CDE Detailed Report
Disease:
Sub-Domain: Participant Characteristics
CRF:

5 results.
CDE ID CDE Name Variable Name Definition Short Description Additional Notes (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 / Guideline) Sub Domain Name Domain Name Size Input Restrictions Min Value Max Value Measurement Type Source Form Set Form Field Domain CDASH Variable CDASH Definition CDASH Label Controlled Terminology Prompt Essentiality Question Text CDASH imp guidance SDTM IG target csDSR PhenX Data Type CRF Completion Inst SDTMIG Target Var SDTMIG Target Map Codelist Name PVs Pre Pop Value Query Display List Style
C19500 Assessment performed date AssessmentPerformedDate The date of assessment of the examination being performed. The date of assessment of the examination being performed. Date of Interview/Examination/Bioassay (MM/DD/YYYY): Date or Date & Time Adult;Pediatric Proposed 1.00 2014-06-18 08:10:12.0 PhenX Toolkit: Ethnicity Data Collection Worksheet Participant Characteristics cookie-policy

Free-Form Entry
C59281 Hispanic latino spanish origin code HspncLtnSpnshOriginCode Code indicating whether a person is of Hispanic, Latino or Spanish origin. Code indicating whether a person is of Hispanic, Latino or Spanish origin. Do you consider yourself to be Hispanic, Latino, or of Spanish origin? 1;2;7;9 Yes;No;Refused;Don't know Alphanumeric Adult;Pediatric Proposed 1.00 2019-03-28 17:26:08.0 PhenX Toolkit: Ethnicity Data Collection Worksheet Participant Characteristics cookie-policy

Single Pre-Defined Value Selected

 PhenX Core Tier 1 Ethnicity 1
C59282 Ancestry code AncestryCode Code indicating where the subject/participant's ancestors came from. Code indicating where the subject/participant's ancestors came from. READ IF NECESSARY: Where do your ancestors come from? Puerto Rican;Cuban or Cuban American;Dominican Republic;Mexican or Mexican American;Central or South American;Other Latin American;Other Hispanic or Latino Puerto Rican;Cuban or Cuban American;Dominican Republic;Mexican or Mexican American;Central or South American;Other Latin American;Other Hispanic or Latino Alphanumeric Adult;Pediatric Proposed 1.00 2019-03-28 17:40:33.0 PhenX Toolkit: Ethnicity Data Collection Worksheet Participant Characteristics cookie-policy

Multiple Pre-Defined Values Selected

 PhenX Core Tier 2 Ethnicity 2
C59283 Ancestor country code AncestorCountryCode Code indicating subject or participant's ancestor country of origin. Code indicating subject or participant's ancestor country of origin. Please give the number of the group that represents your Hispanic/Latino or Spanish origin or ancestry. Please select 1 or more of these categories.

PROBE: Where do your ancestors come from? 		10;11;12;13;14;15;16;17;18;19;20;21;22;23;24;25;26;27;28;29;30;31;32;33;34;35;36;40;41;77;99 Mexican;Puerto Rican;Cuban;Dominican Republic;Costa Rican;Guatemalan;Honduran;Nicaraguan;Panamanian;Salvadoran;Other Central American;Argentinean;Bolivian;Chilean;Colombian;Ecuadorian;Paraguayan;Peruvian;Uruguayan;Venezuelan;Other South American;Filipino;Spaniard;Spanish;Spanish American;Hispano/Hispana;Hispanic/Latino;Other Hispanic/Latino (specificy);Chicano;Refused;Don't know Alphanumeric Adult;Pediatric Proposed 1.00 2019-03-28 17:51:24.0 PhenX Toolkit: Ethnicity Data Collection Worksheet Participant Characteristics cookie-policy

Multiple Pre-Defined Values Selected

 PhenX Core Tier 1 Ethnicity 3
C59284 Specific Hispanic Latino type SpecificHispanicLatinoTyp Type indicating the specific Hispanic/Latino ancestry if not otherwise listed. Type indicating the specific Hispanic/Latino ancestry if not otherwise listed. If 'Other Hispanic/Latino', please specify: Alphanumeric Adult;Pediatric Proposed 1.00 2019-03-28 18:33:20.0 PhenX Toolkit: Ethnicity Data Collection Worksheet Participant Characteristics cookie-policy 255

Free-Form Entry

 PhenX Core Tier 1 Ethnicity n/a
5 results.
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