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

  1. 9/19/12 9/19/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
  3. 9/17/21 9/17/21 -
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

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.

Identification Data
Description

Identification Data

CIBMTR Center Number:
Description

HematopoieticStemCellTransplantationRecipientInstitution::CenterforInternationalBloodandMarrowTransplantResearchFacilityNumber

Data type

float

Alias
NCI Thesaurus ObjectClass
C12551
UMLS 2011AA ObjectClass
C0018956
NCI Thesaurus ObjectClass-2
C15342
UMLS 2011AA ObjectClass-2
C0029216
NCI Thesaurus Property
C53268
UMLS 2011AA Property
C1709854
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ValueDomain-2
C41206
UMLS 2011AA ValueDomain-2
C1272753
NCI Thesaurus ValueDomain-3
C62574
UMLS 2011AA ValueDomain-3
C1547538
Today's date:
Description

ClinicalDataFormTodayDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus Property
C19464
UMLS 2011AA Property
C0376315
NCI Thesaurus ObjectClass
C15783
UMLS 2011AA ObjectClass
C1516606
NCI Thesaurus ValueDomain-2
C41134
UMLS 2011AA ValueDomain-2
C0750526
Recipient Date
Description

Recipient Date

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

Institution::CenterForInternationalBloodAndMarrowResearchRecipientIdentificationNumberAssignmentReason

Data type

text

Alias
NCI Thesaurus ObjectClass
C25337
UMLS 2011AA ObjectClass
C0237753
NCI Thesaurus ObjectClass-2
C53268
UMLS 2011AA ObjectClass-2
C1709854
NCI Thesaurus ObjectClass-3
C25737
UMLS 2011AA ObjectClass-3
C0205396
NCI Thesaurus ObjectClass-4
C41206
UMLS 2011AA ObjectClass-4
C1272753
NCI Thesaurus ObjectClass-5
C25426
UMLS 2011AA ObjectClass-5
C1516050
NCI Thesaurus Property
C25638
UMLS 2011AA Property
C0392360
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ValueDomain-2
C25638
UMLS 2011AA ValueDomain-2
C0392360
NCI Thesaurus ValueDomain-3
C25737
UMLS 2011AA ValueDomain-3
C0205396
NCI Thesaurus ValueDomain-4
C25426
UMLS 2011AA ValueDomain-4
C1516050
NCI Thesaurus ValueDomain-5
C41184
UMLS 2011AA ValueDomain-5
C0392360
Specify other indication for CRID assignment:
Description

Institution::CenterForInternationalBloodAndMarrowResearchRecipientIdentificationNumberAssignmentReasonSpecifyText

Data type

text

Alias
NCI Thesaurus ObjectClass
C25337
UMLS 2011AA ObjectClass
C0237753
NCI Thesaurus ObjectClass-2
C53268
UMLS 2011AA ObjectClass-2
C1709854
NCI Thesaurus ObjectClass-3
C25737
UMLS 2011AA ObjectClass-3
C0205396
NCI Thesaurus ObjectClass-4
C41206
UMLS 2011AA ObjectClass-4
C1272753
NCI Thesaurus ObjectClass-5
C25426
UMLS 2011AA ObjectClass-5
C1516050
NCI Thesaurus Property
C25638
UMLS 2011AA Property
C0392360
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus ValueDomain-2
C25704
UMLS 2011AA ValueDomain-2
C1527021
Recipient Data Part 2 Of 3
Description

Recipient Data Part 2 Of 3

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

StudyParticipationOccurrenceIndicator

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C25608
UMLS 2011AA ObjectClass
C0679823
NCI Thesaurus ObjectClass-2
C71104
UMLS 2011AA ObjectClass-2
C0008976
NCI Thesaurus Property
C25275
UMLS 2011AA Property
C2745955
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
NCI Thesaurus ValueDomain-2
C49488
UMLS 2011AA ValueDomain-2
C1705108
NCI Thesaurus ValueDomain-3
C49487
UMLS 2011AA ValueDomain-3
C1298908
NCI Thesaurus ValueDomain-4
C48660
UMLS 2011AA ValueDomain-4
C1272460
NCI Thesaurus ValueDomain-5
C17998
UMLS 2011AA ValueDomain-5
C0439673
NCI Thesaurus ValueDomain-6
C49484
UMLS 2011AA ValueDomain-6
C1272696
Specify the group that is administering the clinical trial:
Description

