CDE Detailed Report
Subdomain Name: Demographics
CRF: Demographics Form
Displaying 1 - 29 of 29
| CDE ID | CDE Name | Variable Name | Definition | Short Description | Question Text | Permissible Values | Description | Data Type | Disease Specific Instructions | Disease Specific Reference | Population | Classification (e.g., Core) | Version Number | Version Date | CRF Name (CRF Module / Guidance) | Subdomain Name | Domain Name | Size | Input Restrictions | Min Value | Max Value | Measurement Type | External Id Loinc | External Id Snomed | External Id caDSR | External Id CDISC |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C00030 | Race USA category | RaceUSACat | The patient's self declared racial origination, independent of ethnic origination, using OMB approved categories | The patient's self declared racial origination, independent of ethnic origination, using OMB approved categories | What is the suject's racial background (as defined by OMB)? | American Indian or Alaska Native;Asian;Black or African-American;Native Hawaiian or Other Pacific Islander;White;Unknown;Not Reported | 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.;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.;A person having origins in any of the black racial groups of Africa. Terms such as 'Haitian' can be used in addition to 'Black or African American.';A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.;A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.;Could not be determined or unsure;Not provided or unavailable | Alphanumeric |
Select all that apply. |
Collection of Race and Ethnicity Data in Clinical Trials (FDA, September 2005 - http://www.fda.gov/RegulatoryInformation/Guidances/ucm126340.htm) <br />Jorde LB and Wooding SP. Genetic variation, classification and "race". Nature Genetics. 2004;36(11):S28-S33. Bhopal R and Donaldson L. White, European, Western, Caucasian, or What? Inappropriate labeling in Research on Race, Ethnicity, and Health. Amer J of Publ Health. 1998;88:1303-1307. NCI CDE Browser Public ID = 2192199 | Adult;Pediatric | Supplemental | 3.1 | 10/16/2024 8:51:18 AM | Demographics Form | Demographics | Participant Characteristics |
Multiple Pre-Defined Values Selected |
2192199 | |||||||
| C21806 | Parent alive status | ParentAliveStatus | Specifies whether the participant's/subjects parents are still living | Specifies whether the participant's/subjects parents are still living | What are the living statuses of the subject's parents? | Mother alive;Father alive;Father deceased;Mother deceased;Mother unknown;Father unknown | Mother alive;Father alive;Father deceased;Mother deceased;Mother unknown;Father unknown | Alphanumeric |
Select all that apply. Answer for both parents |
Adult;Pediatric | Supplemental | 1.00 | 2016-06-03 11:20:14.0 | Demographics Form | Demographics | Participant Characteristics |
Multiple Pre-Defined Values Selected |
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| C00004 | Birth country ISO code | BirthCntryISOCode | Code (ISO 3166-1 alpha-2 code) for country where the participant was born | Code (ISO 3166-1 alpha-2 code) for country where the participant was born | What is the subject's birth country (use ISO code)? | AU;CA;MX;GB;US | AUSTRALIA;CANADA;MEXICO;UNITED KINGDOM;UNITED STATES | Alphanumeric |
Select one: If other is selected, please write in response. |
Adult;Pediatric | Supplemental | 3.1 | 10/16/2024 8:51:21 AM | Demographics Form | Demographics | Participant Characteristics |
Single Pre-Defined Value Selected |
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| C00031 | Race expanded category | RaceCat | Category of race(s) or region(s) the participant/subject most closely identifies with | Category of race(s) or region(s) the participant/subject most closely identifies with | What is the subject's racial background (expanded categories)? | Not reported;Other;Unknown;Black African American;Black African;Black Afro Caribbean;South/Central American Indian;North American Indian;Alaskan Native;Inuit;South Asian;Far Eastern Asian;Western Asian;White North American;White South American;White European;White Middle Eastern;White African;White Australian;Hawaiian;Pacific Islander | Not reported;Other;Unknown;Black African American (for OMB purposes, this value is considered to be part of Black or African-American);Black African (for OMB purposes, this value is considered to be part of Black or African-American);Black Afro Caribbean (for OMB purposes, this value is considered to be part of Black or African-American);South/Central American Indian (for OMB purposes, this value is considered to be part of American Indian or Alaska Native);North American Indian (for OMB purposes, this value is considered to be part of American Indian or Alaska Native);Alaskan Native (for OMB purposes, this value is considered to be part of American Indian