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1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
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)
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