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Long NameDemography NCI Standard Template
DefinitionThe collection of CDEs used in the demography module.
ContextcaBIG
Protocol Long NameNCI Standard Template Forms
WorkflowRELEASED
TypeCRF
Public ID2674812
Version4.0
Module Long NameModule InstructionsQuestionCDECDE Public IDCDE VersionValue Domain Data TypeValue Domain Unit of MeasureDisplay FormatValid ValueForm Value Meaning TextForm Value Meaning Desc.
Mandatory Demography QuestionsThese items must be included when this data is collected for reporting
GenderPerson Gender Text Type22006043.0CHARACTER
FemaleFemale GenderAn individual who reports belonging to the cultural gender role distinction of female.
MaleMale GenderAn individual who reports belonging to the cultural gender role distinction of male.
UnknownUnknownNot known, not observed, not recorded, or refused.
UnspecifiedUnspecifiedNot stated explicitly or in detail.
RaceRace Category Text21921991.0CHARACTER
American Indian or Alaska NativeAmerican Indian or Alaska Native 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.
AsianAsianA 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.
Black or African AmericanBlack or African American A person having origins in any of the black racial groups of Africa. Terms such as "Haitian" or "Negro" can be used in addition to "Black or African American."
Native Hawaiian or other Pacific IslanderNative Hawaiian or Other Pacific IslanderA person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
Not ReportedNot ReportedNot provided or available
UnknownUnknownCould not be determined or unsure
WhiteWhiteA person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
Patient's Date of BirthPerson Birth Date7935.1DATEMM/DD/YYYY
EthnicityEthnic Group Category Text21922172.0CHARACTER
Hispanic or LatinoHispanic or LatinoA person of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin, regardless of race.
Not Hispanic or LatinoNot Hispanic or LatinoA person not meeting the definition for Hispanic or Latino.
Not reportedNot ReportedNot provided or available
UnknownUnknownCould not be determined or unsure
Conditional Demography QuestionsThere are business rules to indicate situations under which these elements should be used on a case report form.
ZIP CodeAddress Postal Code Identifier21796062.0CHARACTER
Payment MethodPerson Healthcare Payer Type28651301.0CHARACTER
Managed Care/MedicareManaged Care/MedicareAn arrangement whereby a third-party payer (e.g., insurance company, federal government, or corporation) mediates between physicians and patients, negotiating fees for service and overseeing the types of treatment given. Managed care has virtually replaced unmanaged indemnity plans, where payment is automatic and oversight procedures are minimal. Whereas 96% of American workers had unmanaged indemnity in 1984, only 28% did in 1988. Typically, in managed care, the third-party payer requires second opinions and pre-certification review for patients requiring hospital admission. They obtain wholesale prices from doctors, and carry out cost-containment measures, including auditing hospitals and reviewing claims. Managed care has figured heavily in the national debate over health care.: A program under the U.S. Social Security Administration that reimburses hospitals and physicians for medical care provided to qualifying people over 65 years old.
MedicaidMedicaidA jointly funded program of the United States federal and state governments that provides hospital expense and medical expense coverage to some people with low-income and certain aged and disabled individuals.
Medicaid and MedicareMedicare And MedicaidA program under the U.S. Social Security Administration that reimburses hospitals and physicians for medical care provided to qualifying people over 65 years old.: An article which expresses the relation of connection or addition. It is used to conjoin a word with a word, a clause with a clause, or a sentence with a sentence.: A jointly funded program of the United States federal and state governments that provides hospital expense and medical expense coverage to some people with low-income and certain aged and disabled individuals.
MedicareMedicareA program under the U.S. Social Security Administration that reimburses hospitals and physicians for medical care provided to qualifying people over 65 years old.
Medicare and Private InsuranceMedicare And Private InsuranceA program under the U.S. Social Security Administration that reimburses hospitals and physicians for medical care provided to qualifying people over 65 years old.: An article which expresses the relation of connection or addition. It is used to conjoin a word with a word, a clause with a clause, or a sentence with a sentence.: Not public; kept secret or restricted.: A mechanism for guarding against financial aspects of risk by making payments in the form of premiums to an insurance company, which pays an agreed-upon sum to the insured in the event of loss.
Military or Veterans Sponsored, NOSMilitary Or Veterans Sponsored Insurance, Not Otherwise SpecifiedThe armed forces of a country.: Or; used to connect words, phrases, or clauses representing alternatives; used to connect alternative terms for the same thing; used in correlation; used to correct or rephrase what was previously said; otherwise.: A division of the Executive Branch of the United States government concerned with overall planning, promoting, and administering programs pertaining to veterans. The Department of Veterans Affairs (VA) was established March 15, 1989 as a Cabinet-level position.: A person or organization that supports or champions something.: Not characterized in any other way.: A mechanism for guarding against financial aspects of risk by making payments in the form of premiums to an insurance company, which pays an agreed-upon sum to the insured in the event of loss.