or Alaska Native);Inuit (for OMB purposes, this value is considered to be part of American Indian or Alaska Native);South Asian (Indian subcontinent) (for OMB purposes, this value is considered to be part of Asian);Far Eastern Asian (e.g., China, Japan, Korea, etc.) (for OMB purposes, this value is considered to be part of Asian);Western Asian (e.g., Pakistan, Iraq, Iran) (for OMB purposes, this value is considered to be part of Asian);White North American (for OMB purposes, this value is considered to be part of White);White South American (for OMB purposes, this value is considered to be part of White);White European (for OMB purposes, this value is considered to be part of White);White Middle Eastern (for OMB purposes, this value is considered to be part of White);White African (for OMB purposes, this value is considered to be part of White);White Australian (for OMB purposes, this value is considered to be part of White);Hawaiian (for OMB purposes, this value is considered to be part of Native Hawaiian or Other Pacific Islander);Pacific Islander (for OMB purposes, this value is considered to be part of Native Hawaiian or Other Pacific Islander) | Alphanumeric |
Select all that apply. |
Collection of Race and Ethnicity Data in Clinical Trials (FDA, September 2005 - http://www.fda.gov/RegulatoryInformation/Guidances/ucm126340.htm) <br />Jorde LB and Wooding SP. Genetic variation, classification and "race". Nature Genetics. 2004;36(11):S28-S33. Bhopal R and Donaldson L. White, European, Western, Caucasian, or What? Inappropriate labeling in Research on Race, Ethnicity, and Health. Amer J of Publ Health. 1998;88:1303-1307. NCI CDE Browser Public ID = 2192199 | Adult;Pediatric | Supplemental | 3.00 | 2013-07-22 16:57:17.79 | Demographics Form | Demographics | Participant Characteristics |
Multiple Pre-Defined Values Selected |
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| C22684 | Parent gender type | ParentGenderTyp | Self-reported gender of the participant's/subject's parent. Gender is the socially constructed identity of sex. Gender is equated with phenotypic sex. Gender may differ from the sex of a parent determined genetically | Self-reported gender of the participant's/subject's parent. Gender is the socially constructed identity of sex. Gender is equated with phenotypic sex. Gender may differ from the sex of a parent determined geneticall | What is the parent, guardian or caregiver's gender? | Female;Male;Unknown;Unspecified;Not reported | Female;Male;Unknown;Undifferentiated/Indeterminant/Intersex;Not reported | Alphanumeric |
Select one. Choose one. Response is obtained by report of the participant/subject or parent, guardian, or caretaker. |
Adult;Pediatric | Supplemental | 3.00 | 2013-08-28 16:08:00.453 | Demographics Form | Demographics | Participant Characteristics |
Single Pre-Defined Value Selected |
2200604 | ||||||||
| C00005 | Birth country name | BirthCntryName | Name for country where the participant was born | Name for country where the participant was born | What is the subject's birth country name? | Alphanumeric |
Write in response. |
Adult;Pediatric | Supplemental | 3.1 | 10/16/2024 8:51:20 AM | Demographics Form | Demographics | Participant Characteristics | 255 |
Free-Form Entry |
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| C00035 | Gender type | GenderTyp | Self-reported gender of the participant/subject | Self-reported gender of the participant/subjec | What is the subject's gender? | Alphanumeric |
Select one. |
Adult;Pediatric | Supplemental | 3.00 | 2013-08-28 16:08:00.453 | Demographics Form | Demographics | Participant Characteristics |
Single Pre-Defined Value Selected |
2200604 | ||||||||||
| C22688 | Parent Race USA Category | ParentRaceUSACat | The participant's/subject's parent self declared racial origination, independent of ethnic origination, using OMB approved categories | The participant's/subject's parent self declared racial origination, independent of ethnic origination, using OMB approved categorie | What is the parent, guardian, or caregiver's race, based on the OBM race standards? | American Indian or Alaska Native;Asian;Black or African-American;Native Hawaiian or Other Pacific Islander;White;Unknown;Not Reported | 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.;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.;A person having origins in any of the black racial groups of Africa. Terms such as 'Haitian' can be used in addition to 'Black or African American.';A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.;A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.;Could not be determined or unsure;Not provided or unavailable | Alphanumeric |
