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OrderQuestion TextPromptCRF Completion InstructionsCDASH VariableSDTMIG Target VariableSDTMIG Target MappingControlled Terminology CodeList NamePermissible ValuesPre-Populated Value
1What is the subject's year of birth?Birth DateRecord the subject's year of birth (e.g., YYYY, a 4-digit year).BRTHDATBRTHDTCBRTHDAT


2What is the sex of the subject?SexRecord the appropriate sex (e.g., Female, Male).SEXSEXSEX(SEX)Male; Female; Unknown; Undifferentiated
3Do you consider yourself Hispanic/Latino or not Hispanic/Latino?EthnicityRecord the participants self-report ethnicity, ETHNICETHNICETHNIC(ETHNIC)Hispanic or Latino; Not Hispanic or Latino; Not Reported
4 What is the ethnicity of the subject? (More than 1 choice is acceptable.)EthnicityFor a subject who self-reported ethnicity as Hispanic or Latino, Select each value that applies to the subject.   CETHNIC(n)SUPPDM.QVALSUPPDM.QVAL where SUPPDM.QNAM = ETHNIC(n)  and SUPPDM.QLABEL = Collected Ethnicity (n) (ETHNICC)

CENTRAL AMERICAN ; CUBAN AMERICAN; LATIN AMERICAN; MEXICAN; MEXICAN AMERICAN;PUERTO RICAN;SOUTH AMERICAN ; SPANISH



5

Which of the following racial designations best describes you? (More than 1 choice is acceptable.)

RaceRecord the participant self-report race, RACE(n)RACERACE(n)(RACE)AMERICAN INDIAN OR ALASKA NATIVE;ASIAN;BLACK OR AFRICAN AMERICAN;NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER; WHITE;NOT REPORTED;UNKNOWN








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