ID

43101

Description

DEM Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FF1A18C7-58B3-19A7-E034-0003BA3F9857

Lien

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FF1A18C7-58B3-19A7-E034-0003BA3F9857

Mots-clés

Versions (4)
  1. 19/09/2012 19/09/2012 -
  2. 09/01/2015 09/01/2015 - Martin Dugas
  3. 27/06/2015 27/06/2015 -
  4. 20/09/2021 20/09/2021 -
Téléchargé le

20 septembre 2021

DOI

Pour une demande vous connecter.

Licence

Creative Commons BY-NC 3.0 Legacy
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    DEM

    Anglais

    No Instruction available.

    1 Formulaires  
    Patient demographics
    Description

    Patient demographics

    Gender
    Description

    Gender

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25372
    UMLS CUI-1
    C0079399
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C17357
    Date of Birth
    Description

    PersonBirthDate

    Type de données

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ObjectClass
    C25190
    UMLS 2011AA ObjectClass
    C0027361
    NCI Thesaurus Property
    C25155
    UMLS 2011AA Property
    C0005615
    Ethnicity
    Description

    Ethnic Group

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25372
    UMLS CUI-1
    C0015031
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C16564
    Race
    Description

    Racial Group

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25372
    UMLS CUI-1
    C0034510
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C17049
    Specify race
    Description

    OtherRaceCategoryText

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    UMLS 2011AA ValueDomain
    C1521902
    NCI Thesaurus Property
    C25372
    UMLS 2011AA Property
    C0683312
    NCI Thesaurus ObjectClass
    C17049
    UMLS 2011AA ObjectClass
    C0034510
    Specify race
    Description

    OtherRaceCategoryText

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    UMLS 2011AA ValueDomain
    C1521902
    NCI Thesaurus Property
    C25372
    UMLS 2011AA Property
    C0683312
    NCI Thesaurus ObjectClass
    C17049
    UMLS 2011AA ObjectClass
    C0034510
    Comments
    Description

    Research Comments

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704
    UMLS CUI-1
    C0947611
    NCI Thesaurus ObjectClass
    C15319
    NCI Thesaurus Property
    C25393
    Name code
    Description

    Namecode

    Type de données

    text

    IBMTR IUBMID # (if already known or assigned)
    Description

    IBMTRIUBMID#(ifalreadyknownorassigned)

    Type de données

    text

    Secondary race
    Description

    Secondaryrace

    Type de données

    text

    Retour au début de la page

    Similar models

    No Instruction available.