Select all that apply. Response is obtained by report of the participant/subject or caretaker. Collecting information on race may not be allowed in some countries for concerns related to discrimination. In other countries, however, these concerns are considered a reason for recording race in order to guarantee equal access to care. Investigators receiving funding from the US National Institutes of Health (NIH) are required to report the number of subjects enrolled on an annual basis using the racial categories listed. |
Adult;Pediatric | Supplemental | 3.00 | 2013-07-25 08:54:08.2 | Demographics Form | Demographics | Participant Characteristics |
Multiple Pre-Defined Values Selected |
2192199 | ||||||||
| C00007 | Birth date | BirthDate | Date (and time, if applicable and known) the participant was born | Date (and time, if applicable and known) the participant was born | What is the subject's date of birth? | Date or Date & Time |
Write in response. |
Adult;Pediatric | Supplemental | 3.1 | 10/16/2024 8:51:14 AM | Demographics Form | Demographics | Participant Characteristics |
Free-Form Entry |
793 | ||||||||||
| C08147 | Data source | DataSource | Source of the data provided on the case report form | Source of the data provided on the case report form | Who filled out this form? | Participant/subject;Mother;Father;Sister;Brother;Son;Daughter;Friend;Physician;Chart/Medical record;Other, specify;Spouse | Participant/subject;Mother;Father;Sister;Brother;Son;Daughter;Friend;Physician;Chart/Medical record;Other, specify;Spouse | Alphanumeric |
Select one. If other is selected, please write in response. |
Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:46:24.96 | Demographics Form | Demographics | Participant Characteristics |
Multiple Pre-Defined Values Selected |
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| C22689 | Parent race expanded category | ParentRaceCat | Category of race(s) or region(s) the particpant's/subject's parent/guardian most closely identifies with | Category of race(s) or region(s) the particpant's/subject's parent/guardian most closely identifies with | What is the parent, guardian, or caregiver's race, using expanded race categories? | Not reported;Other;Unknown;Black African American;Black African;Black Afro Caribbean;South/Central American Indian;North American Indian;Alaskan Native;Inuit;South Asian;Far Eastern Asian;Western Asian;White North American;White South American;White European;White Middle Eastern;White African;White Australian;Hawaiian;Pacific Islander | Not reported;Other;Unknown;Black African American (for OMB purposes, this value is considered to be part of Black or African-American);Black African (for OMB purposes, this value is considered to be part of Black or African-American);Black Afro Caribbean (for OMB purposes, this value is considered to be part of Black or African-American);South/Central American Indian (for OMB purposes, this value is considered to be part of American Indian or Alaska Native);North American Indian (for OMB purposes, this value is considered to be part of American Indian or Alaska Native);Alaskan Native (for OMB purposes, this value is considered to be part of American Indian or Alaska Native);Inuit (for OMB purposes, this value is considered to be part of American Indian or Alaska Native);South Asian (Indian subcontinent) (for OMB purposes, this value is considered to be part of Asian);Far Eastern Asian (e.g., China, Japan, Korea, etc.) (for OMB purposes, this value is considered to be part of Asian);Western Asian (e.g., Pakistan, Iraq, Iran) (for OMB purposes, this value is considered to be part of Asian);White North American (for OMB purposes, this value is considered to be part of White);White South American (for OMB purposes, this value is considered to be part of White);White European (for OMB purposes, this value is considered to be part of White);White Middle Eastern (for OMB purposes, this value is considered to be part of White);White African (for OMB purposes, this value is considered to be part of White);White Australian (for OMB purposes, this value is considered to be part of White);Hawaiian (for OMB purposes, this value is considered to be part of Native Hawaiian or Other Pacific Islander);Pacific Islander (for OMB purposes, this value is considered to be part of Native Hawaiian or Other Pacific Islander) | Alphanumeric |
Select all that apply. Response is obtained by report of the participant/subject or caretaker. Collecting information on race may not be allowed in some countries for concerns related to discrimination. In other countries, however, these concerns are considered a reason for recording race in order to guarantee equal access to care. Investigators receiving funding from the US National Institutes of Health (NIH) are required to report the number of subject's enrolled on an annual basis using the racial categories listed. |
Adult;Pediatric | Supplemental | 3.00 | 2013-07-22 16:57:17.79 | Demographics Form | Demographics | Participant Characteristics |