CoordinatingGroupIdentifierGroupName

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C17005
UMLS 2011AA ObjectClass
C1257890
NCI Thesaurus ObjectClass-2
C25462
UMLS 2011AA ObjectClass-2
C0700114
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
 Specify other group:
Description

CoordinatingGroupIdentifierSpecifyText

Data type

text

Alias
NCI Thesaurus ObjectClass
C17005
UMLS 2011AA ObjectClass
C1257890
NCI Thesaurus ObjectClass-2
C25462
UMLS 2011AA ObjectClass-2
C0700114
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus ValueDomain-2
C25704
UMLS 2011AA ValueDomain-2
C1527021
Study ID number:
Description

ClinicalStudyProtocolIdentifierNumber

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus Property
C42651
UMLS 2011AA Property
C0442711
NCI Thesaurus ObjectClass
C15206
UMLS 2011AA ObjectClass
C0008972
NCI Thesaurus ValueDomain-2
C83082
UMLS 2011AA ValueDomain-2
C2826693
Recipient Data Part 3 Of 4
Description

Recipient Data Part 3 Of 4

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

FacilityDataSetStorageAnd/OrCreationDesignatedInstitution::CenterForInternationalBlood&MarrowTransplantResearchIndicator

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C47824
UMLS 2011AA ObjectClass
C0150098
NCI Thesaurus ObjectClass-2
C62574
UMLS 2011AA ObjectClass-2
C1547538
NCI Thesaurus Property
C48928
UMLS 2011AA Property
C1706528
NCI Thesaurus Property-2
C42620
UMLS 2011AA Property-2
C1706214
NCI Thesaurus Property-3
C41206
UMLS 2011AA Property-3
C1272753
NCI Thesaurus Property-4
C60824
UMLS 2011AA Property-4
C1698986
NCI Thesaurus Property-5
C25479
UMLS 2011AA Property-5
C1524084
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
NCI Thesaurus ValueDomain-2
C49488
UMLS 2011AA ValueDomain-2
C1705108
NCI Thesaurus ValueDomain-3
C49487
UMLS 2011AA ValueDomain-3
C1298908
NCI Thesaurus ValueDomain-4
C48660
UMLS 2011AA ValueDomain-4
C1272460
NCI Thesaurus ValueDomain-5
C17998
UMLS 2011AA ValueDomain-5
C0439673
NCI Thesaurus ValueDomain-6
C49484
UMLS 2011AA ValueDomain-6
C1272696
Has the recipient given written consent to allow his / her transplant data to be used for research? (For autologous HSCTs only.)
Description

HematopoieticStemCellTransplantationRecipientResearchDataSharedConsentYesNoCharacterIndicator

Data type

boolean

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

PersonGiven/FirstName

Data type

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-2
C40974
UMLS 2011AA Property-2
C1443235
Last Name
Description

PersonFamily/LastName

Data type

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-2
C40975
UMLS 2011AA Property-2
C1301584
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.)
Description

Birth Date

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS CUI-1
C0421451
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25155
City: (Recipient location of birth.)
Description

AddressCityName

Data type

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
NCI Thesaurus ValueDomain-2
C25160
UMLS 2011AA ValueDomain-2
C0008848
State: (Recipient location of birth.)
Description

AddressState/ProvinceName

Data type

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
Country: (Recipient location of birth.)
Description

AddressCountryName

Data type

text

Alias
NCI Thesaurus Property
C25464
UMLS 2011AA Property
C0454664
NCI Thesaurus ValueDomain
C25464
UMLS 2011AA ValueDomain
C0454664
NCI Thesaurus ObjectClass
C25407
UMLS 2011AA ObjectClass
C1442065
NCI Thesaurus ValueDomain-2
C42614
UMLS 2011AA ValueDomain-2
C0027365
Recipient Gender:
Description

