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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 VersionQuestion InstructionsValue 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 Name21795912.0Conditionality Rule: Conditionality rests on the local organization's need to capture name as a unique identifier; this item will never be exchanged. CHARACTER
Participant First NamePerson Given/First Name21795892.0Conditionality Rule: Conditionality rests on the local organization's need to capture name as a unique identifier; this item will never be exchanged. CHARACTER
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
Participant StateAddress State/Province Name21796032.0ALPHANUMERIC
AguascalientesAguascalientesAguascalientes
AlabamaAlabamaAlabama
AlaskaAlaskaAlaska
AlbertaAlbertaAlberta
American SamoaAmerican SamoaAmerican Samoa
ArizonaArizonaArizona
ArkansasArkansasArkansas
Baja CaliforniaBaja CaliforniaBaja California
Baja California SurBaja California SurBaja California Sur
British ColumbiaBritish ColumbiaBritish Columbia
CaliforniaCaliforniaCalifornia
CampecheCampecheCampeche
ChiapasChiapasChiapas
ChihuahuaChihuahuaThe Chihuahua is a tiny dog with an apple-shaped head and a short pointed muzzle. It has round, large, very dark eyes and trademark large ears. The body is cobby (stout), longer than it is tall. Besides the common short-haired variety there is also a long-haired type. Colors include fawn, sand, chestnut, silver and steel blue, black, tan and parti-color. Height: 6-9 inches (15-23 cm.) Weight: 2-6 pounds (1-3 kg.)
Coahuila de ZaragozaCoahuila de ZaragozaCoahuila de Zaragoza
ColimaColimaColima
ColoradoColoradoColorado
ConnecticutConnecticutConnecticut
DelawareDelawareDelaware
District of ColumbiaDistrict of ColumbiaDistrict of Columbia
Distrito FederalDistrito FederalDistrito Federal
DurangoDurangoDurango
FloridaFloridaFlorida
GeorgiaGeorgiaGeorgia
GuamGuamGuam
GuanajuatoGuanajuatoGuanajuato
GuerreroGuerreroGuerrero
HawaiiHawaiiHawaii
HildalgoHildalgoHildalgo
IdahoIdahoIdaho
IllinoisIllinoisIllinois
IndianaIndianaIndiana
IowaIowaIowa
JaliscoJaliscoJalisco
KansasKansasKansas
KentuckyKentuckyKentucky
LouisianaLouisianaLouisiana
MaineMaineMaine
ManitobaManitobaManitoba
Marshall IslandsMarshall IslandsMarshall Islands
MarylandMarylandMaryland
MassachusettsMassachusettsMassachusetts
MexicoMexicoMexico
MichiganMichiganMichigan
Michoacan de OcampoMichoacan de OcampoMichoacan de Ocampo
MicronesiaMicronesiaMicronesia
MinnesotaMinnesotaMinnesota
MississippiMississippiMississippi
MissouriMissouriMissouri
MontanaMontanaMontana
MorelosMorelosMorelos
NayaritNayaritNayarit
NebraskaNebraskaNebraska
NevadaNevadaNevada
New BrunswickNew BrunswickNew Brunswick
New HampshireNew HampshireNew Hampshire
New JerseyNew JerseyNew Jersey
New MexicoNew MexicoNew Mexico
New YorkNew YorkNew York
NewfoundlandNewfoundlandNewfoundland
North CarolinaNorth CarolinaNorth Carolina
North DakotaNorth DakotaNorth Dakota
Northern Mariana IslandsNorthern Mariana IslandsNorthern Mariana Islands
Northwest TerritoriesNorthwest TerritoriesNorthwest Territories
Nova ScotiaNova ScotiaNova Scotia
Nuevo LeonNuevo LeonNuevo Leon
NunavutNunavutNunavut
OaxacaOaxacaOaxaca
OhioOhioOhio
OklahomaOklahomaOklahoma
OntarioOntarioOntario
OregonOregonOregon
PalauPalauPalau
PennsylvaniaPennsylvaniaPennsylvania
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 IslandRhode Island
San Luis PotosiSan Luis PotosiSan Luis Potosi
SaskatchewanSaskatchewanSaskatchewan
SinaloaSinaloaSinaloa
SonoraSonoraSonora
South CarolinaSouth CarolinaSouth Carolina
South DakotaSouth DakotaSouth Dakota
TabascoTabascoTabasco
TamaulipasTamaulipasTamaulipas
TennesseeTennesseeTennessee
TexasTexasTexas
TlaxcalaTlaxcalaTlaxcala
US Minor Outlying IslandsUS Minor Outlying IslandsUS Minor Outlying Islands
UtahUtahUtah
Veracruz-LlaveVeracruz-LlaveVeracruz-Llave
VermontVermontVermont
Virgin Islands of the USVirgin Islands of the USVirgin Islands of the US
VirginiaVirginiaVirginia
WashingtonWashingtonWashington
West VirginiaWest VirginiaWest Virginia
WisconsinWisconsinWisconsin
WyomingWyomingWyoming
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