Multiple Pre-Defined Values Selected |
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| C00020 | Ethnicity USA category | EthnUSACat | Category of ethnicity the participant most closely identifies with | Category of ethnicity the participant most closely identifies with | What is the subject's ethnic background? | Hispanic or Latino;Not Hispanic or Latino;Unknown;Not reported;Other, specify | A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. The term 'Spanish origin' can also be used in addition to 'Hispanic or Latino.';A person not meeting the definition for Hispanic or Latino.;Could not be determined or unsure;Not reported;Other, specify | Alphanumeric |
Select one. If other is selected, please write in response. |
The NIH Guidelines on Inclusion of Women and Minorities as Subjects in Clinical Research: The Office of Management and Budget Directive No. 15 defines the minimum standard of basic racial and ethnic categories. (http://grants.nih.gov/grants/funding/women_min/guidelines_update.htm)<br />Collection of Race and Ethnicity Data in Clinical Trials (FDA, September 2005 - http://www.fda.gov/RegulatoryInformation/Guidances/ucm126340.htm) | Adult;Pediatric | Supplemental | 3.1 | 10/16/2024 8:51:17 AM | Demographics Form | Demographics | Participant Characteristics |
Single Pre-Defined Value Selected |
2192217 | |||||||
| C10676 | Country of residence code | CntryResdnceISOCode | Code (ISO 3166-1 alpha-2) for the country where the participant/subject currently lives | Code (ISO 3166-1 alpha-2) for the country where the participant/subject currently live | What is the subject's country of residence? | US;CA;GB;MX;AU;Other, specify | USA (US);Canada (CA);United Kingdom (GB);Mexico (MX);Australia (AU);Other, specify | Alphanumeric |
Select one: If other is selected, please write in response. |
ISO 3166-1 alpha-2 codes (http://www.iso.org/iso/iso_3166_code_lists) | Adult;Pediatric | Supplemental | 3.00 | 2013-07-11 15:03:49.2 | Demographics Form | Demographics | Participant Characteristics |
Single Pre-Defined Value Selected |
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| C22690 | Parent Ethnicity USA category | ParentEthnUSACat | Category of ethnicity the parent, guardian, or caregiver most closely identifies with | Category of ethnicity the parent, guardian, or caregiver most closely identifies with | What is the parent, guardian, or caregiver's ethnicity? | Hispanic or Latino;Not Hispanic or Latino;Unknown;Not reported;Other, specify | A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. The term 'Spanish origin' can also be used in addition to 'Hispanic or Latino.';A person not meeting the definition for Hispanic or Latino.;Could not be determined or unsure;Not reported;Other, specify | Alphanumeric |
Select one. If other is selected, please write in response. The NIH Guidelines on Inclusion of Women and Minorities as Subjects in Clinical Research: The Office of Management and Budget Directive No. 15 defines the minimum standard of basic racial and ethnic categories. (http://grants.nih.gov/grants/funding/women_min/guidelines_update.htm) Collection of Race and Ethnicity Data in Clinical Trials (FDA, September 2005 - http://www.fda.gov/RegulatoryInformation/Guidances/ucm126340.htm) |
Adult;Pediatric | Supplemental | 3.00 | 2013-08-28 16:08:00.453 | Demographics Form | Demographics | Participant Characteristics |
Single Pre-Defined Value Selected |
2192217 | ||||||||
| C00023 | Hand preference type | HandPrefTyp | Hand which the participant/subject uses predominantly, not necessarily the hand he/she writes with exclusively | Hand which the participant/subject uses predominantly, not necessarily the hand he/she writes with exclusivel | What is the subject's handedness preference, or dominant hand? | Left hand;Right hand;Both hands;Unknown | Left hand;Right hand;Both hands;Unknown | Alphanumeric |
Select one. |
Adult;Pediatric | Supplemental | 3.00 | 2013-07-25 08:54:08.2 | Demographics Form | Demographics | Participant Characteristics |
Single Pre-Defined Value Selected |
2180147 | ||||||||
| C14123 | Country of residence name | CntryResdnceName | Country where the participant/subject currently lives | Country where the participant/subject currently live | What is the subject's current country of residence name? | Alphanumeric |
Write in response. |
Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Demographics Form | Demographics | Participant Characteristics | 255 |
Free-Form Entry |
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| C22691 | Parent birth country ISO code | ParentBirthCntryISOCode | Code (ISO 3166-1 alpha-2 code) for country where the participant's/subject's parent, guardian, or caregiver was born | Code (ISO 3166-1 alpha-2 code) for country where the participant's/subject's parent, guardian, or caregiver was bor | What is the parent, guardian or caregiver's birht country ISO code? | AU;CA;MX;GB;US | AUSTRALIA;CANADA;MEXICO;UNITED KINGDOM;UNITED STATES | Alphanumeric |