PersonSexGenderType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C28421
UMLS 2011AA Property
C1522384
Recipient Social Security number:
Description

PersonSocialSecurityNumber

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C25686
UMLS 2011AA Property
C1301821
If necessary, please validate the Social Security number response:
Description

PersonSocialSecurityNumberDataValidationIndicator

Data type

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C25686
UMLS 2011AA Property
C1301821
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
NCI Thesaurus ValueDomain-2
C25474
UMLS 2011AA ValueDomain-2
C1511726
NCI Thesaurus ValueDomain-3
C16237
UMLS 2011AA ValueDomain-3
C1519941
Recipient NMDP ID:
Description

PatientInstitution::NationalMarrowDonorProgramIdentifier

Data type

float

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ValueDomain
C25364
UMLS 2011AA ValueDomain
C0600091
NCI Thesaurus ValueDomain-2
C41206
UMLS 2011AA ValueDomain-2
C1272753
If necessary, please validate patient identifier response.
Description

PatientIdentifierDataValidationIndicator

Data type

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
NCI Thesaurus ValueDomain-2
C25474
UMLS 2011AA ValueDomain-2
C1511726
NCI Thesaurus ValueDomain-3
C16237
UMLS 2011AA ValueDomain-3
C1519941
Recipient EBMT ID:
Description

PatientIdentifierInstitution::EuropeanGroupforBloodAndMarrowTransplantationIdentifier

Data type

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ValueDomain
C25364
UMLS 2011AA ValueDomain
C0600091
NCI Thesaurus ValueDomain-2
C41206
UMLS 2011AA ValueDomain-2
C1272753
EBMT CIC:
Description

ClinicsandHospitalsIdentifierInstitution::EuropeanGroupforBloodAndMarrowTransplantationFacilityNumber

Data type

float

Alias
NCI Thesaurus ObjectClass
C19326
UMLS 2011AA ObjectClass
C0587906
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ValueDomain-2
C41206
UMLS 2011AA ValueDomain-2
C1272753
NCI Thesaurus ValueDomain-3
C62574
UMLS 2011AA ValueDomain-3
C1547538
If necessary, please validate the recipient IUBMID and / or Team ID response.
Description

PatientAndClinicsandHospitalsEntityIdentifierDataValidationIndicator

Data type

text

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

Recipient Date

Recipient IUBMID: (Former CIBMTR #)
Description

PatientIdentifierInstitutionBloodOrBoneMarrowUniqueIdentifierNumber

Data type

text

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

ClinicsandHospitalsIdentifierNumber

Data type

float

Alias
NCI Thesaurus ObjectClass
C19326
UMLS 2011AA ObjectClass
C0587906
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ValueDomain-2
C25364
UMLS 2011AA ValueDomain-2
C0600091
NCI Thesaurus ValueDomain-3
C19326
UMLS 2011AA ValueDomain-3
C0587906
Recipient's mother's maiden name: (Optional for non-U.S. centers)
Description

MotherMaidenName

Data type

text

Alias
NCI Thesaurus ObjectClass
C25189
UMLS 2011AA ObjectClass
C0026591
NCI Thesaurus ValueDomain
C42614
UMLS 2011AA ValueDomain
C0027365
NCI Thesaurus Property
C25381
UMLS 2011AA Property
C0806887
Tentative infusion date:
Description

ScheduleInfusionProcedurePerformedDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus ObjectClass
C15388
UMLS 2011AA ObjectClass
C0574032
NCI Thesaurus ObjectClass-2
C25211
UMLS 2011AA ObjectClass-2
C0086960
If necessary, please validate the recipient IUBMID and / or Team ID response.
Description