Military Sponsored (Including CHAMPUS & TriCare)Military InsuranceThe armed forces of a country.: A mechanism for guarding against financial aspects of risk by making payments in the form of premiums to an insurance company, which pays an agreed-upon sum to the insured in the event of loss.
No Means of Payment (No Insurance)No InsuranceThe non-affirmative response to a question.: A mechanism for guarding against financial aspects of risk by making payments in the form of premiums to an insurance company, which pays an agreed-upon sum to the insured in the event of loss.
OtherOtherNot otherwise specified.
Private InsurancePrivate InsuranceNot public; kept secret or restricted.: A mechanism for guarding against financial aspects of risk by making payments in the form of premiums to an insurance company, which pays an agreed-upon sum to the insured in the event of loss.
Self-Pay (No Insurance)Self PaymentThe individual as the object of his own reflective consciousness.: Payment; a sum of money paid.
State Supplemental Health InsuranceState Supplemental Health InsuranceA U.S. State is any one of the fifty states which is a member of the federation known as the United States of America. Other US geographic areas, such as Puerto Rico and the District of Columbia, are essentially equivalent to State when used in an address. (from Wikipedia and NCI): Something added to complete a thing, make up for a deficiency, or extend or strengthen the whole; serving to complete or make an addition.: The state of the organism when it functions optimally without evidence of disease.: A mechanism for guarding against financial aspects of risk by making payments in the form of premiums to an insurance company, which pays an agreed-upon sum to the insured in the event of loss.
UnknownUnknownNot known, not observed, not recorded, or refused.
Veterans SponsoredVeterans Administration Sponsor InsuranceA division of the Executive Branch of the United States government concerned with overall planning, promoting, and administering programs pertaining to veterans. The Department of Veterans Affairs (VA) was established March 15, 1989 as a Cabinet-level position.: A person or organization that supports or champions something.: A mechanism for guarding against financial aspects of risk by making payments in the form of premiums to an insurance company, which pays an agreed-upon sum to the insured in the event of loss.
Country of ResidencePerson Address Country Name3154.0CHARACTER
Date CompletedForm Completion Date20037455.0DATEDD/MON/YYYY
CDC Race CodeCenters for Disease Control and Prevention Race Unique Identifier Code22002861.0CHARACTER
CDC Ethnicity CodeCenters for Disease Control and Prevention Ethnicity Unique Identifier Codes22002842.0CHARACTER
Optional Demography 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.
Highest Education LevelPerson Education Level Summary Type26815521.0CHARACTER
Bachelor's DegreeBachelor's DegreeBachelor's degree is an award (baccalaureate or equivalent degree, as determined by the Secretary of the U.S. Department of Education) conferred by a college, university, or other postsecondary education institution as official recognition for the successful completion of a program of studies, that normally requires at least four years of full-time equivalent college-level work. This includes bachelor's degrees conferred in a five-year cooperative program.
Doctoral degree or professional degreeProfessional Doctorate or Doctorate DegreeA doctorate awarded in certain fields where most holders of the degree are not engaged primarily in scholarly research and academic activities, but rather in a profession, such as law, medicine, music, or ministry.: Or; used to connect words, phrases, or clauses representing alternatives; used to connect alternative terms for the same thing; used in correlation; used to correct or rephrase what was previously said; otherwise.: The Doctor's Degree is the highest award a student can earn for graduate study. The doctor's degree classification includes such degrees in any field.
Grade SchoolGrade SchoolA school for young children; usually the first 6 or 8 grades.
Graduate or professional degreeGraduation Or Professional DegreeConferral or receipt of an academic degree or diploma marking the completion of a defined set of coursework.: Or; used to connect words, phrases, or clauses representing alternatives; used to connect alternative terms for the same thing; used in correlation; used to correct or rephrase what was previously said; otherwise.: An occupation requiring special education, especially in the liberal arts or sciences.: An academic degree is an award conferred by a college, university, or other postsecondary education institution as official recognition for the successful completion of a program of studies.
High school graduate (including equivalency)High School Completion or General Equivalency Diploma (GED) CompletionIndicates that a person has attended high school and has received a high school diploma.: Or; used to connect words, phrases, or clauses representing alternatives; used to connect alternative terms for the same thing; used in correlation; used to correct or rephrase what was previously said; otherwise.: Indicates that a person has received a General Equivalency Diploma in lieu of a high school diploma.