Select one. If other is selected, please write in response. Code (ISO 3166-1 alpha-2 code) for country where the participant/subject was born |
Adult;Pediatric | Supplemental | 3.00 | 2013-07-24 21:00:23.88 | Demographics Form | Demographics | Participant Characteristics |
Single Pre-Defined Value Selected |
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| C00025 | Language primary text | LangPrimryTxt | Text for the language the participant/subject speaks most often | Text for the language the participant/subject speaks most often | What is the subject's primary language (use ISO code)? | eng;spa;sgn;chi;fre;ger;Other, specify | English;Spanish;Sign Languages;Chinese languages;French;German;Other, specify | Alphanumeric |
Write in response. |
ISO 639-2 language codes (http://www.loc.gov/standards/iso639-2/php/code_list.php) | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Demographics Form | Demographics | Participant Characteristics |
Single Pre-Defined Value Selected |
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| C17396 | Sex genotype type | SexGenotypTyp | The difference between male and female, based upon the interactions between genes and between the genotype and the environment. Genotype is identified based on the individual's reproductive organs and functions assigned by chromosomal complement | Sex chromosomes of the participant/subject based upon genotyping | Sex at birth | XX;XY;XXX;XYY;XXY;Other, specify;Unknown;Unspecified | XX;XY;XXX;XYY;XXY;Other, specify;Unknown;Undifferentiated/Indeterminant/Intersex | Alphanumeric | Adult;Pediatric | Supplemental | 3.10 | 2018-07-26 00:00:00.0 | Demographics Form | Demographics | Participant Characteristics |
Single Pre-Defined Value Selected |
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| C22692 | Parent birth country name | ParentBirthCntryName | Name for country where the parent, guardian, or caregiver was born | Name for country where the parent, guardian, or caregiver was born | What is the parent, guardian, or caregiver's birth country name? | Alphanumeric |
Write in response. Code (ISO 3166-1 alpha-2 code) for country where the participant/subject was born |
Adult;Pediatric | Supplemental | 3.00 | 2013-07-24 21:00:23.88 | Demographics Form | Demographics | Participant Characteristics | 255 |
Free-Form Entry |
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| C00026 | Language spoken Fluent text | LangSpokeFluentTxt | Text for each language that the participant/subject speaks fluently | Text for each language that the participant/subject speaks fluently | Please list each language the subject can speak fluently: | Alphanumeric |
Write in response. |
Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Demographics Form | Demographics | Participant Characteristics | 255 |
Free-Form Entry |
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| C18667 | Data source other text | DataSourcOTH | The free-text field related to 'Data source' specifying other text. Source of the data provided on the case report form | The free-text field related to 'Data source' specifying other text. Source of the data provided on the case report form | Other, specify: | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2014-05-27 13:34:46.0 | Demographics Form | Demographics | Participant Characteristics | 4000 |
Free-Form Entry |
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| C55578 | Sexual orientation type | SexualOrientTyp | Self-reported sexual orientation of the participant/subject | Self-reported sexual orientation of the participant/subject | Sexual orientation | Bisexual;Gay/Lesbian;Heterosexual;Not reported;Other;Unknown | Bisexual;Gay/Lesbian;Heterosexual;Not reported;Other;Unknown | Alphanumeric |
Select one. |
Adult;Pediatric | Supplemental | 3.00 | 2013-08-28 16:08:00.453 | Demographics Form | Demographics | Participant Characteristics |
Multiple Pre-Defined Values Selected |
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| C00027 | Language written Fluent text | LangWrtnFlntlyTxt | Text for each language that the participant/subject writes fluently | Text for each language that the participant/subject writes fluently | Please list each language the subject can write fluently: | Alphanumeric |
Write in response. |
ISO 639-2 language codes (http://www.loc.gov/standards/iso639-2/php/code_list.php) | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Demographics Form | Demographics | Participant Characteristics | 255 |
Free-Form Entry |
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| C18732 | Language primary other text | LangPrimryOTH | The free-text field related to 'Language primary text' specifying other text. Text for the language the participant/subject speaks most often | The free-text field related to 'Language primary text' specifying other text. Text for the language the participant/subject speaks most often | Other, specify: | Alphanumeric |