PatientAndClinicsandHospitalsEntityIdentifierDataValidationIndicator

Data type

text

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

Recipient Date

Cell source for the HSCT: (Planned)
Description

HematopoieticStemCellGraftSourceName

Data type

text

Alias
NCI Thesaurus ObjectClass
C12551
UMLS 2011AA ObjectClass
C0018956
NCI Thesaurus ObjectClass-2
C12981
UMLS 2011AA ObjectClass-2
C0332835
NCI Thesaurus Property
C25683
UMLS 2011AA Property
C0449416
NCI Thesaurus ValueDomain
C12551
UMLS 2011AA ValueDomain
C0018956
NCI Thesaurus ValueDomain-2
C25683
UMLS 2011AA ValueDomain-2
C0449416
NCI Thesaurus ValueDomain-3
C42614
UMLS 2011AA ValueDomain-3
C0027365
Was a particular hematopoietic stem cell source used?
Description

HematopoieticStemCellGraftSourceTherapyInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C12551
UMLS 2011AA ObjectClass
C0018956
NCI Thesaurus ObjectClass-2
C12981
UMLS 2011AA ObjectClass-2
C0332835
NCI Thesaurus Property
C25683
UMLS 2011AA Property
C0449416
Hematopoietic Stem Cell Transplant Date Part 2 Of 4
Description

Hematopoietic Stem Cell Transplant Date Part 2 Of 4

Product type (Planned)
Description

HematopoieticStemCellGraftTypeName

Data type

text

Alias
NCI Thesaurus ObjectClass
C12551
UMLS 2011AA ObjectClass
C0018956
NCI Thesaurus ObjectClass-2
C12981
UMLS 2011AA ObjectClass-2
C0332835
NCI Thesaurus Property
C25284
UMLS 2011AA Property
C0332307
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ValueDomain-2
C12551
UMLS 2011AA ValueDomain-2
C0018956
NCI Thesaurus ValueDomain-3
C12981
UMLS 2011AA ValueDomain-3
C0332835
NCI Thesaurus ValueDomain-4
C42614
UMLS 2011AA ValueDomain-4
C0027365
Was a particular hematopoietic stem cell transplant type used?
Description

HematopoieticStemCellGraftTypeTherapyInd-2

Data type

boolean

Alias
NCI Thesaurus Property
C25284
UMLS 2011AA Property
C0332307
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C12551
UMLS 2011AA ObjectClass
C0018956
NCI Thesaurus ObjectClass-2
C12981
UMLS 2011AA ObjectClass-2
C0332835
Specify other product: (Answer only if the response to CDE 2730912 is "Other.")
Description

HematopoieticStemCellGraftOtherTypeSpecify

Data type

text

Alias
NCI Thesaurus ObjectClass
C12551
UMLS 2011AA ObjectClass
C0018956
NCI Thesaurus ObjectClass-2
C12981
UMLS 2011AA ObjectClass-2
C0332835
NCI Thesaurus Property
C25284
UMLS 2011AA Property
C0332307
NCI Thesaurus Property-2
C17649
UMLS 2011AA Property-2
C0205394
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus ValueDomain-2
C17649
UMLS 2011AA ValueDomain-2
C0205394
Hematopoietic Stem Cell Transplant Part 3 Of 4
Description

Hematopoietic Stem Cell Transplant Part 3 Of 4

Primary disease for which the HSCT would be performed:
Description

HematopoieticStemCellTransplantationDiseasePrimaryClassificationType

Data type

text

Alias
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus ObjectClass-2
C12551
UMLS 2011AA ObjectClass-2
C0018956
NCI Thesaurus ObjectClass-3
C15342
UMLS 2011AA ObjectClass-3
C0029216
NCI Thesaurus Property
C25251
UMLS 2011AA Property
C0205225
NCI Thesaurus Property-2
C25161
UMLS 2011AA Property-2
C0008902
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ValueDomain-2
C25251
UMLS 2011AA ValueDomain-2
C0205225
NCI Thesaurus ValueDomain-3
C2991
UMLS 2011AA ValueDomain-3
C0012634
Hematopoietic Stem Cell Transplant Part 4 Of 4
Description

