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Case report form RRL 100013

1 forms  
Patient demographics
Description

Patient demographics

Subject Identifier
Description

Subject Identifier

Data type

integer

Alias
UMLS CUI [1]
C2348585
Date of birth
Description

Date of birth

Data type

date

Alias
UMLS CUI [1]
C0421451
Date of visit
Description

Date of visit

Data type

date

Alias
UMLS CUI [1]
C1320303
Gender
Description

Gender

Data type

integer

Alias
UMLS CUI [1]
C0079399
Ethnicity
Description

Please tick on box

Data type

integer

Alias
UMLS CUI [1]
C0015031
Race
Description

check all that apply

Data type

integer

Alias
UMLS CUI [1]
C0034510
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Similar models

Case report form RRL 100013

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Patient demographics
Subject Identifier
Item
Subject Identifier
integer
C2348585 (UMLS CUI [1])
Date of birth
Item
Date of birth
date
C0421451 (UMLS CUI [1])
Date of visit
Item
Date of visit
date
C1320303 (UMLS CUI [1])
Item
Gender
integer
C0079399 (UMLS CUI [1])
Gender
Code List
Gender
CL Item
male (m)
C0086582 (UMLS CUI-1)
CL Item
female (f)
C0086287 (UMLS CUI-1)
Item
Ethnicity
integer
C0015031 (UMLS CUI [1])
Ethnicity
Code List
Ethnicity
CL Item
Hispanic or Latino (1)
C0019576 (UMLS CUI-1)
CL Item
Not Hispanic or Latino (2)
C1518424 (UMLS CUI-1)
Item
Race
integer
C0034510 (UMLS CUI [1])
Race
Code List
Race
CL Item
African American/African Heritage (1)
C0085756 (UMLS CUI-1)
CL Item
American Indian or Alaskan Native (2)
C0682125 (UMLS CUI-1)
CL Item
Asian - Central/South Asian Heritage (3)
CL Item
Asian - East Asian Heritage (4)
CL Item
Asian - Japanese Heritage (5)
CL Item
Asian - South East Asian Heritage (6)
CL Item
Native Hawaiian or Other Pacific Islander (7)
CL Item
White - Arabic/North African Heritage (8)
CL Item
White - White/Caucasian/European Heritage (9)
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