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Long NameRegistration NCI Standard Template
DefinitionThe collection of CDEs used in the registration module. Registration consists of the registering institution applying for entry of a consented participant into a specific research study by conveying designated registration information to a central facility that is in charge of accepting participants into the study.
Protocol Long NameNCI Standard Template Forms
Public ID2745056
Module Long NameModule InstructionsQuestionCDECDE Public IDCDE VersionValue Domain Data TypeValue Domain Unit of MeasureDisplay FormatValid ValueForm Value Meaning TextForm Value Meaning Desc.
Mandatory Registration QuestionsThese items must be included when this data is collected for reporting.
Study IdentifierProtocol Clinical Study Identifier Number27464591.0CHARACTER
Date of RegistrationPatient Registration Date21714.0DATEMM/DD/YYYY
Conditional Registration QuestionsThere are business rules to indicate situations under which these elements should be used on a case report form.
Was the participant on a prior study with this group?Participant Prior Clinical Study Participation Ind-327464661.0CHARACTER
UnknownUnknownNot known, not observed, not recorded, or refused.
YesYesThe affirmative response to a question or activity.
NoNoThe non-affirmative response to a question.
What was the prior study participant identifier?Participant Prior Clinical Study Identifier28227901.0CHARACTER
Stratification Factors (protocol specific)Study Stratification Text36084.0CHARACTER
Participant Subgroup CodePatient Subgroup Code19252.31CHARACTER
Registering Institution NameRegistration Name Institution Institution Name25517371.0CHARACTER
Randomization DatePatient Randomization Date21820721.0DATEDD/MON/YYYY
Optional Registration 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.
Registering Institution CodeRegistering Institution Identification Code20033074.0CHARACTER
Treating physicianTreating Physician Name627493.0CHARACTER
Person Completing FormResponsible Person Name20061631.0CHARACTER
Person Completing Form, PhoneResponsible Person Phone Number21753.0CHARACTER
Person Completing Form, FaxResponsible Person Fax Number21765.0CHARACTER
Responsible CRAClinical Research Associate Responsible Person Name24526921.0CHARACTER
CRA phone numberClinical Research Associate Person Telephone Number26610031.0CHARACTER
CRA fax numberClinical Research Associate Person Fax Number26610123.0CHARACTER
Projected Start Date of TreatmentTreatment Projected Begin Date6573.0DATEmm/dd/yyyy
Specialist Physician NameSpecialist Physician Name27464801.0CHARACTER
Participant Local IdentifierHealthcare Facility Participant Identifier27464681.0ALPHANUMERIC