Hematopoietic Stem Cell Transplant Part 4 Of 4

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.)
Description

HematopoieticStemCellTransplantationFirstOccurrenceIndicator

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C12551
UMLS 2011AA ObjectClass
C0018956
NCI Thesaurus ObjectClass-2
C15342
UMLS 2011AA ObjectClass-2
C0029216
NCI Thesaurus Property
C25509
UMLS 2011AA Property
C1279901
NCI Thesaurus Property-2
C25275
UMLS 2011AA Property-2
C2745955
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
NCI Thesaurus ValueDomain-2
C49488
UMLS 2011AA ValueDomain-2
C1705108
NCI Thesaurus ValueDomain-3
C49487
UMLS 2011AA ValueDomain-3
C1298908
NCI Thesaurus ValueDomain-4
C48660
UMLS 2011AA ValueDomain-4
C1272460
NCI Thesaurus ValueDomain-5
C17998
UMLS 2011AA ValueDomain-5
C0439673
NCI Thesaurus ValueDomain-6
C49484
UMLS 2011AA ValueDomain-6
C1272696
Date of previous HSCT:
Description

PriorHematopoieticStemCellTransplantationPerformedDate

Data type

date

Alias
NCI Thesaurus ObjectClass
C25629
UMLS 2011AA ObjectClass
C0332152
NCI Thesaurus ObjectClass-2
C12551
UMLS 2011AA ObjectClass-2
C0018956
NCI Thesaurus ObjectClass-3
C15342
UMLS 2011AA ObjectClass-3
C0029216
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
Autologous (Cell sources for previous HSCT.)
Description

PriorAutologousHematopoieticStemCellTransplantationPerformedIndicator

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C25629
UMLS 2011AA ObjectClass
C0332152
NCI Thesaurus ObjectClass-2
C12551
UMLS 2011AA ObjectClass-2
C0018956
NCI Thesaurus ObjectClass-3
C15342
UMLS 2011AA ObjectClass-3
C0029216
NCI Thesaurus ObjectClass-4
C28000
UMLS 2011AA ObjectClass-4
C0439859
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
NCI Thesaurus ValueDomain-2
C49488
UMLS 2011AA ValueDomain-2
C1705108
NCI Thesaurus ValueDomain-3
C49487
UMLS 2011AA ValueDomain-3
C1298908
NCI Thesaurus ValueDomain-4
C48660
UMLS 2011AA ValueDomain-4
C1272460
NCI Thesaurus ValueDomain-5
C17998
UMLS 2011AA ValueDomain-5
C0439673
NCI Thesaurus ValueDomain-6
C49484
UMLS 2011AA ValueDomain-6
C1272696
Allogeneic, unrelated (Cell sources for previous HSCT.)
Description

PriorUnrelatedAllogenicHematopoieticStemCellTransplantationPerformedIndicator

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C25328
UMLS 2011AA ObjectClass
C0445356
NCI Thesaurus ObjectClass-2
C25629
UMLS 2011AA ObjectClass-2
C0332152
NCI Thesaurus ObjectClass-3
C12551
UMLS 2011AA ObjectClass-3
C0018956
NCI Thesaurus ObjectClass-4
C15342
UMLS 2011AA ObjectClass-4
C0029216
NCI Thesaurus ObjectClass-5
C28343
UMLS 2011AA ObjectClass-5
C1515895
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
NCI Thesaurus ValueDomain-2
C49488
UMLS 2011AA ValueDomain-2
C1705108
NCI Thesaurus ValueDomain-3
C49487
UMLS 2011AA ValueDomain-3
C1298908
NCI Thesaurus ValueDomain-4
C48660
UMLS 2011AA ValueDomain-4
C1272460
NCI Thesaurus ValueDomain-5
C17998
UMLS 2011AA ValueDomain-5
C0439673
NCI Thesaurus ValueDomain-6
C49484
UMLS 2011AA ValueDomain-6
C1272696
Allogeneic, related (Cell sources for previous HSCT.)
Description

PriorBiologicalRelativeAllogenicHematopoieticStemCellTransplantationPerformedIndicator

