ID

43656

Description

The collection of CDEs used in the demography module. Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=74E63D0F-0BF0-E8D1-E040-BB89AD430251

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=74E63D0F-0BF0-E8D1-E040-BB89AD430251

Keywords

Versions (3)
  1. 8/27/12 8/27/12 -
  2. 7/14/17 7/14/17 - Martin Dugas
  3. 9/20/21 9/20/21 -
Uploaded on

September 20, 2021

DOI

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License

Creative Commons BY-NC 3.0
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NCI Standard Demography Template

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No Instruction available.

1 forms  
  1. StudyEvent: NCI Standard Demography Template
    1. No Instruction available.
Mandatory Demography Question
Description

Mandatory Demography Question

Alias
UMLS CUI-1
C0011298
Gender
Description

Person Gender

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
NCI Thesaurus ObjectClass
C25190
NCI Thesaurus Property
C17357
UMLS CUI [1]
C0079399
Race
Description

Race Category

Data type

text

Alias
NCI Thesaurus Property
C25372
NCI Thesaurus ValueDomain
C25372
NCI Thesaurus ObjectClass
C17049
UMLS CUI [1]
C0034510
Patient's Date of Birth
Description

Birth Date

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ObjectClass
C25190
NCI Thesaurus Property
C25155
UMLS CUI [1]
C0421451
Ethnicity
Description

Ethnic Group

Data type

text

Alias
NCI Thesaurus Property
C25372
NCI Thesaurus ValueDomain
C25372
NCI Thesaurus ObjectClass
C16564
UMLS CUI [1]
C0015031
Conditional Demography Question
Description

Conditional Demography Question

Alias
UMLS CUI-1
C0011298
UMLS CUI-2
C1701901
ZIP Code
Description

Postal Code

Data type

text

Alias
NCI Thesaurus ObjectClass
C25407
NCI Thesaurus Property
C25621
NCI Thesaurus ValueDomain
C25364
NCI Thesaurus ValueDomain-2
C25407
NCI Thesaurus ValueDomain-3
C25621
UMLS CUI [1]
C1514254
Payment Method
Description

Healthcare Payer

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
NCI Thesaurus ObjectClass
C25190
NCI Thesaurus Property
C70686
NCI Thesaurus ValueDomain-2
C70686
UMLS CUI [1]
C2348942
Country of Residence
Description

Country

Data type

text

Alias
NCI Thesaurus ObjectClass
C25190
NCI Thesaurus ValueDomain
C25464
NCI Thesaurus Property
C25407
NCI Thesaurus ValueDomain-2
C42614
UMLS CUI [1]
C1562954
Date Completed
Description

Form Completion Date

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ObjectClass
C40988
NCI Thesaurus Property
C25250
UMLS CUI [1]
C1115437
CDC Race Code
Description

CDC Race Code

Data type

text

Alias
NCI Thesaurus ValueDomain
C25162
NCI Thesaurus Property
C25372
NCI Thesaurus ObjectClass
C17049
UMLS CUI [1,1]
C0034510
UMLS CUI [1,2]
C0007670
CDC Ethnicity Code
Description

CDC Ethnicity Code

Data type

text

Alias
NCI Thesaurus ValueDomain
C25162
NCI Thesaurus Property
C25372
NCI Thesaurus ObjectClass
C16564
UMLS CUI [1,1]
C0015031
UMLS CUI [1,2]
C0007670
Optional Demography Quesitons
Description

Optional Demography Quesitons

Alias
UMLS CUI-1
C0011298
UMLS CUI-2
C1518600
Highest Education Level
Description

Highest Education Level

Data type

text

Alias
NCI Thesaurus ObjectClass
C25190
NCI Thesaurus Property
C17953
NCI Thesaurus ValueDomain
C25284
NCI Thesaurus ValueDomain-2
C17953
NCI Thesaurus ValueDomain-3
C42581
UMLS CUI [1]
C0013658
Country of Birth
Description

Country of Birth

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
NCI Thesaurus ObjectClass
C25190
NCI Thesaurus Property
C25464
NCI Thesaurus Property-2
C25155
UMLS CUI [1]
C1300001
Highest Education Level
Description

