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Long NameParticipant Identification NCI Standard Template
DefinitionThe collection of CDEs used in the Participant ID module.
ContextcaBIG
Protocol Long NameNCI Standard Template Forms
WorkflowRELEASED
TypeCRF
Public ID2729615
Version2.0
Module Long NameModule InstructionsQuestionCDECDE Public IDCDE VersionValue Domain Data TypeValue Domain Unit of MeasureDisplay FormatValid ValueForm Value Meaning TextForm Value Meaning Desc.
Conditional Participant ID QuestionsThere are business rules to indicate situations under which these elements should be used on a case report form.
Participant Last NamePerson Family/Last Name21795912.0CHARACTER
Participant First NamePerson Given/First Name21795892.0CHARACTER
Optional Participant ID QuestionsThere is no requirement for inclusion of these elements on the case report form. If the design and scientific questions posed in the study dictate the need to collect this type of data, these elements should be included.
Participant Middle NamePerson Middle Name21795902.0CHARACTER
Person Name SuffixIndividual Genealogy Suffix Code20064752.0CHARACTER
IFirstPreceding all others in time or space or degree.
IISecond: C49463A suffix denoting the second person having the same complete name (first, middle, and family names).
IIIThirdA suffix denoting the third person having the same complete name (first, middle, and family names).
IVFourthA suffix denoting the fourth person having the same complete name (first, middle, and family names).
Jr.JuniorA suffix used to distinguish a son from his father when they have the same given name.
Sr.SeniorA suffix used to distinguish a father from his son when they have the same given name.
Participant Home Street AddressPerson Address Name625873.0CHARACTER
Participant CityAddress City Name21796011.0ALPHANUMERIC
StateAddress State/Province Name21796032.0ALPHANUMERIC
HidalgoHidalgoA state in east central Mexico. Its capital is Pachuca.
AguascalientesAguascalientesAguascalientes
AlabamaAlabamaA state in the southeast United States. Its capital is Montgomery.
AlaskaAlaskaA state in the far northwestern United States. Its capital is Juneau.
AlbertaAlbertaAlberta
American SamoaAmerican SamoaAmerican Samoa
ArizonaArizonaA state in the southwestern United States. Its capital is Phoenix.
ArkansasArkansasA state in the southern midwest United States. Its capital is Little Rock.
Baja CaliforniaBaja CaliforniaBaja California
Baja California SurBaja California SurBaja California Sur
British ColumbiaBritish ColumbiaBritish Columbia
CaliforniaCaliforniaA state on the western coast of the United States. Its capital is Sacramento.
CampecheCampecheCampeche
ChiapasChiapasChiapas
ChihuahuaChihuahuaChihuahua
Coahuila de ZaragozaCoahuila de ZaragozaCoahuila de Zaragoza
ColimaColimaColima
ColoradoColoradoA state in the Rocky Mountains of western United States. Its capital is Denver.
ConnecticutConnecticutA state in the northeastern United States. Its capital is Hartford.
DelawareDelawareA state in the mid-atlantic United States. Its capital is Dover.
District of ColumbiaDistrict of ColumbiaThe area in the United States comprised of a 68 square mile area northeast of the Potomac River donated by the state of Maryland. The District of Columbia, also known as D.C., is not a state, nor is it part of any state. It is a "federal district" established by the US Constitution as the seat of government. The district is occupied entirely by the city of Washington.
Distrito FederalDistrito FederalDistrito Federal
DurangoDurangoDurango
FloridaFloridaA state in the southeastern United States. Its capital isTallahassee.
GeorgiaGeorgiaA state in the southeastern United States. Its capital is Atlanta.
GuamGuamGuam
GuanajuatoGuanajuatoGuanajuato
GuerreroGuerreroGuerrero
HawaiiHawaiiA pacific island state in the United States. Its capital is Honolulu.
HildalgoHildalgoHildalgo
IdahoIdahoA state in the northern Rocky Mountains of western United States. Its capital is Boise.
IllinoisIllinoisA state in the central midwest United States. Its capital is Springfield.
IndianaIndianaA state in the north central United States. Its capital is Indianapolis.
IowaIowaA state in the northern midwest United States. Its capital is Des Moines.
JaliscoJaliscoJalisco
KansasKansasA state in the central midwest United States. Its capital is Topeka.
KentuckyKentuckyA state in the north central United States. Its capital is Frankfort.
LouisianaLouisianaA state in the southern midwest United States. Its capital is Baton Rouge.
MaineMaineA state in the northeastern United States. Its capital is Augusta.
ManitobaManitobaManitoba
Marshall IslandsMarshall IslandsMarshall Islands
MarylandMarylandA state in the mid-atlantic United States. Its capital is Annapolis.
MassachusettsMassachusettsA state in the northeast United States. Its capital is Boston.
MexicoMexicoA country in Central America, bordering the Caribbean Sea and the Gulf of Mexico, between Belize and the US and bordering the North Pacific Ocean, between Guatemala and the US. (CIA World Factbook 2002)
MichiganMichiganA state in the north central United States. Its capital is Lansing.