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C25629
UMLS 2011AA ObjectClass
C0332152
NCI Thesaurus ObjectClass-2
C12551
UMLS 2011AA ObjectClass-2
C0018956
NCI Thesaurus ObjectClass-3
C15342
UMLS 2011AA ObjectClass-3
C0029216
NCI Thesaurus ObjectClass-4
C28343
UMLS 2011AA ObjectClass-4
C1515895
NCI Thesaurus ObjectClass-5
C71384
UMLS 2011AA ObjectClass-5
C1266852
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
NCI Thesaurus ValueDomain-2
C49488
UMLS 2011AA ValueDomain-2
C1705108
NCI Thesaurus ValueDomain-3
C49487
UMLS 2011AA ValueDomain-3
C1298908
NCI Thesaurus ValueDomain-4
C48660
UMLS 2011AA ValueDomain-4
C1272460
NCI Thesaurus ValueDomain-5
C17998
UMLS 2011AA ValueDomain-5
C0439673
NCI Thesaurus ValueDomain-6
C49484
UMLS 2011AA ValueDomain-6
C1272696
Syngeneic (Identical twin. Cell sources for previous HSCT.)
Description

PriorSyngeneicHematopoieticStemCellTransplantationPerformedIndicator

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C25629
UMLS 2011AA ObjectClass
C0332152
NCI Thesaurus ObjectClass-2
C12551
UMLS 2011AA ObjectClass-2
C0018956
NCI Thesaurus ObjectClass-3
C15342
UMLS 2011AA ObjectClass-3
C0029216
NCI Thesaurus ObjectClass-4
C71901
UMLS 2011AA ObjectClass-4
C2348628
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
NCI Thesaurus ValueDomain-2
C49488
UMLS 2011AA ValueDomain-2
C1705108
NCI Thesaurus ValueDomain-3
C49487
UMLS 2011AA ValueDomain-3
C1298908
NCI Thesaurus ValueDomain-4
C48660
UMLS 2011AA ValueDomain-4
C1272460
NCI Thesaurus ValueDomain-5
C17998
UMLS 2011AA ValueDomain-5
C0439673
NCI Thesaurus ValueDomain-6
C49484
UMLS 2011AA ValueDomain-6
C1272696
Bone marrow (Product types for previous HSCT.)
Description

PriorBoneMarrowTransplantationIndicator

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus ObjectClass
C25629
UMLS 2011AA ObjectClass
C0332152
NCI Thesaurus ObjectClass-2
C15194
UMLS 2011AA ObjectClass-2
C0005961
Peripheral blood stem cells (PBSC. Product types for previous HSCT.)
Description

PriorPeripheralBloodStemCellTransplantationPerformedIndicator

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C25629
UMLS 2011AA ObjectClass
C0332152
NCI Thesaurus ObjectClass-2
C15342
UMLS 2011AA ObjectClass-2
C0029216
NCI Thesaurus ObjectClass-3
C12946
UMLS 2011AA ObjectClass-3
C1518999
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
NCI Thesaurus ValueDomain-2
C49488
UMLS 2011AA ValueDomain-2
C1705108
NCI Thesaurus ValueDomain-3
C49487
UMLS 2011AA ValueDomain-3
C1298908
NCI Thesaurus ValueDomain-4
C48660
UMLS 2011AA ValueDomain-4
C1272460
NCI Thesaurus ValueDomain-5
C17998
UMLS 2011AA ValueDomain-5
C0439673
NCI Thesaurus ValueDomain-6
C49484
UMLS 2011AA ValueDomain-6
C1272696
Umbilical cord blood (Product types for previous HSCT.)
Description

PriorUmbilicalCordBloodTransplantationPerformedIndicator

Data type

boolean

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

Recipient Data Part 4 Of 4

Indication for cellular therapy:
Description

CellularTherapyIndicationReason

Data type

text

Alias
NCI Thesaurus ObjectClass
C70601
UMLS 2011AA ObjectClass
C0302189
NCI Thesaurus Property
C41184
UMLS 2011AA Property
C0392360
NCI Thesaurus ValueDomain
C25638
UMLS 2011AA ValueDomain
C0392360
NCI Thesaurus ValueDomain-2
C70601
UMLS 2011AA ValueDomain-2
C0302189
NCI Thesaurus ValueDomain-3
C41184
UMLS 2011AA ValueDomain-3
C0392360
Specify other indication for cellular therapy:
Description

