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  1. StudyEvent: NCCTG N0733 Demography Form
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Standard Patient Identifier
CL386173 (UMLS CUI-1)
Patient initials last name
Item
Patient Initials LastName
text
C25191 (NCI Thesaurus ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
C25551 (NCI Thesaurus Property)
C2986440 (UMLS CUI-1)
Patient initials first name
Item
Patient initials first name
text
C25191 (NCI Thesaurus ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
C25509 (NCI Thesaurus Property)
C2986440 (UMLS CUI-1)
Patient initials middle name
Item
Patient initials middle name
text
C25191 (NCI Thesaurus ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
C25569 (NCI Thesaurus Property)
C2986440 (UMLS CUI-1)
Social security number
Item
Patient SSN
text
C25337 (NCI Thesaurus ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C25686 (NCI Thesaurus Property)
C1301821 (UMLS CUI-1)
Medical Record Number
Item
Patient Medical Record Number
text
C25337 (NCI Thesaurus ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C25261 (NCI Thesaurus Property)
C25198 (NCI Thesaurus Property)
C1301894 (UMLS CUI-1)
Item Group
Standard Demographics
C1704791 (UMLS CUI-1)
Item
Ethnicity
text
C25372 (NCI Thesaurus Property)
C25372 (NCI Thesaurus ValueDomain)
C16564 (NCI Thesaurus ObjectClass)
C0015031 (UMLS CUI-1)
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
Gender of a Person
text
C25284 (NCI Thesaurus ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C17357 (NCI Thesaurus Property)
C0079399 (UMLS CUI-1)
Code List
Gender of a Person
CL Item
Female Gender (Female Gender)
C46110 (NCI Thesaurus)
C0086287 (UMLS 2011AA)
CL Item
Male Gender (Male Gender)
C46109 (NCI Thesaurus)
C1706180 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
CL Item
Unspecified (Unspecified)
C38046 (NCI Thesaurus)
C0205370 (UMLS 2011AA)
Birth Date
Item
Patient's Date of Birth
date
C25164 (NCI Thesaurus ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C25367 (NCI Thesaurus ValueDomain)
C25155 (NCI Thesaurus Property)
C0421451 (UMLS CUI-1)
Census Tract Codes
Item
2000 Census Tract Codes
text
C16495 (NCI Thesaurus ObjectClass)
C67490 (NCI Thesaurus Property)
C25337 (NCI Thesaurus ValueDomain)
C25704 (NCI Thesaurus ValueDomain)
C25407 (NCI Thesaurus ValueDomain)
C67490 (NCI Thesaurus ValueDomain)
Country
Item
Patient's Country of Residence
text
C16960 (NCI Thesaurus ObjectClass)
C25464 (NCI Thesaurus ValueDomain)
C25407 (NCI Thesaurus Property)
C42614 (NCI Thesaurus ValueDomain)
C1562954 (UMLS CUI-1)
Postal Code
Item
Patient's ZIP Code
text
C25407 (NCI Thesaurus ObjectClass)
C25621 (NCI Thesaurus Property)
C25364 (NCI Thesaurus ValueDomain)
C25407 (NCI Thesaurus ValueDomain)
C25621 (NCI Thesaurus ValueDomain)
C0421454 (UMLS CUI-1)
Item Group
Race
C0034510 (UMLS CUI-1)
Item
Race Category
text
C25372 (NCI Thesaurus Property)
C25372 (NCI Thesaurus ValueDomain)
C17049 (NCI Thesaurus ObjectClass)
C0034510 (UMLS CUI-1)
Code List
Race Category
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
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)
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
Method Of Payment
C0680264 (UMLS CUI-1)
Item
Method of Payment
text
C25162 (NCI Thesaurus ValueDomain)
C16847 (NCI Thesaurus Property)
C25371 (NCI Thesaurus ObjectClass)
C0680264 (UMLS CUI-1)
Code List
Method of Payment
CL Item
Private Insurance (1)
CL Item
Medicare (2)
C16665 (NCI Thesaurus)