Michoacan de OcampoMichoacan de OcampoMichoacan de Ocampo
MicronesiaMicronesiaMicronesia
MinnesotaMinnesotaA state in the northern midwest United States. Its capital is St. Paul.
MississippiMississippiA state in the southeastern United States. Its capital is Jackson.
MissouriMissouriA state in the central midwest United States. Its capital is Jefferson City.
MontanaMontanaA state in the northern midwest United States. Its capital is Helena.
MorelosMorelosMorelos
NayaritNayaritNayarit
NebraskaNebraskaA state in the central midwest United States. Its capital is Lincoln.
NevadaNevadaA state in the western United States. Its capital is Carson City.
New BrunswickNew BrunswickNew Brunswick
New HampshireNew HampshireA state in the northeastern United States. Its capital is Concord.
New JerseyNew JerseyA state in the mid-atlantic United States. Its capital is Trenton.
New MexicoNew MexicoA state in the southwestern United States. Its capital is Santa Fe.
New YorkNew YorkA state in the northeastern United States. Its capital is Albany.
NewfoundlandNewfoundlandNewfoundland
North CarolinaNorth CarolinaA state in the mid-atlantic United States. Its capital is Raleigh.
North DakotaNorth DakotaA state in the northern midwest United States. Its capital is Bismarck.
Northern Mariana IslandsNorthern Mariana IslandsNorthern Mariana Islands
Northwest TerritoriesNorthwest TerritoriesNorthwest Territories
Nova ScotiaNova ScotiaNova Scotia
Nuevo LeonNuevo LeonNuevo Leon
NunavutNunavutNunavut
OaxacaOaxacaOaxaca
OhioOhioA state in the north central United States. Its capital is Columbus.
OklahomaOklahomaA state in the southern midwest United States. Its capital is Oklahoma City.
OntarioOntarioOntario
OregonOregonA state in the northwestern United States. Its capital is Salem.
PalauPalauPalau
PennsylvaniaPennsylvaniaA state in the mid-atlantic United States. Its capital is Harrisburg.
Prince Edward IslandPrince Edward IslandPrince Edward Island
PueblaPueblaPuebla
Puerto RicoPuerto RicoPuerto Rico
QuebecQuebecQuebec
Queretaro de ArteagaQueretaro de ArteagaQueretaro de Arteaga
Quintana RooQuintana RooQuintana Roo
Rhode IslandRhode IslandA state in the northeastern United States. Its capital is Providence.
San Luis PotosiSan Luis PotosiSan Luis Potosi
SaskatchewanSaskatchewanSaskatchewan
SinaloaSinaloaSinaloa
SonoraSonoraSonora
South CarolinaSouth CarolinaA state in the mid-atlantic United States. Its capital is Columbia.
South DakotaSouth DakotaA state in the northern midwest United States. Its capital is Pierre.
TabascoTabascoTabasco
TamaulipasTamaulipasTamaulipas
TennesseeTennesseeA state in the southeastern United States. Its capital is Nashville.
TexasTexasA state in the southern midwest United States. Its capital is Austin.
TlaxcalaTlaxcalaTlaxcala
US Minor Outlying IslandsUS Minor Outlying IslandsUS Minor Outlying Islands
UtahUtahA state in the western United States. Its capital is Salt Lake City.
Veracruz-LlaveVeracruz-LlaveVeracruz-Llave
VermontVermontA state in the northeastern United States. Its capital is Montpelier.
Virgin Islands of the USVirgin Islands of the USVirgin Islands of the US
VirginiaVirginiaA state in the mid-atlantic United States. Its capital is Richmond.
WashingtonWashingtonA state in the northwest United States. Its capital is Olympia.
West VirginiaWest VirginiaA state in the mid-atlantic United States. Its capital is Charleston.
WisconsinWisconsinA state in the northern midwest United States. Its capital is Madison.
WyomingWyomingA state in the western United States. Its capital is Cheyenne.
YucatanYucatanYucatan
Yukon TerritoryYukon TerritoryYukon Territory
ZacatecasZacatecasZacatecas
Participant Postal CodeAddress Postal Code Identifier21796062.0CHARACTER
Telephone Number TypeTelephone Number Type21795942.0ALPHANUMERIC
CellularCellular TelephoneA hand-held mobile radiotelephone for use in an area divided into small sections (cells), each with its own short-range transmitter/receiver
FacsimileFacsimile MachineA machine which scans and transmits via telephone, fixed graphic material including pictures, text, or images.
HomeHomeHome
Mobile TelephoneMobile TelephoneMobile communications system that uses a combination of radio wave transmission and conventional telephone switching to permit telephone communication to and from mobile users within a specified area.
ModemModem Device ComponentAn electronic device for converting between serial data from a computer and an audio signal suitable for transmission over a telephone line connected to another modem.
PagerPagerA small wireless radio receiver designed to be carried by a person, to give an indication when activated by the reception of a radio signal containing its specific code, and to display a short messages in a text-only format.
WorkWorksite: C17556Place or physical location of work or employment.
Participant PhoneTelephone Number21795933.0ALPHANUMERIC
Participant InitialsPatient Initials Name20010394.0CHARACTER