA ObjectClass-2)
C15342 (NCI Thesaurus ObjectClass-3)
C0029216 (UMLS 2011AA ObjectClass-3)
C25251 (NCI Thesaurus Property)
C0205225 (UMLS 2011AA Property)
C25161 (NCI Thesaurus Property-2)
C0008902 (UMLS 2011AA Property-2)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25251 (NCI Thesaurus ValueDomain-2)
C0205225 (UMLS 2011AA ValueDomain-2)
C2991 (NCI Thesaurus ValueDomain-3)
C0012634 (UMLS 2011AA ValueDomain-3)

CL.17

Code List

Primary disease for which the HSCT would be performed:

CL Item

Acute Myeloid Leukemia (Acute myelogenous leukemia (AML or ANLL))

C3171 (NCI Thesaurus)
C0023467 (UMLS 2011AA)

CL Item

All (Acute lymphoblastic leukemia (ALL))

C3167 (NCI Thesaurus)
C0023449 (UMLS 2011AA)

CL Item

Other Acute Leukemia (Other acute leukemia)

C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
C9300 (NCI Thesaurus-3)
C0085669 (UMLS 2011AA-4)

CL Item

Chronic Myelogenous Leukemia (Chronic myelogenous leukemia (CML))

C3174 (NCI Thesaurus)
C0023473 (UMLS 2011AA)

CL Item

Myelodysplastic/myeloproliferative Disease (Myelodysplastic (MDS) / myeloproliferative (MPS) disorders)

C27262 (NCI Thesaurus)
C1301355 (UMLS 2011AA)

CL Item

Other Leukemia (Other leukemias)

C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
C3161 (NCI Thesaurus-3)
C0023418 (UMLS 2011AA-4)

CL Item

Hodgkin's Lymphoma (Hodgkin lymphoma)

C9357 (NCI Thesaurus)
C0019829 (UMLS 2011AA)

CL Item

Non-hodgkin's Lymphoma (Non-Hodgkin lymphoma)

C3211 (NCI Thesaurus)
C0024305 (UMLS 2011AA)

CL Item

Plasma Cell Myeloma (Multiple myeloma / plasma cell disorder (PCD))

C3242 (NCI Thesaurus)
C0026764 (UMLS 2011AA)

CL Item

Breast Carcinoma (Breast Cancer)

C4872 (NCI Thesaurus)
C0678222 (UMLS 2011AA)

CL Item

Other Diseases And Disorders (Other disease)

C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
C2991 (NCI Thesaurus-3)
C0012634 (UMLS 2011AA-4)

CL Item

Other Malignant Neoplasm (Other malignancies)

C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
C9305 (NCI Thesaurus-3)
C0006826 (UMLS 2011AA-4)

CL Item

Severe Aplastic Anemia (Severe aplastic anemia)

C61229 (NCI Thesaurus)
C1883018 (UMLS 2011AA)

CL Item

Congenital Abnormalities Of Erythrocyte Differentiation Or Function (Inherited abnormalities of erythrocyte differentiation or function)

C61234 (NCI Thesaurus)
C1880167 (UMLS 2011AA)

CL Item

Platelet Diseases And Disorders (Platelet disorder)

C2991 (NCI Thesaurus)
C0012634 (UMLS 2011AA)
C12520 (NCI Thesaurus-3)
C0005821 (UMLS 2011AA-4)

CL Item

Histiocytic Disorders (Histiocytic disorders)

CL Item

Congenital Metabolic Disorder Osteopetrosis (Inherited disorders of metabolism / osteopetrosis)

C34816 (NCI Thesaurus)
C0025521 (UMLS 2011AA)
C26840 (NCI Thesaurus-3)
C0029454 (UMLS 2011AA-4)

CL Item

Immunodeficiency Syndrome (Immune deficiencies)

C3131 (NCI Thesaurus)
C0021051 (UMLS 2011AA)

CL Item

Autoimmune Disease (Autoimmune Disorder)

C2889 (NCI Thesaurus)
C0004364 (UMLS 2011AA)

Hematopoietic Stem Cell Transplant (HSCT) Data Part 4 of 4

Item Group

Hematopoietic Stem Cell Transplant Part 4 Of 4

HematopoieticStemCellTransplantationFirstOccurrenceIndicator

Item

Is this the first HSCT for this recipient? (Do not include donor cellular infusions. To facilitate FormsNet validation, this CDE is included in the repeating module.)