Person Education Level

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
NCI Thesaurus ObjectClass
C25190
NCI Thesaurus Property
C17953
NCI Thesaurus ValueDomain-2
C17953
UMLS CUI [1]
C0013658
Census Tract Code at Enrollment
Description

Census Tract Code

Data type

text

Alias
NCI Thesaurus ObjectClass
C25190
NCI Thesaurus Property
C45255
NCI Thesaurus Property-2
C25407
NCI Thesaurus Property-3
C37948
NCI Thesaurus Property-4
C67490
NCI Thesaurus ValueDomain
C25162
NCI Thesaurus ValueDomain-2
C45255
NCI Thesaurus ValueDomain-3
C17234
NCI Thesaurus ValueDomain-4
C67490
UMLS CUI [1]
C1555581
Marital Status
Description

Marital Status

Data type

text

Alias
NCI Thesaurus ObjectClass
C25190
NCI Thesaurus ValueDomain
C25372
NCI Thesaurus Property
C25188
UMLS CUI [1]
C0024819
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Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Mandatory Demography Question
C0011298 (UMLS CUI-1)
Item
Gender
text
C25284 (NCI Thesaurus ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C17357 (NCI Thesaurus Property)
C0079399 (UMLS CUI [1])
CL.1
Code List
Gender
CL Item
Female Gender (Female)
C46110 (NCI Thesaurus)
C0086287 (UMLS CUI-1)
CL Item
Male Gender (Male)
C46109 (NCI Thesaurus)
C0086582 (UMLS CUI-1)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS CUI-1)
CL Item
Unspecified (Unspecified)
C38046 (NCI Thesaurus)
C0205370 (UMLS CUI-1)
Item
Race
text
C25372 (NCI Thesaurus Property)
C25372 (NCI Thesaurus ValueDomain)
C17049 (NCI Thesaurus ObjectClass)
C0034510 (UMLS CUI [1])
CL.2
Code List
Race
CL Item
A Person Having Origins In Any Of The Original Peoples Of North And South America (including Central America), And Who Maintains Tribal Affiliation Or Community Attachment. (American Indian or Alaska Native)
C41259 (NCI Thesaurus)
C1515945 (UMLS 2011AA)
CL Item
A Person Having Origins In Any Of The Original Peoples Of The Far East, Southeast Asia, Or The Indian Subcontinent Including, For Example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, The Philippine Islands, Thailand, And Vietnam. (Asian)
C41260 (NCI Thesaurus)
C0078988 (UMLS 2011AA)
CL Item
A Person Having Origins In Any Of The Black Racial Groups Of Africa. Terms Such As "haitian" Or "negro" Can Be Used In Addition To "black Or African American." (Black or African American)
C16352 (NCI Thesaurus)
C0085756 (UMLS 2011AA)
CL Item
A Person Having Origins In Any Of The Original Peoples Of Hawaii, Guam, Samoa, Or Other Pacific Islands. (Native Hawaiian or other Pacific Islander)
C41219 (NCI Thesaurus)
C1513907 (UMLS 2011AA)
CL Item
Not Provided Or Available (Not Reported)
C43234 (NCI Thesaurus)
C1706613 (UMLS 2011AA)
CL Item
Could Not Be Determined Or Unsure (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
CL Item
A Person Having Origins In Any Of The Original Peoples Of Europe, The Middle East, Or North Africa. (White)
C41261 (NCI Thesaurus)
C0007457 (UMLS 2011AA)
Birth Date
Item
Patient's Date of Birth
date
C25164 (NCI Thesaurus ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C25155 (NCI Thesaurus Property)