CellularTherapyIndicationSpecifyText

Data type

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus ValueDomain-2
C25704
UMLS 2011AA ValueDomain-2
C1527021
NCI Thesaurus ObjectClass
C70601
UMLS 2011AA ObjectClass
C0302189
NCI Thesaurus Property
C41184
UMLS 2011AA Property
C0392360
Is this the first application of cellular therapy for this indication?
Description

CellularTherapyFirstAdministrationIndicator

Data type

boolean

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

Author Information

First Name
Description

PersonGiven/FirstName

Data type

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-2
C40974
UMLS 2011AA Property-2
C1443235
Telephone number:
Description

ContactPersonLocationTelephoneNumber

Data type

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ObjectClass-2
C25461
UMLS 2011AA ObjectClass-2
C0337611
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ValueDomain-2
C25395
UMLS 2011AA ValueDomain-2
C0039457
Last Name
Description

PersonFamily/LastName

Data type

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-2
C40975
UMLS 2011AA Property-2
C1301584
Fax number:
Description

ContactPersonLocationFaxNumber

Data type

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ObjectClass-2
C25461
UMLS 2011AA ObjectClass-2
C0337611
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ValueDomain-2
C25210
UMLS 2011AA ValueDomain-2
C0085205
E-mail address:
Description

PersonEmailAddressText

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C42775
UMLS 2011AA Property
C1705961
Form Processing
Description

Form Processing

CIBMTR Recipient ID (CRID):
Description

HematopoieticStemCellTransplantationRecipientIdentificationNumber

Data type

float

Alias
NCI Thesaurus ObjectClass
C12551
UMLS 2011AA ObjectClass
C0018956
NCI Thesaurus ObjectClass-2
C15342
UMLS 2011AA ObjectClass-2
C0029216
NCI Thesaurus Property
C53268
UMLS 2011AA Property
C1709854
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ValueDomain-2
C25737
UMLS 2011AA ValueDomain-2
C0205396
Search result:
Description

SearchOutcomeType

Data type

text

Alias
NCI Thesaurus ObjectClass
C54117
UMLS 2011AA ObjectClass
C1706202
NCI Thesaurus Property
C20200
UMLS 2011AA Property
C1274040
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ValueDomain-2
C20200
UMLS 2011AA ValueDomain-2
C1274040
NCI Thesaurus ValueDomain-3
C54117
UMLS 2011AA ValueDomain-3
C1706202
CRID processing result:
Description

IdentificationNumberProcessingOutcomeType

Data type

text

Alias
NCI Thesaurus ObjectClass
C25337
UMLS 2011AA ObjectClass
C0237753
NCI Thesaurus ObjectClass-2
C48177
UMLS 2011AA ObjectClass-2
C1709694
NCI Thesaurus ObjectClass-3
C25737
UMLS 2011AA ObjectClass-3
C0205396
NCI Thesaurus Property
C20200
UMLS 2011AA Property
C1274040
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ValueDomain-2
C25284
UMLS 2011AA ValueDomain-2
C0332307
NCI Thesaurus ValueDomain-3
C20200
UMLS 2011AA ValueDomain-3
C1274040
NCI Thesaurus ValueDomain-4
C48177
UMLS 2011AA ValueDomain-4
C1709694
NCI Thesaurus ValueDomain-5
C25737
UMLS 2011AA ValueDomain-5
C0205396
Form processing result :
Description

FormProcessingOutcomeType

Data type

text

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

Similar models

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
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)
Item Group
Recipient Date
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)
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)
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)
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)
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)
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)
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)
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)
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)
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)
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)
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)
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)
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)
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)
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
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)
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)
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)
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)
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)
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)
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)
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)
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)
Item Group
Hematopoietic Stem Cell Transplant Date Part 2 Of 4
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)
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)
Item Group
Hematopoietic Stem Cell Transplant Part 3 Of 4
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)
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)
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
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)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
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)
Item Group
Recipient Data Part 4 Of 4
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)
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)
Item Group
Author Information
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)
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)
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)
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)
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)
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)
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)
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)
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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