boolean

C12551 (NCI Thesaurus ObjectClass)
C0018956 (UMLS 2011AA ObjectClass)
C15342 (NCI Thesaurus ObjectClass-2)
C0029216 (UMLS 2011AA ObjectClass-2)
C25509 (NCI Thesaurus Property)
C1279901 (UMLS 2011AA Property)
C25275 (NCI Thesaurus Property-2)
C2745955 (UMLS 2011AA Property-2)
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C49488 (NCI Thesaurus ValueDomain-2)
C1705108 (UMLS 2011AA ValueDomain-2)
C49487 (NCI Thesaurus ValueDomain-3)
C1298908 (UMLS 2011AA ValueDomain-3)
C48660 (NCI Thesaurus ValueDomain-4)
C1272460 (UMLS 2011AA ValueDomain-4)
C17998 (NCI Thesaurus ValueDomain-5)
C0439673 (UMLS 2011AA ValueDomain-5)
C49484 (NCI Thesaurus ValueDomain-6)
C1272696 (UMLS 2011AA ValueDomain-6)

PriorHematopoieticStemCellTransplantationPerformedDate

Item

Date of previous HSCT:

date

PriorAutologousHematopoieticStemCellTransplantationPerformedIndicator

Item

Autologous (Cell sources for previous HSCT.)

boolean

C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C12551 (NCI Thesaurus ObjectClass-2)
C0018956 (UMLS 2011AA ObjectClass-2)
C15342 (NCI Thesaurus ObjectClass-3)
C0029216 (UMLS 2011AA ObjectClass-3)
C28000 (NCI Thesaurus ObjectClass-4)
C0439859 (UMLS 2011AA ObjectClass-4)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C49488 (NCI Thesaurus ValueDomain-2)
C1705108 (UMLS 2011AA ValueDomain-2)
C49487 (NCI Thesaurus ValueDomain-3)
C1298908 (UMLS 2011AA ValueDomain-3)
C48660 (NCI Thesaurus ValueDomain-4)
C1272460 (UMLS 2011AA ValueDomain-4)
C17998 (NCI Thesaurus ValueDomain-5)
C0439673 (UMLS 2011AA ValueDomain-5)
C49484 (NCI Thesaurus ValueDomain-6)
C1272696 (UMLS 2011AA ValueDomain-6)

PriorUnrelatedAllogenicHematopoieticStemCellTransplantationPerformedIndicator

Item

Allogeneic, unrelated (Cell sources for previous HSCT.)

boolean

C25328 (NCI Thesaurus ObjectClass)
C0445356 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus ObjectClass-2)
C0332152 (UMLS 2011AA ObjectClass-2)
C12551 (NCI Thesaurus ObjectClass-3)
C0018956 (UMLS 2011AA ObjectClass-3)
C15342 (NCI Thesaurus ObjectClass-4)
C0029216 (UMLS 2011AA ObjectClass-4)
C28343 (NCI Thesaurus ObjectClass-5)
C1515895 (UMLS 2011AA ObjectClass-5)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C49488 (NCI Thesaurus ValueDomain-2)
C1705108 (UMLS 2011AA ValueDomain-2)
C49487 (NCI Thesaurus ValueDomain-3)
C1298908 (UMLS 2011AA ValueDomain-3)
C48660 (NCI Thesaurus ValueDomain-4)
C1272460 (UMLS 2011AA ValueDomain-4)
C17998 (NCI Thesaurus ValueDomain-5)
C0439673 (UMLS 2011AA ValueDomain-5)
C49484 (NCI Thesaurus ValueDomain-6)
C1272696 (UMLS 2011AA ValueDomain-6)

PriorBiologicalRelativeAllogenicHematopoieticStemCellTransplantationPerformedIndicator

Item

Allogeneic, related (Cell sources for previous HSCT.)

boolean

C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C12551 (NCI Thesaurus ObjectClass-2)
C0018956 (UMLS 2011AA ObjectClass-2)
C15342 (NCI Thesaurus ObjectClass-3)
C0029216 (UMLS 2011AA ObjectClass-3)
C28343 (NCI Thesaurus ObjectClass-4)
C1515895 (UMLS 2011AA ObjectClass-4)
C71384 (NCI Thesaurus ObjectClass-5)
C1266852 (UMLS 2011AA ObjectClass-5)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C49488 (NCI Thesaurus ValueDomain-2)
C1705108 (UMLS 2011AA ValueDomain-2)
C49487 (NCI Thesaurus ValueDomain-3)
C1298908 (UMLS 2011AA ValueDomain-3)
C48660 (NCI Thesaurus ValueDomain-4)
C1272460 (UMLS 2011AA ValueDomain-4)
C17998 (NCI Thesaurus ValueDomain-5)
C0439673 (UMLS 2011AA ValueDomain-5)
C49484 (NCI Thesaurus ValueDomain-6)
C1272696 (UMLS 2011AA ValueDomain-6)