Text for participant's/subject's primary language. It may be easier to record the full name of the language and code the data later using the ISO 639-2 codes. |
ISO 639-2 language codes (http://www.loc.gov/standards/iso639-2/php/code_list.php) | Adult;Pediatric | Supplemental | 1.00 | 2014-05-27 13:34:46.0 | Demographics Form | Demographics | Participant Characteristics | 4000 |
Free-Form Entry |
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| C00028 | Language spoken fluent ISO code | LangSpokeFluentISOCode | Code (ISO 639-2)for each language that the participant/subject speaks fluently | Code (ISO 639-2)for each language that the participant/subject speaks fluently | What are the ISO codes for each language the subject can speak fluently? The ISO codes represent the international codes for each country. | English (eng);Spanish (spa);German (ger);Chinese (chi);French/Creole (cpf);Arabic;Russian (rus);Italian (ita);Polish (pol);Other specify;American Sign Language (sgn);Chinese languages (Chi) | English (eng);Spanish (spa);German (ger);Chinese (chi);French/Creole (cpf);Arabic (ara);Russian (rus);Italian (ita);Polish (pol);Other specify;American Sign Language (sgn);Chinese languages (Chi) | Alphanumeric |
Write in response. |
ISO 639-2 language codes (http://www.loc.gov/standards/iso639-2/php/code_list.php) | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Demographics Form | Demographics | Participant Characteristics |
Multiple Pre-Defined Values Selected |
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| C18806 | Country of residence other text | CntryResdnceISOOTH | The free-text field related to 'Country of residence code' specifying other text. Code (ISO 3166-1 alpha-2) for the country where the participant/subject currently lives | The free-text field related to 'Country of residence code' specifying other text. Code (ISO 3166-1 alpha-2) for the country where the participant/subject currently live | Other, specify: | Alphanumeric |
Choose only one country which the subject/participant currently lives. If the country code is not included on the form and therefore the country is written-in under 'Other, specify' then code the data later using ISO 3166-1 alpha-2 codes. ISO 3166-1 alpha-2 codes (http://www.iso.org/iso/iso_3166_code_lists) |
ISO 3166-1 alpha-2 codes (http://www.iso.org/iso/iso_3166_code_lists) | Adult;Pediatric | Supplemental | 3.00 | 2013-07-11 15:03:49.2 | Demographics Form | Demographics | Participant Characteristics | 4000 |
Free-Form Entry |
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| C00029 | Language written fluent ISO code | LangWrtnFlntlyTxtISOCode | Code (ISO 639-2) for each language that the participant/subject writes fluently | Code (ISO 639-2) for each language that the participant/subject writes fluently | What are the ISO codes for each language the subject can write fluently? | Alphanumeric |
Write in response. |
ISO 639-2 language codes (http://www.loc.gov/standards/iso639-2/php/code_list.php) | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Demographics Form | Demographics | Participant Characteristics | 255 |
Free-Form Entry |
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| C21805 | Caregiver primary extended type | CaregvPrimryExtendType | Type of relationship between the person who acts as the primary caregiver for the participant/subject and the participant/subject | Type of relationship between the person who acts as the primary caregiver for the participant/subject and the participant/subject | What is the relationahip between the person who acts as the primary caregiver for the subject and the subject? | Adoptive father;Adoptive mother;Adoptive parents;Biological father;Biological father - not a primary caregiver;Biological mother;Biological mother - not a primary caregiver;Biological parents;Child;Grandfather;Grandmother;Home aide;Legal guardian;Long-term care/nursing facility staff;Parent;Relative;Self;Sibling;Spouse or partner;Stepfather;Stepmother;Stepparent;Unknown;Other, specify | Adoptive father;Adoptive mother;Adoptive parents;Biological father;Biological father - not a primary caregiver;Biological mother;Biological mother - not a primary caregiver;Biological parents;Child;Grandfather;Grandmother;Home aide;Legal guardian;Long-term care/nursing facility staff;Parent;Relative;Self;Sibling;Spouse or partner;Stepfather;Stepmother;Stepparent;Unknown;Other, specify | Alphanumeric |
Select all that apply. If other is selected, please write in response. |
Adult;Pediatric | Supplemental | 1.00 | 2016-06-03 11:18:55.0 | Demographics Form | Demographics | Participant Characteristics |
Multiple Pre-Defined Values Selected |