C0421451 (UMLS CUI [1])
Item
Ethnicity
text
C25372 (NCI Thesaurus Property)
C25372 (NCI Thesaurus ValueDomain)
C16564 (NCI Thesaurus ObjectClass)
C0015031 (UMLS CUI [1])
CL.3
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
Not Provided Or Available (Not reported)
C43234 (NCI Thesaurus)
C1706613 (UMLS 2011AA)
CL Item
Could Not Be Determined Or Unsure (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item Group
Conditional Demography Question
C0011298 (UMLS CUI-1)
C1701901 (UMLS CUI-2)
Postal Code
Item
ZIP Code
text
C25407 (NCI Thesaurus ObjectClass)
C25621 (NCI Thesaurus Property)
C25364 (NCI Thesaurus ValueDomain)
C25407 (NCI Thesaurus ValueDomain-2)
C25621 (NCI Thesaurus ValueDomain-3)
C1514254 (UMLS CUI [1])
Item
Payment Method
text
C25284 (NCI Thesaurus ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C70686 (NCI Thesaurus Property)
C70686 (NCI Thesaurus ValueDomain-2)
C2348942 (UMLS CUI [1])
CL.4
Code List
Payment Method
CL Item
Managed Care/medicare (Managed Care/Medicare)
C16665 (NCI Thesaurus)
C15364 (NCI Thesaurus-3)
C0018717 (UMLS CUI-1)
C0086583 (UMLS CUI-2)
CL Item
Medicaid (Medicaid)
C68633 (NCI Thesaurus)
C0025071 (UMLS CUI-1)
CL Item
Medicare And Medicaid (Medicaid and Medicare)
C16665 (NCI Thesaurus)
C37912 (NCI Thesaurus-3)
C68633 (NCI Thesaurus-5)
C0018717 (UMLS CUI-1)
C0025071 (UMLS CUI-2)
CL Item
Medicare (Medicare)
C16665 (NCI Thesaurus)
C0018717 (UMLS CUI-1)
CL Item
Medicare And Private Insurance (Medicare and Private Insurance)
C16665 (NCI Thesaurus)
C37912 (NCI Thesaurus-3)
C16745 (NCI Thesaurus-5)
C54104 (NCI Thesaurus-7)
C0018717 (UMLS CUI-1)
C3845555 (UMLS CUI-2)
CL Item
Military Or Veterans Sponsored Insurance, Not Otherwise Specified (Military or Veterans Sponsored, NOS)
C19594 (NCI Thesaurus)
C37998 (NCI Thesaurus-3)
C16745 (NCI Thesaurus-5)
C68638 (NCI Thesaurus-7)
C48355 (NCI Thesaurus-9)
C17239 (NCI Thesaurus-11)
C0026126 (UMLS CUI-1)
C0041735 (UMLS CUI-2)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS CUI-1)
CL Item
Private Insurance (Private Insurance)
C16745 (NCI Thesaurus)
C54104 (NCI Thesaurus-3)
C3845555 (UMLS CUI-1)
CL Item
State Supplemental Health Insurance (State Supplemental Health Insurance)
C68641 (NCI Thesaurus)
C16745 (NCI Thesaurus-3)
C30010 (NCI Thesaurus-5)
C25178 (NCI Thesaurus-7)
C0021682 (UMLS CUI-1)
C2348609 (UMLS CUI-2)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS CUI-1)
CL Item
Veterans Administration Sponsor Insurance (Veterans Sponsored)
C16745 (NCI Thesaurus)
C48355 (NCI Thesaurus-3)
C17239 (NCI Thesaurus-5)
C0041735 (UMLS CUI-1)
CL Item
Military Insurance (Military Sponsored (Including CHAMPUS & TriCare)
C0026126 (UMLS CUI-1)
CL Item
No Insurance (No Means of Payment (No Insurance)
C3845078 (UMLS CUI-1)
CL Item
Self Payment (Self-Pay (No Insurance)
C1718325 (UMLS CUI-1)
Country
Item
Country of Residence
text
C25190 (NCI Thesaurus ObjectClass)
C25464 (NCI Thesaurus ValueDomain)
C25407 (NCI Thesaurus Property)
C42614 (NCI Thesaurus ValueDomain-2)
C1562954 (UMLS CUI [1])
Form Completion Date
Item
Date Completed