PriorSyngeneicHematopoieticStemCellTransplantationPerformedIndicator

Item

Syngeneic (Identical twin. Cell sources for previous HSCT.)

boolean

C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C12551 (NCI Thesaurus ObjectClass-2)
C0018956 (UMLS 2011AA ObjectClass-2)
C15342 (NCI Thesaurus ObjectClass-3)
C0029216 (UMLS 2011AA ObjectClass-3)
C71901 (NCI Thesaurus ObjectClass-4)
C2348628 (UMLS 2011AA ObjectClass-4)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C49488 (NCI Thesaurus ValueDomain-2)
C1705108 (UMLS 2011AA ValueDomain-2)
C49487 (NCI Thesaurus ValueDomain-3)
C1298908 (UMLS 2011AA ValueDomain-3)
C48660 (NCI Thesaurus ValueDomain-4)
C1272460 (UMLS 2011AA ValueDomain-4)
C17998 (NCI Thesaurus ValueDomain-5)
C0439673 (UMLS 2011AA ValueDomain-5)
C49484 (NCI Thesaurus ValueDomain-6)
C1272696 (UMLS 2011AA ValueDomain-6)

PriorBoneMarrowTransplantationIndicator

Item

Bone marrow (Product types for previous HSCT.)

boolean

C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C15194 (NCI Thesaurus ObjectClass-2)
C0005961 (UMLS 2011AA ObjectClass-2)

PriorPeripheralBloodStemCellTransplantationPerformedIndicator

Item

Peripheral blood stem cells (PBSC. Product types for previous HSCT.)

boolean

C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C15342 (NCI Thesaurus ObjectClass-2)
C0029216 (UMLS 2011AA ObjectClass-2)
C12946 (NCI Thesaurus ObjectClass-3)
C1518999 (UMLS 2011AA ObjectClass-3)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C49488 (NCI Thesaurus ValueDomain-2)
C1705108 (UMLS 2011AA ValueDomain-2)
C49487 (NCI Thesaurus ValueDomain-3)
C1298908 (UMLS 2011AA ValueDomain-3)
C48660 (NCI Thesaurus ValueDomain-4)
C1272460 (UMLS 2011AA ValueDomain-4)
C17998 (NCI Thesaurus ValueDomain-5)
C0439673 (UMLS 2011AA ValueDomain-5)
C49484 (NCI Thesaurus ValueDomain-6)
C1272696 (UMLS 2011AA ValueDomain-6)

PriorUmbilicalCordBloodTransplantationPerformedIndicator

Item

Umbilical cord blood (Product types for previous HSCT.)

boolean

C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C15342 (NCI Thesaurus ObjectClass-2)
C0029216 (UMLS 2011AA ObjectClass-2)
C13300 (NCI Thesaurus ObjectClass-3)
C0162371 (UMLS 2011AA ObjectClass-3)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C49488 (NCI Thesaurus ValueDomain-2)
C1705108 (UMLS 2011AA ValueDomain-2)
C49487 (NCI Thesaurus ValueDomain-3)
C1298908 (UMLS 2011AA ValueDomain-3)
C48660 (NCI Thesaurus ValueDomain-4)
C1272460 (UMLS 2011AA ValueDomain-4)
C17998 (NCI Thesaurus ValueDomain-5)
C0439673 (UMLS 2011AA ValueDomain-5)
C49484 (NCI Thesaurus ValueDomain-6)
C1272696 (UMLS 2011AA ValueDomain-6)

Cellular Therapy for Regenerative Medicine

Item Group

Recipient Data Part 4 Of 4

CellularTherapyIndicationReason

Item

Indication for cellular therapy:

text

C70601 (NCI Thesaurus ObjectClass)
C0302189 (UMLS 2011AA ObjectClass)
C41184 (NCI Thesaurus Property)
C0392360 (UMLS 2011AA Property)
C25638 (NCI Thesaurus ValueDomain)
C0392360 (UMLS 2011AA ValueDomain)
C70601 (NCI Thesaurus ValueDomain-2)
C0302189 (UMLS 2011AA ValueDomain-2)
C41184 (NCI Thesaurus ValueDomain-3)
C0392360 (UMLS 2011AA ValueDomain-3)

CL.26

Code List

Indication for cellular therapy:

CL Item

Autoimmune Disease (Autoimmune disease)

C2889 (NCI Thesaurus)
C0004364 (UMLS 2011AA)