    1 Formulaires
    Name
    Type
    Description | Question | Decode (Coded Value)
    Type de données
    Alias
    Item Group
    Patient demographics
    Item
    Gender
    text
    C25372 (NCI Thesaurus ValueDomain)
    C0079399 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C17357 (NCI Thesaurus Property)
    CL.1
    Code List
    Gender
    CL Item
    Male (Male)
    C46109 (NCI Thesaurus)
    C1706180 (UMLS 2011AA)
    CL Item
    Female (Female)
    C46110 (NCI Thesaurus)
    C0086287 (UMLS 2011AA)
    PersonBirthDate
    Item
    Date of Birth
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C25190 (NCI Thesaurus ObjectClass)
    C0027361 (UMLS 2011AA ObjectClass)
    C25155 (NCI Thesaurus Property)
    C0005615 (UMLS 2011AA Property)
    Item
    Ethnicity
    text
    C25372 (NCI Thesaurus ValueDomain)
    C0015031 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C16564 (NCI Thesaurus Property)
    CL.2
    Code List
    Ethnicity
    CL Item
    A Person Of Mexican, Puerto Rican, Cuban, Central Or South American Or Other Spanish Culture Or Origin, Regardless Of Race. (Hispanic or Latino)
    C17459 (NCI Thesaurus)
    C0086409 (UMLS 2011AA)
    CL Item
    A Person Not Meeting The Definition For Hispanic Or Latino. (Not Hispanic or Latino)
    C41222 (NCI Thesaurus)
    C1518424 (UMLS 2011AA)
    CL Item
    Could Not Be Determined Or Unsure (Unknown)
    C17998 (NCI Thesaurus)
    C0439673 (UMLS 2011AA)
    CL Item
    Not Provided Or Available (Not answered)
    C43234 (NCI Thesaurus)
    C1706613 (UMLS 2011AA)
    Item
    Race
    text
    C25372 (NCI Thesaurus ValueDomain)
    C0034510 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C17049 (NCI Thesaurus Property)
    CL.3
    Code List
    Race
    CL Item
    White (not otherwise specified) (White (not otherwise specified))
    CL Item
    European (not otherwise specified) (European (not otherwise specified))
    CL Item
    Mediterranean (Mediterranean)
    CL Item
    White North American (White North American)
    CL Item
    South or Central American White (South or Central American White)
    CL Item
    Eastern European (Eastern European)
    CL Item
    Northern European (Northern European)
    CL Item
    Western European (Western European)
    CL Item
    White Caribbean (White Caribbean)
    CL Item
    North Coast of Africa (North Coast of Africa)
    CL Item
    Black (not otherwise specified) (Black (not otherwise specified))
    CL Item
    African American (African American)
    CL Item
    African Black (both parents born in Africa) (African Black (both parents born in Africa))
    CL Item
    Caribbean Black (Caribbean Black)
    CL Item
    South or Central American Black (South or Central American Black)
    CL Item
    Black, other specify (Black, other specify)
    CL Item
    Asian (not otherwise specified) (Asian (not otherwise specified))
    CL Item
    Indian/South Asian (Indian/South Asian)
    CL Item
    Filipino (pilipino) (Filipino (pilipino))
    CL Item
    Japanese (Japanese)
    CL Item
    Korean (Korean)
    CL Item
    Chinese (Chinese)
    CL Item
    Other Southeast Asian (Other Southeast Asian)
    CL Item
    Vietnamese (Vietnamese)
    CL Item
    Native American (not otherwise specified) (Native American (not otherwise specified))
    CL Item
    Native Alaskan/Eskimo/Aleut (Native Alaskan/Eskimo/Aleut)
    CL Item
    American Indian (not otherwise specified) (American Indian (not otherwise specified))
    CL Item
    North American Indian (North American Indian)
    CL Item
    South or Central American Indian (South or Central American Indian)
    CL Item
    Caribbean Indian (Caribbean Indian)
    CL Item
    Native Pacific Islander (not otherwise specified) (Native Pacific Islander (not otherwise specified))
    CL Item
    Guamanian (Guamanian)
    CL Item
    Hawaiian (Hawaiian)
    CL Item
    Samoan (Samoan)
    CL Item
    Could Not Be Determined Or Unsure (Unknown)
    C17998 (NCI Thesaurus)
    C0439673 (UMLS 2011AA)
    CL Item
    Other, specify (Other, specify)
    CL Item
    Not Provided Or Available (Not answered)
    C43234 (NCI Thesaurus)
    C1706613 (UMLS 2011AA)
    OtherRaceCategoryText
    Item
    Specify race
    text
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    C25372 (NCI Thesaurus Property)
    C0683312 (UMLS 2011AA Property)
    C17049 (NCI Thesaurus ObjectClass)
    C0034510 (UMLS 2011AA ObjectClass)
    OtherRaceCategoryText
    Item
    Specify race
    text
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    C25372 (NCI Thesaurus Property)
    C0683312 (UMLS 2011AA Property)
    C17049 (NCI Thesaurus ObjectClass)
    C0034510 (UMLS 2011AA ObjectClass)
    Research Comments
    Item
    Comments
    text
    C25704 (NCI Thesaurus ValueDomain)
    C0947611 (UMLS CUI-1)
    C15319 (NCI Thesaurus ObjectClass)
    C25393 (NCI Thesaurus Property)
    Namecode
    Item
    Name code
    text
    IBMTRIUBMID#(ifalreadyknownorassigned)
    Item
    IBMTR IUBMID # (if already known or assigned)
    text
    Item
    Secondary race
    text
    CL.4
    Code List
    Secondary race
    CL Item
    White (not otherwise specified) (White (not otherwise specified))
    CL Item
    European (not otherwise specified) (European (not otherwise specified))
    CL Item
    Mediterranean (Mediterranean)
    CL Item
    White North American (White North American)
    CL Item
    South or Central American White (South or Central American White)
    CL Item
    Eastern European (Eastern European)
    CL Item
    Northern European (Northern European)
    CL Item
    Western European (Western European)
    CL Item
    White Caribbean (White Caribbean)
    CL Item
    North Coast of Africa (North Coast of Africa)
    CL Item
    Black (not otherwise specified) (Black (not otherwise specified))
    CL Item
    African American (African American)
    CL Item
    African Black (both parents born in Africa) (African Black (both parents born in Africa))
    CL Item
    Caribbean Black (Caribbean Black)
    CL Item
    South or Central American Black (South or Central American Black)
    CL Item
    Black, other specify (Black, other specify)
    CL Item
    Asian (not otherwise specified) (Asian (not otherwise specified))
    CL Item
    Indian/South Asian (Indian/South Asian)
    CL Item
    Filipino (pilipino) (Filipino (pilipino))
    CL Item
    Japanese (Japanese)
    CL Item
    Korean (Korean)
    CL Item
    Chinese (Chinese)
    CL Item
    Other Southeast Asian (Other Southeast Asian)
    CL Item
    Vietnamese (Vietnamese)
    CL Item
    Native American (not otherwise specified) (Native American (not otherwise specified))
    CL Item
    Native Alaskan/Eskimo/Aleut (Native Alaskan/Eskimo/Aleut)
    CL Item
    American Indian (not otherwise specified) (American Indian (not otherwise specified))
    CL Item
    North American Indian (North American Indian)
    CL Item
    South or Central American Indian (South or Central American Indian)
    CL Item
    Caribbean Indian (Caribbean Indian)
    CL Item
    Native Pacific Islander (not otherwise specified) (Native Pacific Islander (not otherwise specified))
    CL Item
    Guamanian (Guamanian)
    CL Item
    Hawaiian (Hawaiian)
    CL Item
    Samoan (Samoan)
    CL Item
    Unknown (Unknown)
    CL Item
    Other, specify (Other, specify)
    CL Item
    Not answered (Not answered)
    Retour au début de la page 

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