date
C25164 (NCI Thesaurus ValueDomain)
C40988 (NCI Thesaurus ObjectClass)
C25250 (NCI Thesaurus Property)
C1115437 (UMLS CUI [1])
CDC Race Code
Item
CDC Race Code
text
C25162 (NCI Thesaurus ValueDomain)
C25372 (NCI Thesaurus Property)
C17049 (NCI Thesaurus ObjectClass)
C0034510 (UMLS CUI [1,1])
C0007670 (UMLS CUI [1,2])
CDC Ethnicity Code
Item
CDC Ethnicity Code
text
C25162 (NCI Thesaurus ValueDomain)
C25372 (NCI Thesaurus Property)
C16564 (NCI Thesaurus ObjectClass)
C0015031 (UMLS CUI [1,1])
C0007670 (UMLS CUI [1,2])
Item Group
Optional Demography Quesitons
C0011298 (UMLS CUI-1)
C1518600 (UMLS CUI-2)
Item
Highest Education Level
text
C25190 (NCI Thesaurus ObjectClass)
C17953 (NCI Thesaurus Property)
C25284 (NCI Thesaurus ValueDomain)
C17953 (NCI Thesaurus ValueDomain-2)
C42581 (NCI Thesaurus ValueDomain-3)
C0013658 (UMLS CUI [1])
CL.5
Code List
Highest Education Level
CL Item
Bachelor's Degree (Bachelor's Degree)
C39327 (NCI Thesaurus)
C1511035 (UMLS CUI-1)
CL Item
Professional Doctorate Or Doctorate Degree (Doctoral degree or professional degree)
C37998 (NCI Thesaurus)
C39392 (NCI Thesaurus-3)
C67143 (NCI Thesaurus-5)
C1512027 (UMLS CUI-1)
CL Item
Grade School (Grade School)
C80410 (NCI Thesaurus)
C0683859 (UMLS CUI-1)
CL Item
Graduation Or Professional Degree (Graduate or professional degree)
C37998 (NCI Thesaurus)
C52581 (NCI Thesaurus-3)
C75558 (NCI Thesaurus-5)
C25354 (NCI Thesaurus-7)
C1711333 (UMLS CUI-1)
CL Item
Master's Degree (Master's Degree)
C39453 (NCI Thesaurus)
C1513010 (UMLS CUI-1)
CL Item
No Formal Schooling (No formal education)
C67122 (NCI Thesaurus)
C0557286 (UMLS CUI-1)
CL Item
Not High School Graduate (Not high school graduate)
C76123 (NCI Thesaurus)
C2825140 (UMLS CUI-1)
CL Item
Some College Or Associates Degree (Some college or associate degree)
C37998 (NCI Thesaurus)
C71340 (NCI Thesaurus-3)
C65099 (NCI Thesaurus-5)
C61514 (NCI Thesaurus-7)
C1549943 (UMLS CUI-1)
CL Item
High School Completion Or General Equivalency Diploma (ged) Completion (High school graduate (including equivalency)
C0870649 (UMLS CUI-1)
Item
Country of Birth
text
C25284 (NCI Thesaurus ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C25464 (NCI Thesaurus Property)
C25155 (NCI Thesaurus Property-2)
C1300001 (UMLS CUI [1])
CL.6
Code List
Country of Birth
CL Item
Other Country (Other country)
CL Item
Other Country, Specify (Other country, specify)
CL Item
Usa (USA)
CL Item
Usa, Specify The 2 Letter State Code, Eg Ny (USA, specify the 2 letter State code, eg NY)
Item
Highest Education Level
text
C25284 (NCI Thesaurus ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C17953 (NCI Thesaurus Property)
C17953 (NCI Thesaurus ValueDomain-2)
C0013658 (UMLS CUI [1])
CL.7
Code List
Highest Education Level
CL Item
10th Grade (10th Grade)
C67132 (NCI Thesaurus)
C1883613 (UMLS 2011AA)
CL Item
11th Grade (11th Grade)
C67133 (NCI Thesaurus)
C1883614 (UMLS 2011AA)
CL Item
12th Grade (12th Grade No Diploma)
C67134 (NCI Thesaurus)
C1883615 (UMLS 2011AA)
CL Item
1st Grade (1st Grade)
C67123 (NCI Thesaurus)
C1883619 (UMLS 2011AA)