CL Item

Cardiovascular And Peripheral Vascular Disorder Disease Or Disorder (Cardio and peripheral vascular disease)

C25292 (NCI Thesaurus)
C0007226 (UMLS 2011AA)
C2991 (NCI Thesaurus-3)
C0012634 (UMLS 2011AA-4)
C37912 (NCI Thesaurus-5)
C1515981 (UMLS 2011AA-6)
C35136 (NCI Thesaurus-7)
C0085096 (UMLS 2011AA-8)

CL Item

Musculoskeletal Disease Or Disorder (Musculoskeletal disease)

C25348 (NCI Thesaurus)
C0497254 (UMLS 2011AA)
C2991 (NCI Thesaurus-3)
C0012634 (UMLS 2011AA-4)

CL Item

Neurologic Disease Or Disorder (Neurologic disease)

C25262 (NCI Thesaurus)
C0205494 (UMLS 2011AA)
C2991 (NCI Thesaurus-3)
C0012634 (UMLS 2011AA-4)

CL Item

Other (Other)

C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)

CellularTherapyIndicationSpecifyText

Item

Specify other indication for cellular therapy:

text

C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C25704 (NCI Thesaurus ValueDomain-2)
C1527021 (UMLS 2011AA ValueDomain-2)
C70601 (NCI Thesaurus ObjectClass)
C0302189 (UMLS 2011AA ObjectClass)
C41184 (NCI Thesaurus Property)
C0392360 (UMLS 2011AA Property)

CellularTherapyFirstAdministrationIndicator

Item

Is this the first application of cellular therapy for this indication?

boolean

C70601 (NCI Thesaurus ObjectClass)
C0302189 (UMLS 2011AA ObjectClass)
C25509 (NCI Thesaurus Property)
C1279901 (UMLS 2011AA Property)
C25409 (NCI Thesaurus Property-2)
C1533734 (UMLS 2011AA Property-2)
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C49488 (NCI Thesaurus ValueDomain-2)
C1705108 (UMLS 2011AA ValueDomain-2)
C49487 (NCI Thesaurus ValueDomain-3)
C1298908 (UMLS 2011AA ValueDomain-3)
C48660 (NCI Thesaurus ValueDomain-4)
C1272460 (UMLS 2011AA ValueDomain-4)
C17998 (NCI Thesaurus ValueDomain-5)
C0439673 (UMLS 2011AA ValueDomain-5)
C49484 (NCI Thesaurus ValueDomain-6)
C1272696 (UMLS 2011AA ValueDomain-6)

Author Information

Item Group

Author Information

PersonGiven/FirstName

Item

First Name

text

ContactPersonLocationTelephoneNumber

Item

Telephone number:

text

C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25461 (NCI Thesaurus ObjectClass-2)
C0337611 (UMLS 2011AA ObjectClass-2)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25395 (NCI Thesaurus ValueDomain-2)
C0039457 (UMLS 2011AA ValueDomain-2)

PersonFamily/LastName

Item

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-2)
C1301584 (UMLS 2011AA Property-2)

ContactPersonLocationFaxNumber

Item

Fax number:

text

C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25461 (NCI Thesaurus ObjectClass-2)
C0337611 (UMLS 2011AA ObjectClass-2)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25210 (NCI Thesaurus ValueDomain-2)
C0085205 (UMLS 2011AA ValueDomain-2)

PersonEmailAddressText

Item

E-mail address:

text

C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C42775 (NCI Thesaurus Property)
C1705961 (UMLS 2011AA Property)

Form Processing

Item Group

Form Processing

HematopoieticStemCellTransplantationRecipientIdentificationNumber

Item

CIBMTR Recipient ID (CRID):

float

C12551 (NCI Thesaurus ObjectClass)
C0018956 (UMLS 2011AA ObjectClass)
C15342 (NCI Thesaurus ObjectClass-2)
C0029216 (UMLS 2011AA ObjectClass-2)
C53268 (NCI Thesaurus Property)
C1709854 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25737 (NCI Thesaurus ValueDomain-2)
C0205396 (UMLS 2011AA ValueDomain-2)

SearchOutcomeType

Item

Search result:

text

C54117 (NCI Thesaurus ObjectClass)
C1706202 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C20200 (NCI Thesaurus ValueDomain-2)
C1274040 (UMLS 2011AA ValueDomain-2)
C54117 (NCI Thesaurus ValueDomain-3)
C1706202 (UMLS 2011AA ValueDomain-3)

CL.28

Code List

Search result:

CL Item

Negation Match (No match)