Master's DegreeMaster's DegreeThe Master's Degree is an award that requires the successful completion of a program of study of at least the full-time equivalent of 1 but not more than two academic years of work beyond the bachelor's degree.
No formal educationNo Formal SchoolingIndicates that a person has never attended an educational program or formal schooling.
Not high school graduateNot High School GraduateIndicates a person has attended high school but did not complete high school and did not receive a high school diploma.
Some college or associate degreeSome College or Associates DegreeAn institution of higher education created to educate and grant degrees; often a part of a university.: At least a small amount or number of.: Or; used to connect words, phrases, or clauses representing alternatives; used to connect alternative terms for the same thing; used in correlation; used to correct or rephrase what was previously said; otherwise.: A degree granted by a two-year college on successful completion of the undergraduates course of studies.
Country of BirthPerson Birth Country Type20017085.0CHARACTER
Other countryOther countryOther country of birth.
Other country, specifyOTHER COUNTRY, SPECIFYOTHER COUNTRY, SPECIFY
USAUSAUSA
USA, specify the 2 letter State code, eg NYUSA, SPECIFY THE 2 LETTER STATE CODE, EG NYUSA, SPECIFY THE 2 LETTER STATE CODE, EG NY
Highest Education LevelPerson Education Level Type26740762.0CHARACTER
10th Grade10th GradeIndicates that 10th grade is the highest level of educational achievement
11th Grade11th GradeIndicates that 11th grade is the highest level of educational achievement
12th Grade No Diploma12th GradeIndicates that a person was in school through 12th grade but that they did not receive a high school diploma.
1st Grade1st GradeIndicates that 1st grade is the highest level of educational achievement.
2nd Grade2nd GradeIndicates that 2nd grade is the highest level of educational achievement.
3rd Grade3rd GradeIndicates that 3rd grade is the highest level of educational achievement.
4th Grade4th GradeIndicates that 4th grade is the highest level of educational achievement.
5th Grade5th GradeIndicates that 5th grade is the highest level of educational achievement.
6th Grade6th GradeIndicates that 6th grade is the highest level of educational achievement.
7th Grade7th GradeIndicates that 7th grade is the highest level of educational achievement
8th Grade8th GradeIndicates that 8th grade is the highest level of educational achievement
9th Grade9th GradeIndicates that 9th grade is the highest level of educational achievement
Academic Doctorate DegreeAcademic Doctorate Degree CompletionIndicates that a person has received a degree the highest award earned for graduate study.
Associate DegreeAssociate DegreeIndicates that a person has received a degree from a 2 year college program.
Bachelor DegreeBachelor's Degree CompletionIndicates that a person has received a degree for successful completion of a program of studies that normally requires at least 4-5 years of full-time equivalent college-level work.
Don't KnowDoes Not KnowThe answer is not known by the person answering.
General Equivalency DiplomaGeneral Equivalency DiplomaIndicates that a person has received a General Equivalency Diploma in lieu of a high school diploma.
High School GraduateHigh School GraduateIndicates that a person has attended high school and has received a high school diploma.
KindergartenKindergarten CompletionIndicates that kindergarten is the highest level of education achievement.
Master's DegreeMaster's Degree CompletionIndicates that a person has received a degree for completion of at least one year of prescribed study beyond the bachelor's degree.
No Formal SchoolingNever AttendedIndicates that a person never attended school or only attended kindergarten.
PreschoolPreschool CompletionIndicates that preschool is the highest level of education achievement.
Professional Doctorate DegreeProfessional Doctorate Degree CompletionIndicates that a person has received a degree allowing them to practice a profession, such as law, medicine, music, or ministry.
RefusedRefuseTo decline to do, accept, give, or allow something.
Some College, No DegreeSome CollegeIndicates that a person has attended college but that they did not receive any degree.
VoTech ProgramVocational DegreeIndicates that a person has received a degree from a occupational, technical, or vocational program.
Census Tract Code at EnrollmentPerson Enrollment Address United States Integer::2000 Census Tract Code29432431.0CHARACTER9999.99
Marital StatusPerson Marital Status Category21880832.0CHARACTER
DivorcedDivorced: C51776 A person whose marriage has been legally dissolved and has not remarried.
Domestic PartnershipDomestic PartnerA person who is a member of an unmarried couple, including same sex couples, living together in longstanding relationships, that are registered or unregistered.
MarriedMarried: C51773A person currently joined in matrimony. Classify common law marriage as married. Includes married couples living together and not living together.
Never MarriedNever marriedA person who has never been married or whose only marriages have been annulled.
SeparatedSEPARATEDA person living apart from his/her spouse by legal arrangement.
WidowedWIDOWEDA person who is no longer married because of the death of his/her spouse and who has not remarried.