C0018717 (UMLS 2011AA)
CL Item
Medicare And Private Insurance (3)
CL Item
Medicaid (4)
C0025071 (NCI Metathesaurus)
CL Item
Medicaid And Medicare (5)
CL Item
Military Or Veterans Sponsored Nos (6)
CL Item
Military Sponsored (including Champus &tricare) (6a)
CL Item
Veterans Sponsored (6b)
CL Item
Self Pay (no Insurance) (7)
CL Item
No Means Of Payment (no Insurance) (8)
CL Item
Other (98)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
CL Item
Unknown (99)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item Group
Optional Questions
C1518600 (UMLS CUI-1)
C1522634 (UMLS CUI-2)
CDC Race Code
Item
CDC Race Code
text
C25162 (NCI Thesaurus ValueDomain)
C25372 (NCI Thesaurus Property)
C17049 (NCI Thesaurus ObjectClass)
C0007670 (UMLS CUI-1)
C0034510 (UMLS CUI-2)
CDC Ethnicity Code
Item
CDC Ethnicity Code
text
C25162 (NCI Thesaurus ValueDomain)
C25372 (NCI Thesaurus Property)
C16564 (NCI Thesaurus ObjectClass)
C0007670 (UMLS CUI-1)
C0015031 (UMLS CUI-2)
Item
Education Level
text
C25284 (NCI Thesaurus ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C17953 (NCI Thesaurus Property)
C17953 (NCI Thesaurus ValueDomain)
C0013658 (UMLS CUI-1)
Code List
Education Level
CL Item
Preschool Completion (Preschool)
C70433 (NCI Thesaurus)
C0681405 (UMLS 2011AA)
CL Item
Kindergarten Completion (Kindergarten)
C70432 (NCI Thesaurus)
C0681406 (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
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
High School Graduate (High School Graduate)
C67136 (NCI Thesaurus)
C0870649 (UMLS 2011AA)
CL Item
General Equivalency Diploma (General Equivalency Diploma)
C67135 (NCI Thesaurus)
C1880947 (UMLS 2011AA)
CL Item
Bachelor's Degree Completion (Bachelor Degree)
C70555 (NCI Thesaurus)
C2346951 (UMLS 2011AA)
CL Item
Associate Degree (Associate Degree)
C67140 (NCI Thesaurus)
C1879750 (UMLS 2011AA)
CL Item
Academic Doctorate Degree Completion (Academic Doctorate Degree)
C70557 (NCI Thesaurus)
C2348318 (UMLS 2011AA)
CL Item
Master's Degree Completion (Master's Degree)
C70556 (NCI Thesaurus)
C2347079 (UMLS 2011AA)
CL Item
Professional Doctorate Degree Completion (Professional Doctorate Degree)
C70558 (NCI Thesaurus)
C2347690 (UMLS 2011AA)
CL Item
Vocational Degree (VoTech Program)
C67141 (NCI Thesaurus)
C1883542 (UMLS 2011AA)
CL Item
Never Attended (No Formal Schooling)
C67122 (NCI Thesaurus)
C0557286 (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
Does Not Know (Don't Know)
C67142 (NCI Thesaurus)
C1880386 (UMLS 2011AA)
Item
Marital Status
text
C25190 (NCI Thesaurus ObjectClass)
C25372 (NCI Thesaurus ValueDomain)
C25188 (NCI Thesaurus Property)
C0024819 (UMLS CUI-1)
Code List
Marital Status
CL Item
Divorced: C51776 (Divorced)
C51776 (NCI Thesaurus)
C0086170 (UMLS 2011AA)
CL Item
Domestic Partner (Domestic Partnership)
C53262 (NCI Thesaurus)
C1549111 (UMLS 2011AA)
CL Item
Married: C51773 (Married)
C51773 (NCI Thesaurus)
C0555047 (UMLS 2011AA)
CL Item
Never Married (Never Married)
C51774 (NCI Thesaurus)
C0027952 (UMLS 2011AA)
CL Item
Separated (Separated)
C51777 (NCI Thesaurus)
C0086972 (UMLS 2011AA)
CL Item
Widowed (Widowed)
C51775 (NCI Thesaurus)
C0206275 (UMLS 2011AA)
Birth Place
Item
Place of Birth
text
C25190 (NCI Thesaurus ObjectClass)
C25155 (NCI Thesaurus Property)
C25319 (NCI Thesaurus Property)
C37957 (NCI Thesaurus Property)
C25704 (NCI Thesaurus ValueDomain)
C25155 (NCI Thesaurus ValueDomain)
C25319 (NCI Thesaurus ValueDomain)
C0032040 (UMLS CUI-1)

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