C25594 (NCI Thesaurus)
C1518422 (UMLS 2011AA)
C54116 (NCI Thesaurus-3)
C1708943 (UMLS 2011AA-4)

CL Item

Exact Match (Exact match)

C54116 (NCI Thesaurus)
C1708943 (UMLS 2011AA)
C86021 (NCI Thesaurus-3)
C2828393 (UMLS 2011AA-4)

CL Item

Multiple Exact Match (Multiple exact matches)

C17648 (NCI Thesaurus)
C0439064 (UMLS 2011AA)
C54116 (NCI Thesaurus-3)
C1708943 (UMLS 2011AA-4)
C86021 (NCI Thesaurus-5)
C2828393 (UMLS 2011AA-6)

CL Item

Mismatch (Inexact match)

C67078 (NCI Thesaurus)
C1881865 (UMLS 2011AA)

CL Item

Not Applicable (Not applicable)

C48660 (NCI Thesaurus)
C1272460 (UMLS 2011AA)

IdentificationNumberProcessingOutcomeType

Item

CRID processing result:

text

C25337 (NCI Thesaurus ObjectClass)
C0237753 (UMLS 2011AA ObjectClass)
C48177 (NCI Thesaurus ObjectClass-2)
C1709694 (UMLS 2011AA ObjectClass-2)
C25737 (NCI Thesaurus ObjectClass-3)
C0205396 (UMLS 2011AA ObjectClass-3)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25284 (NCI Thesaurus ValueDomain-2)
C0332307 (UMLS 2011AA ValueDomain-2)
C20200 (NCI Thesaurus ValueDomain-3)
C1274040 (UMLS 2011AA ValueDomain-3)
C48177 (NCI Thesaurus ValueDomain-4)
C1709694 (UMLS 2011AA ValueDomain-4)
C25737 (NCI Thesaurus ValueDomain-5)
C0205396 (UMLS 2011AA ValueDomain-5)

CL.29

Code List

CRID processing result:

CL Item

Identification Number Creation (CRID created)

C25337 (NCI Thesaurus)
C0237753 (UMLS 2011AA)
C42620 (NCI Thesaurus-3)
C1706214 (UMLS 2011AA-4)
C25737 (NCI Thesaurus-5)
C0205396 (UMLS 2011AA-6)

CL Item

Negation Identification Number Creation (No CRID created)

C25337 (NCI Thesaurus)
C0237753 (UMLS 2011AA)
C25594 (NCI Thesaurus-3)
C1518422 (UMLS 2011AA-4)
C42620 (NCI Thesaurus-5)
C1706214 (UMLS 2011AA-6)
C25737 (NCI Thesaurus-7)
C0205396 (UMLS 2011AA-8)

CL Item

Not Applicable (Not applicable)

C48660 (NCI Thesaurus)
C1272460 (UMLS 2011AA)

FormProcessingOutcomeType

Item

Form processing result :

text

C19464 (NCI Thesaurus ObjectClass)
C0376315 (UMLS 2011AA ObjectClass)
C48177 (NCI Thesaurus ObjectClass-2)
C1709694 (UMLS 2011AA ObjectClass-2)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C19464 (NCI Thesaurus ValueDomain-2)
C0376315 (UMLS 2011AA ValueDomain-2)
C20200 (NCI Thesaurus ValueDomain-3)
C1274040 (UMLS 2011AA ValueDomain-3)
C48177 (NCI Thesaurus ValueDomain-4)
C1709694 (UMLS 2011AA ValueDomain-4)

CL.30

Code List

Form processing result :

CL Item

Hematopoietic Stem Cell Transplantation Date Revision (HSCT date updated)

C25164 (NCI Thesaurus)
C0011008 (UMLS 2011AA)
C12551 (NCI Thesaurus-3)
C0018956 (UMLS 2011AA-4)
C15342 (NCI Thesaurus-5)
C0029216 (UMLS 2011AA-6)
C54087 (NCI Thesaurus-7)
C1527075 (UMLS 2011AA-8)

CL Item

2400 Made Due (2400 Made due)

CL Item

2400 Already Started For Another Date (2400 Already started for another date)

CL Item

2400 Already Started For Requested Date (2400 Already started for requested date)

CL Item

Unable To Schedule Forms For Other Transplant Center (Unable to schedule forms for other Transplant Center)

CL Item

Not Applicable (Not applicable)

C48660 (NCI Thesaurus)
C1272460 (UMLS 2011AA)

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Item comments for :

Registration - 2804 Revision 3 - CIBMTR Recipient ID Assignment Form - 3113592v1.0

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