CL Item
2nd Grade (2nd Grade)
C67124 (NCI Thesaurus)
C1883622 (UMLS 2011AA)
CL Item
3rd Grade (3rd Grade)
C67125 (NCI Thesaurus)
C1883635 (UMLS 2011AA)
CL Item
4th Grade (4th Grade)
C67126 (NCI Thesaurus)
C1883642 (UMLS 2011AA)
CL Item
5th Grade (5th Grade)
C67127 (NCI Thesaurus)
C1883646 (UMLS 2011AA)
CL Item
6th Grade (6th Grade)
C67128 (NCI Thesaurus)
C1883649 (UMLS 2011AA)
CL Item
7th Grade (7th Grade)
C67129 (NCI Thesaurus)
C1883651 (UMLS 2011AA)
CL Item
8th Grade (8th Grade)
C67130 (NCI Thesaurus)
C1883653 (UMLS 2011AA)
CL Item
9th Grade (9th Grade)
C67131 (NCI Thesaurus)
C1883654 (UMLS 2011AA)
CL Item
Academic Doctorate Degree Completion (Academic Doctorate Degree)
C70557 (NCI Thesaurus)
C2348318 (UMLS 2011AA)
CL Item
Associate Degree (Associate Degree)
C67140 (NCI Thesaurus)
C1879750 (UMLS 2011AA)
CL Item
Bachelor's Degree Completion (Bachelor Degree)
C70555 (NCI Thesaurus)
C2346951 (UMLS 2011AA)
CL Item
Does Not Know (Don't Know)
C67142 (NCI Thesaurus)
C1880386 (UMLS 2011AA)
CL Item
General Equivalency Diploma (General Equivalency Diploma)
C67135 (NCI Thesaurus)
C1880947 (UMLS 2011AA)
CL Item
High School Graduate (High School Graduate)
C67136 (NCI Thesaurus)
C0870649 (UMLS 2011AA)
CL Item
Kindergarten Completion (Kindergarten)
C70432 (NCI Thesaurus)
C0681406 (UMLS 2011AA)
CL Item
Master's Degree Completion (Master's Degree)
C70556 (NCI Thesaurus)
C2347079 (UMLS 2011AA)
CL Item
Never Attended (No Formal Schooling)
C67122 (NCI Thesaurus)
C0557286 (UMLS 2011AA)
CL Item
Preschool Completion (Preschool)
C70433 (NCI Thesaurus)
C0681405 (UMLS 2011AA)
CL Item
Professional Doctorate Degree Completion (Professional Doctorate Degree)
C70558 (NCI Thesaurus)
C2347690 (UMLS 2011AA)
CL Item
Refuse (Refused)
C49161 (NCI Thesaurus)
C1705116 (UMLS 2011AA)
CL Item
Some College (Some College, No Degree)
C67137 (NCI Thesaurus)
C1883065 (UMLS 2011AA)
CL Item
Vocational Degree (VoTech Program)
C67141 (NCI Thesaurus)
C1883542 (UMLS 2011AA)
Census Tract Code
Item
Census Tract Code at Enrollment
text
C25190 (NCI Thesaurus ObjectClass)
C45255 (NCI Thesaurus Property)
C25407 (NCI Thesaurus Property-2)
C37948 (NCI Thesaurus Property-3)
C67490 (NCI Thesaurus Property-4)
C25162 (NCI Thesaurus ValueDomain)
C45255 (NCI Thesaurus ValueDomain-2)
C17234 (NCI Thesaurus ValueDomain-3)
C67490 (NCI Thesaurus ValueDomain-4)
C1555581 (UMLS CUI [1])
Item
Marital Status
text
C25190 (NCI Thesaurus ObjectClass)
C25372 (NCI Thesaurus ValueDomain)
C25188 (NCI Thesaurus Property)
C0024819 (UMLS CUI [1])
CL.8
Code List
Marital Status
CL Item
Divorced (Divorced)
C51776 (NCI Thesaurus)
C0086170 (UMLS CUI-1)
CL Item
Domestic Partner (Domestic Partnership)
C53262 (NCI Thesaurus)
C1549111 (UMLS CUI-1)
CL Item
Married (Married)
C51773 (NCI Thesaurus)
C0555047 (UMLS CUI-1)
CL Item
Never Married (Never Married)
C51774 (NCI Thesaurus)
C0027952 (UMLS CUI-1)
CL Item
Separated (Separated)
C51777 (NCI Thesaurus)
C0086972 (UMLS CUI-1)
CL Item
Widowed (Widowed)
C51775 (NCI Thesaurus)
C0206275 (UMLS CUI-1)
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