CDE Detailed Report
Disease: Sickle Cell Disease
Sub-Domain: Participant Characteristics
CRF: PhenX Toolkit: Race Data Collection Worksheet

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
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: Race Data Collection Worksheet Participant Characteristics Demographics

Free-Form Entry

C59300 Race code RaceCode Code indicating subject/participant's race or races. Code indicating subject/participant's race or races. What race or races do you consider yourself to be? Please select one or more. 1;2;3;4;5;6;99;77 American Indian or Alaska Native;Asian;Black or African American;Native Hawaiian or Pacific Islander;White;Other;Don't know;Refused Alphanumeric Adult;Pediatric Proposed 1.00 2019-03-29 12:39:12.0 PhenX Toolkit: Race Data Collection Worksheet Participant Characteristics Demographics

Multiple Pre-Defined Values Selected

PhenX Core Tier 1 04 Race 1
C59301 Asian ancestry code AsianAncestryCode Code indicating subject/participant's Asian ancestry. Code indicating subject/participant's Asian ancestry. Please give the number of the group that represents your Asian origin or ancestry. Please select one or more of these categories. 10;77;99;44;43;42;41;40;39;38;37;36;35;34;33;32;31;30;29;28;27;26;25;24;23;22;21;20;19;18;17;16;15;14;13;12;11 Asian Indian;Refused;Don't know;Vietnamese;Thai;Taiwanese;Sri Lankan;Singaporean;Siamese;Pakistani;Okinawan;Nipponese;Nepalese;Mong;Maldivian;Malaysian;Madagascar/Malagasy;Laotian;Laohmong;Korean;Japanese;Iwo Jiman;Indonesian;Indochinese;Hmong;Goanese;Filipino;East Indian;Dravidian;Chinese;Cantonese;Cambodian;Burmese;Bhutanese;Bharat;Bengalese;Bangladeshi Alphanumeric Adult;Pediatric Proposed 1.00 2019-03-29 12:56:00.0 PhenX Toolkit: Race Data Collection Worksheet Participant Characteristics Demographics

Multiple Pre-Defined Values Selected

PhenX Core tier 1 04 Race 2
C59302 Native Hawaiian or pacific islander code NtvHwnOrPcfIsldCode Code indicating subject/participant's Native Hawaiian or Pacific Island race. Code indicating subject/participant's Native Hawaiian or Pacific Island race. Please give the number of the group that represents your Native Hawaiian or Pacific Islander origin or ancestry. Please select one or more of these categories. 1;2;3;4;7;9 Native Hawaiian;Guamanian or Chamorro;Samoan;Other Pacific Islander;Refused;Don't know Alphanumeric Adult;Pediatric Proposed 1.00 2019-03-29 13:41:14.0 PhenX Toolkit: Race Data Collection Worksheet Participant Characteristics Demographics

Multiple Pre-Defined Values Selected

PhenX Core tier 1 04 Race 3
C59303 Other race code OtherRaceCode Code indicating subject/participant's race, if "other" selected Code indicating subject/participant's race, if "other" selected Code answer to "other race": 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 2019-03-29 13:47:07.0 PhenX Toolkit: Race Data Collection Worksheet Participant Characteristics Demographics

Multiple Pre-Defined Values Selected

PhenX Core tier 1 04 Race 4
5 results.
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